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Related Concept Videos

Respiratory Volumes01:15

Respiratory Volumes

Respiratory volumes are crucial metrics, meticulously measured to quantify the air exchanged in and out of the lungs during various phases of the breathing cycle. These precise measurements are vital for assessing lung function, diagnosing respiratory conditions, and monitoring overall respiratory health. Each parameter provides specific insights into the mechanics of breathing and the functional capacity of the lungs.
Tidal Volume (TV) Tidal volume (TV) is the air inhaled or exhaled in a...
Chronic Obstructive Pulmonary Disease II: Emphysema01:23

Chronic Obstructive Pulmonary Disease II: Emphysema

Emphysema, a major phenotype of chronic obstructive pulmonary disease (COPD), is characterized by irreversible destruction of alveolar walls and permanent enlargement of distal airspaces. Unlike chronic bronchitis, which primarily affects the airways, emphysema predominantly involves the lung parenchyma, where structural damage leads to airflow limitation.PathophysiologyIt most commonly results from prolonged exposure to cigarette smoke and other toxic gases, particularly cigarette smoke.

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Robotic-assisted Left Pneumonectomy For Vanishing Lung Syndrome
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Lung volume reduction surgery in nonheterogeneous emphysema.

Walter Weder1, Michaela Tutic, Konrad E Bloch

  • 1Department of Surgery, Division of Thoracic Surgery, University Hospital, Zurich, Raemistrasse 100, 8091 Zurich, Switzerland. walter.weder@usz.ch

Thoracic Surgery Clinics
|August 11, 2009
PubMed
Summary

Lung volume reduction surgery (LVRS) can benefit selected patients with homogeneous emphysema, improving respiratory mechanics and symptoms. Careful patient selection is crucial to ensure safety and optimize outcomes for this emphysema type.

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Area of Science:

  • Pulmonology
  • Thoracic Surgery

Background:

  • Homogeneous emphysema historically excluded from lung volume reduction surgery (LVRS) due to concerns over gas exchange and parenchyma removal.
  • Emphysema heterogeneity is a known predictor of functional improvement after LVRS.
  • LVRS primarily improves respiratory mechanics, suggesting potential benefits for homogeneous emphysema if patients are carefully selected.

Purpose of the Study:

  • To evaluate the efficacy and safety of LVRS in selected patients with homogeneous emphysema.
  • To identify critical selection criteria for homogeneous emphysema patients undergoing LVRS.

Main Methods:

  • Retrospective analysis of patients undergoing LVRS.
  • Exclusion criteria included very low diffusing capacity (<20% predicted), pulmonary hypertension, and "vanished lungs" on CT.
  • Consideration of cofactors like recurrent infections, lung scarring, and prior surgery.

Main Results:

  • Selected patients with homogeneous emphysema demonstrated comparable symptomatic and functional improvements to those with heterogeneous emphysema.
  • Perioperative mortality was low.
  • Slightly reduced long-term survival was observed in homogeneous emphysema patients compared to heterogeneous emphysema patients without lung transplantation.

Conclusions:

  • LVRS is a viable option for carefully selected symptomatic patients with advanced homogeneous emphysema and severe hyperinflation.
  • Key selection criteria include diffusing capacity not below 20% predicted and absence of "vanished lungs" on CT.
  • While offering significant benefits, long-term survival may be slightly less than in heterogeneous emphysema patients.