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Collapse phenomenon during Chartis collateral ventilation assessment.

Wolfgang Gesierich1, Konstantinos Samitas2, Frank Reichenberger3

  • 1Klinik für Pneumologie, Asklepios Fachkliniken, Gauting, Comprehensive Pneumology Center Munich (CPC) and Member of the German Center for Lung Research (DZL), Germany These authors contributed equally to this work w.gesierich@asklepios.com.

The European Respiratory Journal
|April 15, 2016
PubMed
Summary
This summary is machine-generated.

The airway collapse phenomenon impacts Chartis assessments for severe emphysema patients undergoing endobronchial valve (EBV) treatment. Fissure integrity on CT scans is crucial for treatment decisions when collapse is present.

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Area of Science:

  • Pulmonology
  • Thoracic Surgery
  • Medical Imaging

Background:

  • Chartis is widely used for assessing collateral ventilation before endobronchial valve (EBV) treatment in severe emphysema.
  • The prognostic value of Chartis is limited by the airway collapse phenomenon, whose frequency and significance are not well understood.
  • Understanding the airway collapse phenomenon is critical for optimizing EBV treatment outcomes in emphysema.

Purpose of the Study:

  • To determine the frequency and clinical significance of the airway collapse phenomenon during Chartis assessments.
  • To correlate Chartis findings, including the collapse phenomenon, with high-resolution computed tomography (HRCT) fissure analysis and clinical response to EBV treatment.
  • To evaluate the optimal conditions for Chartis assessment and guide treatment decisions in the presence of the collapse phenomenon.

Main Methods:

  • Retrospective analysis of 92 patients undergoing Chartis evaluation for severe emphysema.
  • Patients were assessed under spontaneous breathing (n=55) or jet ventilation (n=37).
  • Collateral ventilation status was reassessed and correlated with HRCT fissure analysis and clinical response to endobronchial valve treatment.

Main Results:

  • The airway collapse phenomenon occurred in 31.5% of assessments, more frequently in lower lobes and under jet ventilation.
  • In the absence of the collapse phenomenon, Chartis and HRCT fissure analysis showed comparable predictive value for EBV treatment response.
  • For patients with the collapse phenomenon, complete fissures on HRCT predicted positive response to EBV (11/15 responders), while fissure defects predicted non-response (3/3 non-responders).

Conclusions:

  • Chartis measurements reliably predict EBV treatment response in the absence of the airway collapse phenomenon.
  • In the presence of the collapse phenomenon, HRCT assessment of fissure integrity is essential for guiding EBV treatment decisions.
  • Chartis assessment for EBV treatment planning in emphysema should ideally be performed under spontaneous breathing.