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Lung volume reduction in patients with severe diffuse emphysema. A retrospective study
1Service de Pneumologie et Réanimation Respiratoire, Hôpital Beaujon, Clichy, France.
Chest
|July 1, 1996
Summary
Lung volume reduction surgery can improve symptoms and lung function in severe emphysema patients without large bullae. This procedure offers significant benefits for patients previously considered unsuitable for surgery.
Area of Science:
- Pulmonary Medicine
- Thoracic Surgery
- Respiratory Physiology
Background:
- Lung volume reduction surgery (LVRS) is typically reserved for emphysema patients with large bullae.
- Resection of small bullae or diffuse lung volume reduction has historically yielded poor outcomes.
Purpose of the Study:
- To evaluate the efficacy of lung volume reduction in patients with severe emphysema lacking large bullae.
- To report surgical outcomes in a cohort of patients with diffuse emphysema.
Main Methods:
- Thirteen patients with severe diffuse emphysema (dyspnea grade 4-5, FEV1 18% predicted) underwent unilateral or bilateral lung volume reduction.
- Patients had small bullae or destroyed lung on imaging, with some exhibiting hypercapnia (PaCO2 > 42 mmHg).
Main Results:
- No perioperative mortality and limited morbidity were observed.
- Symptomatic improvement was reported in 92% at 6 months, decreasing to 31% at 36 months.
- Forced expiratory volume in 1 second (FEV1) increased by at least 20% in 92% of patients at 6 months, declining to 24% at 36 months.
Conclusions:
- Lung volume reduction can lead to significant symptomatic and spirometric improvements in selected patients with severe emphysema.
- This approach may be beneficial for patients with diffuse emphysema without large bullae, challenging previous assumptions.