Functional improvements in ventilatory mechanics after lung volume reduction surgery for homogeneous emphysema

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Abstract
OBJECTIVE: Between September 1994 and August 1996 Lung Volume Reduction Surgery (LVRS) was performed through median sternotomy, videoendoscopically or by thoracotomy in 54 consecutive patients (age 34-69 years, mean 48 years). METHODS: The areas with the most destroyed lung parenchyma were resected by means of linear stapling devices. A total of 5 patients died postoperatively due to aspiration pneumonia, multi organ failure and acute hepatic failure respectively. A marked functional improvement and increasein quality of life was observed in the remaining patients. RESULTS: Residual volume decreased from 317.0 ± 12.4% of predicted (%p)preoperatively to 226.2 ± 8.8%p within the first month (P = 0.0001). FeV1significantly increased from 23.7 ± 1.3%p preoperatively to 36.3 ± 4.1%p during the first 6 months postoperatively (P = 0.0016). Radiological signs of hyperinflation and distention of the thorax preoperatively improved to a more dome shaped diaphragm and narrowed intercostal spaces. These morphologic changes resulted in better ventilatory muscle function. The intrinsic PEEP significantly decreased from 5.92 ± 0.64 cm H2O preoperatively to 1.70 ± 0.25 cm H2O postoperatively (P = 0.0001). The work of breathing decreased from 1.58 ± 0.09 J/l preoperatively to 0.99± 0.07 J/l postoperatively (P = 0.0001). CONCLUSIONS: In conclusion, LVRS is an excellent therapeutic option for patients with homogeneous emphysema with additional signs of severe hyperinflation.

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