Unilateral Extrapulmonary Airway Bypass in Advanced Emphysema
2010 (English)In: Annals of Thoracic Surgery, ISSN 0003-4975, Vol. 89, no 3, 899-906E2 p.Article in journal (Refereed) Published
Background. Gas trapping in emphysema results in resting and dynamic hyperinflation. We tested the hypothesis that a direct connection between the lung parenchyma and the atmosphere could increase expiratory flow and thereby potentially improve dyspnea through the relief of gas trapping. Methods. Ex vivo we studied 7 emphysematous lungs and 3 fibrotic lungs (as controls) and measured expiratory flow before and after airway bypass insertion during a forced maneuver in an artificial thorax. Pilot studies were conducted in vivo in 6 patients with advanced emphysema using a size 9 endotracheal tube as a bypass surgically placed through the chest wall into the upper lobe. Results. In the ex vivo emphysematous lungs the volume expelled during a forced expiratory maneuver increased from 169 to 235 mL (p < 0.05). In the in vivo group 4 patients retained the bypass tube for 3 months or more; total lung capacity was reduced, and the forced expiratory volume in 1 second increased by 23% (mean percent predicted at baseline versus 3 months, 24.4% versus 29.5%). Conclusions. An extrapulmonary airway bypass increases expiratory flow in emphysema. This may be a useful approach in hyperinflated patients with homogeneous emphysema. (Ann Thorac Surg 2010;89:899-906)
Place, publisher, year, edition, pages
2010. Vol. 89, no 3, 899-906E2 p.
lung-volume-reduction, obstructive pulmonary-disease, collateral, ventilation, dynamic hyperinflation, expiratory flow, exercise, copd, hospitalization, exacerbation, improves
IdentifiersURN: urn:nbn:se:kth:diva-19235DOI: 10.1016/j.athoracsur.2009.10.067ISI: 000274736800033ScopusID: 2-s2.0-76749101157OAI: oai:DiVA.org:kth-19235DiVA: diva2:337282
QC 201102102010-08-052010-08-052011-02-10Bibliographically approved