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Lung Volume Reduction in Emphysema Improves Chest Wall Asynchrony.

Zoumot Z, LoMauro A, Aliverti A, Nelson C, Ward S, Jordan S, Polkey MI, Shah PL, Hopkinson NS - Chest (2015)

Bottom Line: Participants had an FEV₁ of 34.6 ± 18% predicted and a residual volume of 217.8 ± 46.0% predicted with significant chest wall asynchrony during quiet breathing at baseline (θRC, 31.3° ± 38.4°; and θDIA, -38.7° ± 36.3°).Changes in θRC and θDIA were statistically significant on the treated but not the untreated sides.Successful LVR significantly reduces chest wall asynchrony in patients with emphysema.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Lung volume reduction (LVR) techniques improve lung function in selected patients with emphysema, but the impact of LVR procedures on the asynchronous movement of different chest wall compartments, which is a feature of emphysema, is not known.

Methods: We used optoelectronic plethysmography to assess the effect of surgical and bronchoscopic LVR on chest wall asynchrony. Twenty-six patients were assessed before and 3 months after LVR (surgical [n = 9] or bronchoscopic [n = 7]) or a sham/unsuccessful bronchoscopic treatment (control subjects, n = 10). Chest wall volumes were divided into six compartments (left and right of each of pulmonary ribcage [Vrc,p], abdominal ribcage [Vrc,a], and abdomen [Vab]) and phase shift angles (θ) calculated for the asynchrony between Vrc,p and Vrc,a (θRC), and between Vrc,a and Vab (θDIA).

Results: Participants had an FEV₁ of 34.6 ± 18% predicted and a residual volume of 217.8 ± 46.0% predicted with significant chest wall asynchrony during quiet breathing at baseline (θRC, 31.3° ± 38.4°; and θDIA, -38.7° ± 36.3°). Between-group difference in the change in θRC and θDIA during quiet breathing following treatment was 44.3° (95% CI, -78 to -10.6; P = .003) and 34.5° (95% CI, 1.4 to 67.5; P = .007) toward 0° (representing perfect synchrony), respectively, favoring the LVR group. Changes in θRC and θDIA were statistically significant on the treated but not the untreated sides.

Conclusions: Successful LVR significantly reduces chest wall asynchrony in patients with emphysema.

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Related in: MedlinePlus

Optoelectronic plethysmography. A, B, Infrared cameras. C, D, Marker positioning. E-G, Geometric model. 3D = three-dimensional; Vab = abdominal compartment volume; Vcw = total chest wall volume; Vrc,a = abdominal ribcage volume; Vrc,p = pulmonary ribcage volume. (The patients provided written consent for the use of the photographs.)
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fig01: Optoelectronic plethysmography. A, B, Infrared cameras. C, D, Marker positioning. E-G, Geometric model. 3D = three-dimensional; Vab = abdominal compartment volume; Vcw = total chest wall volume; Vrc,a = abdominal ribcage volume; Vrc,p = pulmonary ribcage volume. (The patients provided written consent for the use of the photographs.)

Mentions: Baseline assessments were performed within 2 weeks prior to the surgical or bronchoscopic procedure. Data collected included demographics, pulmonary function tests (static and dynamic lung volumes and gas transfer performed as per international guidelines using the European Community of Coal and Steel Workers’ cohort normal values22), St. George’s Respiratory Questionnaire (SGRQ),23 modified Medical Research Council dyspnea score, HRCT scan of the thorax, 6-min walk distance (6MWD) per American Thoracic Society guidance,24 arterial blood gas analysis, and an OEP assessment. Patients also underwent endurance cycle ergometry with metabolic measurements at 75% of their maximal workload determined on an initial incremental test (performed between 4 and 24 h before the constant workload test to allow sufficient recovery time). Minute by minute inspiratory capacity (IC) maneuvers were performed to track changes in dynamic hyperinflation assessed as end-expiratory lung volume (EELV). OEP assessments comprised 5-min recordings of quiet breathing (tidal volumes) interspersed by IC maneuvers every minute, with the patient seated on a cycle ergometer at rest before the start of exercise (Fig 1). Further background and details of the OEP system used in this study can be found in e-Appendix 1. The assessments as described here were repeated 3 months after the procedure (LVR or sham).


Lung Volume Reduction in Emphysema Improves Chest Wall Asynchrony.

Zoumot Z, LoMauro A, Aliverti A, Nelson C, Ward S, Jordan S, Polkey MI, Shah PL, Hopkinson NS - Chest (2015)

Optoelectronic plethysmography. A, B, Infrared cameras. C, D, Marker positioning. E-G, Geometric model. 3D = three-dimensional; Vab = abdominal compartment volume; Vcw = total chest wall volume; Vrc,a = abdominal ribcage volume; Vrc,p = pulmonary ribcage volume. (The patients provided written consent for the use of the photographs.)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4493874&req=5

fig01: Optoelectronic plethysmography. A, B, Infrared cameras. C, D, Marker positioning. E-G, Geometric model. 3D = three-dimensional; Vab = abdominal compartment volume; Vcw = total chest wall volume; Vrc,a = abdominal ribcage volume; Vrc,p = pulmonary ribcage volume. (The patients provided written consent for the use of the photographs.)
Mentions: Baseline assessments were performed within 2 weeks prior to the surgical or bronchoscopic procedure. Data collected included demographics, pulmonary function tests (static and dynamic lung volumes and gas transfer performed as per international guidelines using the European Community of Coal and Steel Workers’ cohort normal values22), St. George’s Respiratory Questionnaire (SGRQ),23 modified Medical Research Council dyspnea score, HRCT scan of the thorax, 6-min walk distance (6MWD) per American Thoracic Society guidance,24 arterial blood gas analysis, and an OEP assessment. Patients also underwent endurance cycle ergometry with metabolic measurements at 75% of their maximal workload determined on an initial incremental test (performed between 4 and 24 h before the constant workload test to allow sufficient recovery time). Minute by minute inspiratory capacity (IC) maneuvers were performed to track changes in dynamic hyperinflation assessed as end-expiratory lung volume (EELV). OEP assessments comprised 5-min recordings of quiet breathing (tidal volumes) interspersed by IC maneuvers every minute, with the patient seated on a cycle ergometer at rest before the start of exercise (Fig 1). Further background and details of the OEP system used in this study can be found in e-Appendix 1. The assessments as described here were repeated 3 months after the procedure (LVR or sham).

Bottom Line: Participants had an FEV₁ of 34.6 ± 18% predicted and a residual volume of 217.8 ± 46.0% predicted with significant chest wall asynchrony during quiet breathing at baseline (θRC, 31.3° ± 38.4°; and θDIA, -38.7° ± 36.3°).Changes in θRC and θDIA were statistically significant on the treated but not the untreated sides.Successful LVR significantly reduces chest wall asynchrony in patients with emphysema.

View Article: PubMed Central - PubMed

ABSTRACT

Background: Lung volume reduction (LVR) techniques improve lung function in selected patients with emphysema, but the impact of LVR procedures on the asynchronous movement of different chest wall compartments, which is a feature of emphysema, is not known.

Methods: We used optoelectronic plethysmography to assess the effect of surgical and bronchoscopic LVR on chest wall asynchrony. Twenty-six patients were assessed before and 3 months after LVR (surgical [n = 9] or bronchoscopic [n = 7]) or a sham/unsuccessful bronchoscopic treatment (control subjects, n = 10). Chest wall volumes were divided into six compartments (left and right of each of pulmonary ribcage [Vrc,p], abdominal ribcage [Vrc,a], and abdomen [Vab]) and phase shift angles (θ) calculated for the asynchrony between Vrc,p and Vrc,a (θRC), and between Vrc,a and Vab (θDIA).

Results: Participants had an FEV₁ of 34.6 ± 18% predicted and a residual volume of 217.8 ± 46.0% predicted with significant chest wall asynchrony during quiet breathing at baseline (θRC, 31.3° ± 38.4°; and θDIA, -38.7° ± 36.3°). Between-group difference in the change in θRC and θDIA during quiet breathing following treatment was 44.3° (95% CI, -78 to -10.6; P = .003) and 34.5° (95% CI, 1.4 to 67.5; P = .007) toward 0° (representing perfect synchrony), respectively, favoring the LVR group. Changes in θRC and θDIA were statistically significant on the treated but not the untreated sides.

Conclusions: Successful LVR significantly reduces chest wall asynchrony in patients with emphysema.

Show MeSH
Related in: MedlinePlus