Lung Volume Reduction Surgery Alters Management of Pulmonary Nodules in Patients With Severe COPD: Preoperative Evaluation for LVRS

All patients underwent a detailed history and physical examination. Breathlessness was measured using the baseline/transitional dyspnea indexes (BDI/TDI) of Mahler et al. Routine laboratory data included CBC count, electrolytes, and liver function studies.
Pulmonary Function Testing: Spirometry and lung volumes were performed on a calibrated pneumotachograph (Medical Graphics Co.; St. Paul, Minn) and values were expressed as a percent of the predicted values published by Morris et al. Lung volumes were measured in a whole-body plethysmograph and the data were expressed as a percent of predicted values. Lung volumes were additionally measured using N2 washout and expressed as a percent of predicted values. Maximum voluntary ventilation was measured in all subjects during a 12-s maneuver.
Six-minute walk distance was measured in an air-conditioned hall after standard instructions. Supplemental oxygen was titrated to maintain an oxygen saturation above 88%. The distance the patient walked was measured in feet over 1-min intervals. viagra super active plus

Chest Imaging: Standard chest radiographs and conventional and high-resolution CT (HRCT) were obtained on all patients. HRCT was performed with 1.0- or 1.5-mm-thick axial sections at 1-cm intervals throughout the entire thorax using a scanner (General Electric CT/T Advantage Scanner; Milwaukee) operating in axial nonhelical mode. No oral or IV contrast was administered. The distribution and severity of emphysema as well as the presence and location of additional findings were described by a single chest radiologist (E.A.K.).
Perfusion scans and single-photon emission CT (SPECT) imaging were performed following the IV injection of 4 mCi of mTc macroaggregated albumin. Eight planar views were obtained. Subsequently, SPECT images were acquired with a dual-head large field of view SPECT system, using 180° rotation per head, with at least 32 camera stops. These were reconstructed into transverse, coronal, and sagittal views and were displayed on computer.
Cardiac Imaging: Dobutamine echocardiography was routinely utilized. If right ventricular function appeared compromised or if pulmonary hypertension was suspected, an outpatient right-sided heart catheterization was performed. Similarly, if left ventricular wall motion abnormalities were noted during dobutamine infusion, an outpatient left-sided heart catheterization was performed.
Pulmonary Rehabilitation: All patients undergoing LVRS were required to complete at least 6 weeks of intensive pulmonary rehabilitation. Programs emphasized education and exercise training with the latter including both lower and upper extremity conditioning. The pulmonary function data shown were obtained following completion of pulmonary rehabilitation.


Category: COPD

Tags: lung cancer, lung volume reduction surgery, severe chronic airflow obstruction