Physiological characterization of variability in response to lung volume reduction surgery

Division of 1 Pulmonary and Critical Care Medicine and 2 Thoracic Surgery, Brigham and Women's Hospital, and 3 Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts 02115 This paper examines potential physiological mechanisms responsible for improvement after lung volume reduction surgery (LVRS). In 25 patients (63 ± 9 yr; 11 men, 14 women), spirometry [forced expiratory volume in 1 s (FEV 1 ) and forced vital capacity (FVC)], lung volumes [residual volume (RV) and total lung capacity (TLC)], small airway resistance, recoil pressures, and respiratory muscle contractility (RMC) were measured before and 4-6 mo after LVRS. Data were interpreted to assess how changes in each component of lung mechanics affect overall function. Among responders ( FEV 1 12%; 150 ml), improvement was primarily due to an increase in FVC, not to FEV 1 -to-FVC ratio. Among nonresponders, FEV 1 , FVC, and RV/TLC did not change after surgery, although recoil pressure increased in both groups. Both groups experienced a reduction in RMC after LVRS. In conclusion, LVRS improves function in emphysema by resizing the lung relative to the chest wall by reducing RV. LVRS does not change airway resistance but decreases RMC, which attenuates the potential benefits of LVRS that are generated by reducing RV/TLC. Among nonresponders, recoil pressure increased out of proportion to reduced volume, such that no increase in vital capacity or improvement in FEV 1 occurred. lung volume reduction; emphysema; lung mechanics; lung volumes