Unilateral Extrapulmonary Airway Bypass in Advanced Emphysema

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 v...

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Veröffentlicht in:The Annals of thoracic surgery 2010, Vol.89 (3), p.899-906.e2
Hauptverfasser: Moore, Alastair J., MRCP, PhD, Cetti, Edward, MRCP, Haj-Yahia, Saleem, MD, FRCS, Carby, Martin, FRCP, Björling, Gunilla, PhD, BS, Karlsson, Sigbritt, PhD, MS, Shah, Pallav, MD, FRCP, Goldstraw, Peter, MD, FRCS, Moxham, John, MD, FRCP, Jordan, Simon, MD, FRCS, Polkey, Michael I., FRCP, PhD
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Sprache:eng
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Zusammenfassung: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.
ISSN:0003-4975
1552-6259
1552-6259
DOI:10.1016/j.athoracsur.2009.10.067