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Clinical Investigations: SURGERY |

Quantitation of Regional Ventilation During the Washout Phase of Lung Scintigraphy*: Measurement in Patients With Severe COPD Before and After Bilateral Lung Volume Reduction Surgery

John M. Travaline, MD, FCCP; Alan H. Maurer, MD; N. David Charkes, MD; Jean Luc Urbain, MD; Satoshi Furukawa, MD; Gerard J. Criner, MD, FCCP
Author and Funding Information

*From the Division of Pulmonary and Critical Care Medicine (Drs. Travaline and Criner), Department of Diagnostic Imaging (Drs. Maurer, Charkes, and Urbain), and Cardiothoracic Surgery (Dr. Furukawa), Temple University School of Medicine, Philadelphia, PA.

Correspondence to: John M. Travaline, MD, FCCP, Pulmonary and Critical Care, Temple University School of Medicine, 3401 North Broad St, Philadelphia, PA 19140; e-mail: trav@astro.ocis.temple.edu



Chest. 2000;118(3):721-727. doi:10.1378/chest.118.3.721
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Study objectives: We sought to investigate the effect of lung volume reduction surgery (LVRS) on regional lung ventilation.

Design: Retrospective analysis of routinely acquired data before and after LVRS.

Setting: Large, urban, university medical center.

Patients: Twenty-nine patients with severe emphysema.

Intervention: Bilateral LVRS.

Measurements and results:133Xe washout curves during lung scintigraphy exhibit a biphasic pattern (the first component of the washout curve [mr] corresponds to an initial rapid phase in washout that reflects larger airways emptying, and the second component [ms] reflects a slower phase of washout that is attributed to gas elimination via smaller airways). We analyzed six standardized regions of the lung (upper, mid, and lower zones of the right and left lung), and calculated mr and ms for each lung region. The mean (± SE) baseline FEV1 was 0.69 ± 0.04 L, total lung capacity (TLC) was 139 ± 4% predicted, and the residual volume (RV)/TLC ratio was 65 ± 2%. The mean improvement in FEV1 3 months post-LVRS was 38%. Post-LVRS, mr and ms increased in 79 and 74 lung regions, respectively, and there was no relationship with respect to lung regions that had or had not been operated on. The increase in ms, however, significantly correlated with the increase in FEV1 (r = 0.66; p < 0.0001) and the decrease in RV/TLC (r = −0.67; p < 0.0001). An increase in ms also correlated with a decrease in Paco2 (r = −0.39; p = 0.03), but mr showed no relationship with any parameter.

Conclusions: Small airways ventilation in lung regions that had and had not been operated on is associated with a greater improvement in lung mechanics following LVRS.

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