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Clinical Investigations: SURGERY |

Increased Effective Lung Volume Following Lung Volume Reduction Surgery in Emphysema*

Sean Homan, MSc; Samuel Porter, MBBS; Morris Peacock, MBBS; Nunzia Saccoia, A CertSc; Anne Marie Southcott, MBBS; Richard Ruffin, MD, FCCP
Author and Funding Information

*From the Respiratory Medicine Unit (Mr. Homan, Drs. Porter, Southcott, and Ruffin, and Ms. Saccoia) and the Department of Surgery (Dr. Peacock), The Queen Elizabeth Hospital, Woodville, Australia.

Correspondence to: Sean Homan, MSc, Respiratory Medicine Unit, Queen Elizabeth Hospital, Woodville, South Australia 5011, Australia; e-mail: sean.homan@nwahs.sa.gov.au



Chest. 2001;120(4):1157-1162. doi:10.1378/chest.120.4.1157
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Study objectives: Lung volume reduction surgery (LVRS) for emphysema has a variable effect on spirometry with improvement linked to increases in lung elastic recoil. The mechanism by which recoil increases following LVRS has not been described completely. This study examines preoperative and postoperative pulmonary function to describe a mechanism for changes in airflow obstruction.

Design: Change in pulmonary function following LVRS.

Setting : Public teaching hospital in Australia.

Patients: Patients with severe emphysema and pulmonary function measurements made before and after LVRS.

Measurements: Routine pulmonary function testing performed with ventilated lung alveolar volume (Va) derived from the gas transfer measurement used as a proxy for the effective lung volume.

Results: Pulmonary function tests from 36 consecutive patients with measurements made at the same laboratory were analyzed. The mean FEV1 was 29.1% predicted presurgery and increased following LVRS from 0.900 L (SD, 0.427 L) to 1.283 L (SD, 0.511 L; p < 0.0001) and TLC (143% predicted) decreased from 8.19 L (SD, 1.492 L) to 7.07 L (SD, 1.52 L; p < 0.0001; n = 35). The mean Va increased by 0.674 L (SD, 0.733 L) from 4.04 to 4.72 L (p < 0.0001; n = 34). The change in FEV1 correlated well with the change in Va (r = 0.63). The change in FEV1 in those patients whose Vas did not increase (n = 7) was not significant.

Conclusions: The increase in Va reflects an increase of functional or ventilating lung volume and is associated with an improvement in spirometry following LVRS.

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