0
Original Research: CARDIOTHORACIC SURGERY |

Effects of Lung Volume Reduction Surgery on Gas Exchange and Breathing Pattern During Maximum Exercise

Gerard J. Criner, MD, FCCP; Patricia Belt, BS; Alice L. Sternberg, ScM; Zab Mosenifar, MD, FCCP; Barry J. Make, MD, FCCP; James P. Utz, MD; Frank Sciurba, MD, FCCP; for the National Emphysema Treatment Trial Research Group†
Author and Funding Information

*From Temple University (Dr. Criner), Philadelphia, PA; Johns Hopkins Bloomberg School of Public Health (Ms. Belt and Ms. Sternberg), Baltimore, MD; Cedars-Sinai Medical Center (Dr. Mosenifar), Los Angeles, CA; National Jewish Medical and Research Center (Dr. Make), Denver, CO; the Mayo Clinic (Dr. Utz), Rochester, MN; and the University of Pittsburgh (Dr. Sciurba), Pittsburgh, PA.

Correspondence to: Gerard J. Criner, MD, FCCP, Professor of Medicine, Division of Pulmonary & Critical Care Medicine, Temple Lung Center, Temple University School of Medicine, 3401 North Broad St, Suite 785, Philadelphia, PA 19140; e-mail: crinerg@tuhs.temple.edu

†A list of centers and participants in the National Emphysema Treatment Trial Research Group is located in the Appendix.


The NETT was supported by contracts with the National Heart, Lung, and Blood Institute (NO1HR76101, NO1HR76102, NO1HR76103, NO1HR76104, NO1HR76105, NO1HR76106, NO1HR76107, NO1HR76108, NO1HR76109, NO1HR761010, NO1HR76111, NO1HR76112, NO1HR76113, NO1HR76114, NO1HR76115, NO1HR76116, NO1HR76118, and NO1HR76119), the Centers for Medicare and Medicaid Services, and the Agency for Healthcare Research and Quality.

The authors have reported to the ACCP that no significant conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2009 American College of Chest Physicians


Chest. 2009;135(5):1268-1279. doi:10.1378/chest.08-1625
Text Size: A A A
Published online

Background:  The National Emphysema Treatment Trial studied lung volume reduction surgery (LVRS) for its effects on gas exchange, breathing pattern, and dyspnea during exercise in severe emphysema.

Methods:  Exercise testing was performed at baseline, and 6, 12, and 24 months. Minute ventilation (V̇e), tidal volume (Vt), carbon dioxide output (V̇co2), dyspnea rating, and workload were recorded at rest, 3 min of unloaded pedaling, and maximum exercise. Pao2, Paco2, pH, fraction of expired carbon dioxide, and bicarbonate were also collected in some subjects at these time points and each minute of testing. There were 1,218 patients enrolled in the study (mean [± SD] age, 66.6 ± 6.1 years; mean, 61%; mean FEV1, 0.77 ± 0.24 L), with 238 patients participating in this substudy (mean age, 66.1 ± 6.8 years; mean, 67%; mean FEV1, 0.78 ± 0.25 L).

Results:  At 6 months, LVRS patients had higher maximum V̇e (32.8 vs 29.6 L/min, respectively; p = 0.001), V̇co2, (0.923 vs 0.820 L/min, respectively; p = 0.0003), Vt (1.18 vs 1.07 L, respectively; p = 0.001), heart rate (124 vs 121 beats/min, respectively; p = 0.02), and workload (49.3 vs 45.1 W, respectively; p = 0.04), but less breathlessness (as measured by Borg dyspnea scale score) [4.4 vs 5.2, respectively; p = 0.0001] and exercise ventilatory limitation (49.5% vs 71.9%, respectively; p = 0.001) than medical patients. LVRS patients with upper-lobe emphysema showed a downward shift in Paco2 vs V̇co2 (p = 0.001). During exercise, LVRS patients breathed slower and deeper at 6 months (p = 0.01) and 12 months (p = 0.006), with reduced dead space at 6 months (p = 0.007) and 24 months (p = 0.006). Twelve months after patients underwent LVRS, dyspnea was less in patients with upper-lobe emphysema (p = 0.001) and non–upper-lobe emphysema (p = 0.007).

Conclusion:  During exercise following LVRS, patients with severe emphysema improve carbon dioxide elimination and dead space, breathe slower and deeper, and report less dyspnea.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
Guidelines
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543