Lung Volume Reduction in Emphysema Improves Chest Wall Asynchrony

作者：Zoumot Zaid^*; LoMauro Antonella; Aliverti Andrea; Nelson Christopher; Ward Simon; Jordan Simon; Polkey Michael I; Shah Pallav L; Hopkinson Nicholas S

来源：Chest, 2015, 148(1): 185-195.

DOI：10.1378/chest.14-2380

BACKGROUND: Lung volume reduction (LVR) techniques improve lung function in selected patients with emphysema, but the impact of LVR procedures on the asynchronous movement of different chest wall compartments, which is a feature of emphysema, is not known.
METHODS: We used optoelectronic plethysmography to assess the effect of surgical and bronchoscopic LVR on chest wall asynchrony. Twenty-six patients were assessed before and 3 months aft er LVR (surgical [n = 9] or bronchoscopic [n = 7]) or a sham/unsuccessful bronchoscopic treatment (control subjects, n = 10). Chest wall volumes were divided into six compartments (left and right of each of pulmonary ribcage [Vrc, p], abdominal ribcage [Vrc, a], and abdomen [Vab]) and phase shift angles (theta) calculated for the asynchrony between Vrc, p and Vrc, a (theta RC), and between Vrc, a and Vab (theta DIA).
RESULTS: Participants had an FEV1 of 34.6 +/- 18% predicted and a residual volume of 217.8 +/- 46.0% predicted with significant chest wall asynchrony during quiet breathing at baseline (theta RC, 31.3 degrees +/- 38.4 degrees; and theta DIA, 2 38.7 degrees +/- 36.3 degrees). Between-group difference in the change in theta RC and theta DIA during quiet breathing following treatment was 44.3 degrees (95% CI, -78 to -10.6; P = .003) and 34.5 degrees (95% CI, 1.4 to 67.5; P = .007) toward 0 degrees (representing perfect synchrony), respectively, favoring the LVR group. Changes in theta RC and theta DIA were statistically significant on the treated but not the untreated sides.
CONCLUSIONS: Successful LVR significantly reduces chest wall asynchrony in patients with emphysema.

• 出版日期2015-7