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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -28 مورد

Patient selection for bronchoscopic lung volume reduction with endobronchial valves*

Patient selection for bronchoscopic lung volume reduction with endobronchial valves*
Inclusion criteria
  • Medical history and physical examination
    • Clinical presentation consistent with emphysema
    • Symptomatic despite optimal medical therapy (mMRC ≥2)
    • Clinically stable on ≤20 mg prednisone (or equivalent)/day
    • Nonsmoking for ≥4 months
    • BMI <35 kg/m2
  • Pulmonary function tests
    • FEV1 ≥15% predicted but ≤45% predicted
    • TLC ≥100% predicted
    • RV ≥175% predicted
    • 6MWD ≥100 m and <500 m
  • Imaging
    • Emphysema on HRCT
  • Anesthesia
    • Able to tolerate procedural sedation
  • Collateral ventilation
    • Lobe targeted for EBV placement must have little to no collateral ventilation assessed by Chartis and/or StratXΔ
Exclusion criteria
  • Prior lung transplant, LVRS, median sternotomy, lobectomy
  • Heart failure (LVEF <45%), unstable cardiac arrhythmia, myocardial infarction, stroke
  • Severe hypercapnia: PaCO2 >60 mmHg (8 kPa)◊
  • Severe hypoxemia: PaO2 <45 mmHg (6 kPa)
  • Active pulmonary infection
  • Allergy to nitinol, nickel, titanium, or silicone
  • Large bullae: >30% of either lung
  • Contraindications to bronchoscopy or high risk of postoperative morbidity or mortality

6MWD: six-minute walk distance; BMI: body mass index; EBV: endobronchial valve; FEV1: forced expiratory volume in one second; HRCT: high-resolution computed tomography; LVEF: left ventricular ejection fraction; LVRS: lung volume reduction surgery; mMRC: modified Medical Research Council dyspnea scale; PaCO2: carbon dioxide tension; PaO2: arterial oxygen tension; RV: residual volume; TLC: total lung capacity.

* Endobronchial valves are implanted bronchoscopically in regions of the lung with little to no collateral ventilation to treat adult patients with hyperinflation due to severe emphysema.

¶ Chartis: A specialized catheter for bronchoscopic assessment of localized pressure and flow to assess collateral ventilation. Absence of collateral ventilation improves the likelihood of resorption atelectasis following endobronchial valve placement.

Δ StratX: Quantitative analysis of high resolution computed tomography images to assess amount of emphysematous destruction and fissure completeness. Greater fissure completeness predicts less collateral ventilation and a greater likelihood of success with endobronchial valve placement.

◊ Clinical trials of endobronchial valves typically used a PaCO2 <50 mmHg (<7.33 kPa) as a cutoff for trial entry. In clinical practice, patients with somewhat higher PaCO2 levels are often reasonable candidates for intervention.
References:
  1. Herth FJ, Eberhardt R, Gompelmann D, et al. Radiological and clinical outcomes of using Chartis™ to plan endobronchial valve treatment. Eur Respir J 2013; 41:302.
  2. Koster TD, van Rikxoort EM, Huebner RH, et al. Predicting Lung Volume Reduction after Endobronchial Valve Therapy Is Maximized Using a Combination of Diagnostic Tools. Respiration 2016; 92:150.
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