Patient selection for resection of giant bullae: More favorable and less favorable characteristics

Parameter	Favorable	Less favorable
Clinical	Age ≤60 years	Age >60 years
	Progressive dyspnea despite maximal medical therapy	Comorbid illness (eg, coronary heart disease, heart failure)*
	Ex-smoker	Current smoker
Physiological	FEV₁ ≥40 percent predicted	FEV₁ <40 percent predicted
	Hyperinflation (eg, TLC >100 percent predicted, RV >150 percent predicted)	Absence of hyperinflation
		DLCO <40 percent predicted
		PaCO₂ >45 mmHg
		Pulmonary hypertension (eg, elevated TRV and estimated PA systolic pressure; mean PA pressure >20 mmHg)
		Unable to participate in pulmonary rehabilitation
Imaging	CXR: bulla ≥30 percent of hemithorax in a symptomatic patient	CXR: poorly defined bulla(e)
	HRCT: large and localized bulla with compressed parenchyma and vascular crowding adjacent to the bulla	HRCT: homogeneous, diffuse emphysema without a single large bulla
	Isotope scan: well-localized matching defect with normal uptake and washout for the rest of the lung^¶	Isotope scan: absence of target zones, poor washout in rest of the lung^¶

The table describes characteristics that are more or less favorable for clinical improvement following resection of giant bullae, but are not absolute criteria for bullectomy.

FEV₁: forced expiratory volume in one second; TLC: total lung capacity; RV: residual volume; DLCO: diffusing capacity for carbon monoxide; PA: pulmonary artery; PaCO₂: arterial tension of carbon dioxide; TRV: tricuspid regurgitant velocity; CXR: chest radiograph; HRCT: high resolution computed tomography.
* Comorbid illnesses may be considered relative contraindications depending on degree of severity.
¶ Isotope scanning is rarely performed, having been replaced by HRCT scanning.

Data from: www.thoracic.org/COPD.

Graphic 68646 Version 5.0

خرید پکیج

Patient selection for resection of giant bullae: More favorable and less favorable characteristics