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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -74 مورد

Indications and contraindications for LVRS based on the NETT trial

Indications and contraindications for LVRS based on the NETT trial
Parameter Indications Contraindications
Clinical
  • Age <75 years
  • Ex-smoker (>6 months)
  • Clinical picture consistent with emphysema
  • Dyspnea despite maximal medical therapy and pulmonary rehabilitation
  • Age ≥75 years
  • Current smoking
  • Surgical constraints (eg, previous thoracic procedure, pleurodesis, chest wall deformity)
  • Pulmonary hypertension (PA systolic >45 mmHg, PA mean >35 mmHg)
Comorbid illness*  
  • Clinically significant bronchiectasis
  • Clinically significant coronary heart disease
  • Heart failure with an ejection fraction <45%
  • Uncontrolled hypertension
  • Obesity
Physiology
  • FEV1 after bronchodilator <45% predicted
  • Hyperinflation (TLC >100% predicted, RV >150%)
  • Post rehabilitation 6-minute walk distance >140 meters
  • Low post rehabilitation maximal achieved cycle ergometry wattsΔ
  • FEV1 ≤20% predicted with either DLCO ≤20% predicted or homogeneous emphysema
  • PaO2 ≤45 mmHg on room air
  • PaCO2 ≥60 mmHg
Imaging
  • Chest radiograph – hyperinflation
  • HRCT confirming severe emphysema, ideally with upper lobe predominance
  • Homogeneous emphysema with FEV1 ≤20% predicted
  • Significant pleural or interstitial changes on HRCT
  • Nonupper lobe predominant emphysema and high post rehabilitation maximal achieved cycle ergometry watts◊
 

DLCO: diffusing capacity of the lungs for carbon monoxide; FEV1: forced expiratory volume in one second; HRCT: high-resolution computed tomography; LVRS: lung volume reduction surgery; NETT: National Emphysema Treatment Trial; PaO2: arterial partial pressure of oxygen; PaCO2: arterial partial pressure of carbon dioxide; RV: residual volume; TLC: total lung capacity.

* Comorbid illnesses may be considered relative contraindications depending on degree of severity.

¶ The NETT trial required a body mass index less than 31.1 kg/m2 for men and less than 32.3 kg/m2 for women. It is not known whether more severe obesity would adversely affect perioperative risk.

Δ Low post rehabilitation maximal achieved cycle ergometry watts (W) is defined as at or below the sex specific 40th percentile (25 W for women and 40 W for men).

◊ High post rehabilitation maximal achieved cycle ergometry watts (W) is defined as above the sex specific 40th percentile (25 W for women and 40 W for men). This is a relative contraindication.
Graphic 69501 Version 3.0