Lung Volume Reduction Surgery

Original Editor - Donald John Auson Top Contributors - Donald John Auson and Kim Jackson

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (10/04/2020)

Description

Lung Volume Reduction Surgery (LVRS) is a surgical procedure wherein lung tissue is resected from patients with COPD, particularly those with severe emphysema. the procedure is usually done through 3 different techniques: (1) via open sternotomy, (2) via video-assisted thorascopic surgery or (3) via thoracotomy.

A multi-center prospective randomized controlled trial, National Emphysema Treatment Trial (NETT), was done in 1999. The study aimed to compare medical management alone versus medical management with LVRS as treatment for severe emphysema. NETT involved 1, 218 randomized patients, one of the largest and most complete collection of patient demographic, clinical, physiological, and radiographic data ever compiled in severe emphysema. In addition, NETT emphasized the need to address nonpulmonary issues such as nutrition, cardiac disease, and anxiety and depression.

Indication

LVRS is usually indicated for patients:

• With severe emphysema
• Aged below 70 years old
• With no smoking history within the last 6 months
• Not able to exercise well after completing pulmonary rehabilitation

A criteria was made based on NETT for the selection of candidates. This include:

• Age below 75 years old
• Emphysema (bilateral severe emphysema, predominantly upper-lobe)
• Non-smoker more than 4 months
• Clinically stable on no more than 20 mg prednisone daily
• Significant functional limitation after 6–12 wk of pulmonary rehabilitation on optimal medical therapy
• Demonstrated compliance with medical regimen
• Post-bronchodilator FEV1 ⩽ 45% predicted for all ages and ⩾15% if age ⩾70 yr
• Hyperinflation demonstrated by TLC ⩾ 100% predicted and RV ⩾ 150% predicted
• Postrehabilitation 6MWD > 140 m
• Low postrehabilitation exercise capacity (demonstrated by maximal achieved cycle ergometry watts)

Clinical Presentation

Patients suffering from severe emphysema may present with:

Diagnostic Tests

add text here relating to diagnostic tests for the condition

Preoperative Rehabilitation Program

• Assessment to determine if patient is a candidate for surgical intervention
• Communication between interdisciplinary team members involved in patient care
• Formulation of appropriate preoperative management/ exercise training program
• Preoperative exercise training to reduce possible complications after surgery
• Educate the patient
  • Possible risks/ complications and how to avoid them
  • Postoperative pain management
  • Mobilization after surgery
  • Lung expansion techniques
  • Energy conservation techniques
• Psychological Support
• Nutritional Support

Postoperative Rehabilitation Program

• Assessment of postoperative patient
• Formulation of appropriate postoperative management/ exercise training program
• Postoperative pain management
• Mobilization of postoperative patient
• Postoperative exercise training
• Psychological support
• Nutritional support
  

Resources

add appropriate resources here