Lung Volume Reduction Surgery: Difference between revisions

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* Not able to exercise well after completing pulmonary rehabilitation
* Not able to exercise well after completing pulmonary rehabilitation


A criteria was made based on NETT for the selection of candidates. This include:
A criteria was made based on NETT for the selection of candidates.<ref name=":0">DeCamp Jr. M, Lipson D, Krasna M, MInai O, McKenna Jr. R, Thomashow B. The Evaluation and Preparation of the Patient for Lung Volume Reduction Surgery | Proceedings of the American Thoracic Society. Atsjournals.org. Available from: https://www.atsjournals.org/doi/full/10.1513/pats.200707-087ET</ref> This include:
* Age below 75 years old
* Age below 75 years old
* Emphysema (bilateral severe emphysema, predominantly upper-lobe)
* Emphysema (bilateral severe emphysema, predominantly upper-lobe)
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== Diagnostic Tests  ==
== Diagnostic Tests  ==
Diagnostic procedures and laboratory studies for screening of candidates include:


add text here relating to diagnostic tests for the condition<br>  
Chest Radiography
 
Chest CT Scan
 
α1-Antitrypsin testing
 
A set of screening and evaluation process was made based on NETT.<ref name=":0" /> This includes:
 
Screening
 
<br>  


== Preoperative Rehabilitation Program  ==
== Preoperative Rehabilitation Program  ==

Revision as of 03:48, 10 April 2020

Original Editor - Donald John Auson Top Contributors - Donald John Auson and Kim Jackson
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Description[edit | edit source]

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[edit | edit source]

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.[1] 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[edit | edit source]

Patients suffering from severe emphysema may present with:


Diagnostic Tests[edit | edit source]

Diagnostic procedures and laboratory studies for screening of candidates include:

Chest Radiography

Chest CT Scan

α1-Antitrypsin testing

A set of screening and evaluation process was made based on NETT.[1] This includes:

Screening


Preoperative Rehabilitation Program[edit | edit source]

  • 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[edit | edit source]

  • 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[edit | edit source]

add appropriate resources here

References[edit | edit source]

  1. ↑ 1.0 1.1 DeCamp Jr. M, Lipson D, Krasna M, MInai O, McKenna Jr. R, Thomashow B. The Evaluation and Preparation of the Patient for Lung Volume Reduction Surgery | Proceedings of the American Thoracic Society. Atsjournals.org. Available from: https://www.atsjournals.org/doi/full/10.1513/pats.200707-087ET
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