Successful treatment of ventilator dependent emphysema with Chartis treatment planning and endobronchial valves

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• 作者：J. Votruba^a ; ^{votruba.praha@gmail.com} ; J. Collins^b ; F.J.F. Herth^c
• 关键词：Emphysema ; Endobronchial valves ; Interventional pulmonology ; Lung volume reduction ; Collateral ventilation
• 刊名：International Journal of Surgery Case Reports
• 出版年：2011
• 出版时间：2011
• 年：2011
• 卷：2
• 期：8
• 页码：285-287
• 全文大小：600 K

文摘

INTRODUCTION

Emphysema is a leading cause of disability and death. Patients who require ventilator support as a result of respiratory failure have limited treatment options. We report a successful outcome for a ventilator dependent patient in whom endobronchial valves were inserted into lobes assessed as being without collateral ventilation.

PRESENTATION OF CASE

A 54 year old male patient had been ventilator dependent for two months due to respiratory insufficiency from emphysema. Prior to admission, FEV₁ was 0.89L (25 % predicted) and RV was 4.5L (205 % predicted). CT scan showed destruction of right lower and middle lobes and left lower lobe. Chartis assessment showed the absence of collateral ventilation. Zephyr endobronchial valves were placed in left and right lower lobes. Lung volume reduction bilaterally was confirmed on chest X-ray and CT scan the following day. On day three, ventilator support was discontinued and there was no requirement for supplementary oxygen. At 30 days post procedure, the RV reduced to 3.2L (142 % predicted) and the FEV₁ increased to 1.32L (38 % predicted).

DISCUSSION

Hyperinflation in emphysema compromises lung function. For this ventilator dependent patient, there were no other treatment options. Endoscopic lung volume reduction was successfully achieved by bilateral lower lobe placement of Zephyr endobronchial valves with a prior assessment using Chartis to determine the absence of collateral flow in the targeted lobes. The patient achieved an impressive 48 % improvement in FEV₁ and a 29 % reduction in RV.

CONCLUSION

Endoscopic lung volume reduction assisted by Chartis to plan treatment resulted in a clinical and a health-economic benefit.