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Physiologic Basis for Improved Pulmonary Function after Lung Volume Reduction

¹ Johns Hopkins University School of Medicine, Baltimore, Maryland; ² University of Maryland School of Medicine, Baltimore, Maryland; ³ Harvard School of Medicine, Boston, Massachusetts; ⁴ Division of Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California; and ⁵ Baylor College of Medicine, Houston, Texas

Correspondence and requests for reprints should be addressed to Henry E. Fessler, M.D., Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 1830 Monument Street, Room 544, Baltimore, MD 21287. E-mail: hfessler{at}jhmi.edu

ABSTRACT

It is not readily apparent how pulmonary function could be improved by resecting portions of the lung in patients with emphysema. In emphysema, elevation in residual volume relative to total lung capacity reduces forced expiratory volumes, increases inspiratory effort, and impairs inspiratory muscle mechanics. Lung volume reduction surgery (LVRS) better matches the size of the lungs to the size of the thorax containing them. This restores forced expiratory volumes and the mechanical advantage of the inspiratory muscles. In patients with heterogeneous emphysema, LVRS may also allow space occupied by cysts to be reclaimed by more normal lung. Newer, bronchoscopic methods for lung volume reduction seek to achieve similar ends by causing localized atelectasis, but may be hindered by the low collateral resistance of emphysematous lung. Understanding of the mechanisms of improved function after LVRS can help select patients more likely to benefit from this approach.

Key Words: lung mechanics • emphysema surgery • lung recoil • airflow limitation • respiratory muscles

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Bronchoscopic Lung Volume Reduction in Severe Emphysema

Edward P. Ingenito, Douglas E. Wood, and James P. Utz
Proceedings of the American Thoracic Society 2008 5: 454-460. [Abstract] [Full Text]