RT Journal Article
SR Electronic
T1 Endoscopic lung volume reduction (eLVR) with endobronchial valves (EBV) in patients with hypercapnic respiratory failure
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP PA797
DO 10.1183/13993003.congress-2015.PA797
VO 46
IS suppl 59
A1 Franziska Trudzinski
A1 Dominik Ballek
A1 Franziska Kaestner
A1 Robert Bals
A1 Sebastian Fähndrich
A1 Philipp M. Lepper
YR 2015
UL http://erj.ersjournals.com/content/46/suppl_59/PA797.abstract
AB Even though eLVR with EBV is an established therapy option for patients with severe emphysema, patients with hypercapnic respiratory failure are usually excluded from treatment.We retrospectively evaluated all patients treated in our department. Hypercapnic respiratory failure was defined as CO2 ≥ 50mmHg and/or NIV therapy. All patients underwent V/Q-Scan and were evaluated for collateral ventilation (Chartis) to determine the target lobe. CO2 was analyzed at 3 time points (TP), before, 2-4 days after, and 1-3 months after eLVR.We treated 13 patients (6 bilaterally); (age 61.8 ± 7.6 years). Mean (± SD) FEV1 before EBV implantation was 0.53 ± 0.15 L (19.8 ± 3.8 % pred.); mean residual volume (RV) was 6.24 ± 1.6 L (287 ± 69.5 % pred.). Left upper lobe was treated 4-times, left lower lobe was treated 7-times, right upper lobe was treated 2-times, right lower lobe 6-times. Patients developed atelectasis in 10/19 (52.6%) cases. Overall, CO2 was 55.1 ± 9.5 mmHg before and 50.2 ± 12.6 mmHg after 1-3 months (p<0.05). Mean CO2 in patients who developed atelectasis was 57.3 ± 7.74 mmHg before, 53.10 ± 10.6 mmHg at TP2 and 48.7 ± 5.8 mmHg (p<0.05) at TP3. Absence of an atelectasis was not linked to a significant improvement of CO2 levels. The overall pneumothorax rate was 21.1% (4/19 procedures.); all pneumothoraces were treatable by chest tube only.The results of this retrospective analysis show that EBV treatment in patients with hypercapnic respiratory failure is feasible and safe. Successful eLVR may lead to a decrease of CO2 levels due to improvement in respiratory mechanics. A prospective study has to elucidate the benefit of eLVR in hypercapnic patients.