RT Journal Article
SR Electronic
T1 Collapse phenomenon during Chartis collateral ventilation assessment
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP 1657
OP 1667
DO 10.1183/13993003.01973-2015
VO 47
IS 6
A1 Wolfgang Gesierich
A1 Konstantinos Samitas
A1 Frank Reichenberger
A1 Juergen Behr
YR 2016
UL http://erj.ersjournals.com/content/47/6/1657.abstract
AB Chartis is increasingly used for bronchoscopic assessment of collateral ventilation before endobronchial valve (EBV) treatment for severe emphysema. Its prognostic value is, however, limited by the airway collapse phenomenon. The frequency and clinical significance of the collapse phenomenon remain largely unknown.We performed a retrospective analysis of 92 patients undergoing Chartis evaluation under spontaneous breathing (n=55) or jet ventilation (n=37) from May 2010 to November 2013. Collateral ventilation status (positive/negative/collapse phenomenon/unclear) was reassessed and correlated with high-resolution computed tomography (HRCT) fissure analysis and clinical response.In the absence of the collapse phenomenon, the predictive value of Chartis measurements and HRCT fissural analysis was comparable. The collapse phenomenon was observed in 31.5% of all assessments, and was more frequent in lower lobes (44.9% versus 16.9% in upper lobes) and under jet ventilation (41.4% versus 22.1% under spontaneous breathing). 69.8% of lobes with the collapse phenomenon had complete fissures. Most patients with the collapse phenomenon in the target lobe and complete fissures treated with EBVs were responders (n=11/15). All valve-treated collapse phenomenon patients with fissure defects were nonresponders (n=3).In the absence of the collapse phenomenon Chartis measurement is reliable to predict response to valve treatment. In patients with the collapse phenomenon, treatment decisions should be based on HRCT detection of fissure integrity. Chartis assessment should be performed under spontaneous breathing.Collapse phenomenon during Chartis assessment of collateral ventilation is frequent: fissure analysis should be added http://ow.ly/Y76Ej