Am. J. Respir. Crit. Care Med., Volume 156, Number 2, August 1997, 553-560

Effect of Surgical Lung Volume Reduction on Breathing Patterns in Severe Pulmonary Emphysema

KONRAD E. BLOCH, YIMING LI, JINNONG ZHANG, ROLAND BINGISSER, VLADIMIR KAPLAN, WALTER WEDER, and ERICH W. RUSSI

Pulmonary Division, Department of Internal Medicine, and Department of Surgery, University Hospital of Zürich, Switzerland

Surgical lung volume reduction may improve pulmonary function and dyspnea in advanced pulmonary emphysema. To investigate mechanisms of these beneficial effects we studied breathing patterns before and after surgery. Nineteen patients with diffuse pulmonary emphysema (FEV₁ < 35% of predicted, total lung capacity > 130% predicted) were studied within 1 mo before, and 1.5 to 7 mo after thoracoscopic volume reduction. Changes of rib cage and abdominal volumes were monitored with calibrated respiratory inductive plethysmography for 20 to 60 min during natural breathing at rest. Pulmonary function and dyspnea were also assessed. Postoperative tidal volumes, respiratory cycle times, and minute ventilation were not significantly different from preoperative values. The contribution of abdominal volume changes to tidal volumes increased from a mean ± SD of 43 ± 17% preoperatively to 58 ± 14% postoperatively (p = 0.03). The fraction of inspiratory time with abdominal paradoxical motion decreased from 12.3 ± 8.3% preoperatively to 5.1 ± 5.1% postoperatively (p = 0.02). The phase shift between rib cage and abdominal motion was reduced postoperatively. Hyperinflation, airway obstruction, and subjective ratings of dyspnea were significantly improved. The better synchronization of rib cage-abdominal motion and the greater contribution of abdominal volume changes to tidal volumes are consistent with a reduction of inspiratory loading and a greater force-generating capacity of the diaphragm after surgery.

This article has been cited by other articles:

				T. C. Mineo Epidural anesthesia in awake thoracic surgery Eur. J. Cardiothorac. Surg., July 1, 2007; 32(1): 13 - 19. [Abstract] [Full Text] [PDF]

				Spoken sessions Thorax, December 1, 2005; 60(suppl_2): ii4 - ii52. [Full Text] [PDF]

				C. F. Clarenbach, O. Senn, T. Brack, M. Kohler, and K. E. Bloch Monitoring of Ventilation During Exercise by a Portable Respiratory Inductive Plethysmograph Chest, September 1, 2005; 128(3): 1282 - 1290. [Abstract] [Full Text] [PDF]

				T. Brack, O. Senn, E. W. Russi, and K. E. Bloch Transtracheal High-Flow Insufflation Supports Spontaneous Respiration in Chronic Respiratory Failure Chest, January 1, 2005; 127(1): 98 - 104. [Abstract] [Full Text] [PDF]

				P. Erba, S. Anastasi, O. Senn, M. Maggiorini, and K.E. Bloch Acute mountain sickness is related to nocturnal hypoxemia but not to hypoventilation Eur. Respir. J., August 1, 2004; 24(2): 303 - 308. [Abstract] [Full Text] [PDF]

				K. E. Bloch, W. Weder, A. Boehler, M. P. Zalunardo, and E. W. Russi Successful Lung Volume Reduction Surgery in a Child With Severe Airflow Obstruction and Hyperinflation due to Constrictive Bronchiolitis* Chest, August 1, 2002; 122(2): 747 - 750. [Abstract] [Full Text] [PDF]

				J. Hamacher, S. Buchi, C.L. Georgescu, U. Stammberger, R. Thurnheer, K.E. Bloch, W. Weder, and E.W. Russi Improved quality of life after lung volume reduction surgery Eur. Respir. J., January 1, 2002; 19(1): 54 - 60. [Abstract] [Full Text] [PDF]

				M. CASSART, J. HAMACHER, Y. VERBANDT, S. WILDERMUTH, D. RITSCHER, E. W. RUSSI, P. de FRANCQUEN, M. CAPPELLO, W. WEDER, and M. ESTENNE Effects of Lung Volume Reduction Surgery for Emphysema on Diaphragm Dimensions and Configuration Am. J. Respir. Crit. Care Med., April 1, 2001; 163(5): 1171 - 1175. [Abstract] [Full Text]

				J. Hamacher, E. W. Russi, and W. Weder Lung Volume Reduction Surgery : A Survey on the European Experience Chest, June 1, 2000; 117(6): 1560 - 1567. [Abstract] [Full Text] [PDF]

				D. L. Serna, M. Brenner, K. E. Osann, R. J. McKenna Jr, J. C. Chen, R. J. Fischel, B. U. Jones, A. F. Gelb, and A. F. Wilson SURVIVAL AFTER UNILATERAL VERSUS BILATERAL LUNG VOLUME REDUCTION SURGERY FOR EMPHYSEMA J. Thorac. Cardiovasc. Surg., December 1, 1999; 118(6): 1101 - 1109. [Abstract] [Full Text] [PDF]

				A. F. Gelb, R. J. McKenna Jr., M. Brenner, M. J. Schein, N. Zamel, and R. Fischel Lung Function 4 Years After Lung Volume Reduction Surgery for Emphysema* Chest, December 1, 1999; 116(6): 1608 - 1615. [Abstract] [Full Text] [PDF]

				Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease . A Statement of the American Thoracic Society and European Respiratory Society Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): S2 - 40. [Full Text] [PDF]

				R. THURNHEER, H. ENGEL, W. WEDER, U. STAMMBERGER, I. LAUBE, E. W. RUSSI, and K. E. BLOCH Role of Lung Perfusion Scintigraphy in Relation to Chest Computed Tomography and Pulmonary Function in the Evaluation of Candidates for Lung Volume Reduction Surgery Am. J. Respir. Crit. Care Med., January 1, 1999; 159(1): 301 - 310. [Abstract] [Full Text]

				M. OSWALD-MAMMOSSER, R. KESSLER, G. MASSARD, J.-M. WIHLM, E. WEITZENBLUM, and J. LONSDORFER Effect of Lung Volume Reduction Surgery on Gas Exchange and Pulmonary Hemodynamics at Rest and during Exercise Am. J. Respir. Crit. Care Med., October 1, 1998; 158(4): 1020 - 1025. [Abstract] [Full Text] [PDF]

				G. CRINER, F. C. CORDOVA, V. LEYENSON, B. ROY, J. TRAVALINE, S. SUDARSHAN, G. O'BRIEN, A. M. KUZMA, and S. FURUKAWA Effect of Lung Volume Reduction Surgery on Diaphragm Strength Am. J. Respir. Crit. Care Med., May 1, 1997; 157(5): 1578 - 1585. [Abstract] [Full Text]