Am. J. Respir. Crit. Care Med., Volume 158, Number 1, July 1998, 71-76

Lung Volume Reduction Surgery Has Variable Effects on Blood Gases in Patients with Emphysema

RICHARD K. ALBERT, JOSHUA O. BENDITT, JACK HILDEBRANDT, DOUGLAS E. WOOD, and MICHAEL P. HLASTALA

Departments of Medicine, Physiology, and Biophysics and Surgery, University of Washington, Seattle, Washington

Most studies of bilateral lung volume reduction surgery (LVRS) report increases in arterial oxygenation (Pa_O2). Some suggest this results from an increased alveolar ventilation, but others imply that ventilation-perfusion heterogeneity is reduced. We measured arterial blood gases (ABGs) on air before and 3 mo following LVRS in 46 patients (61% of eligible patients), estimate the difference between alveolar and arterial O₂ (AaPO₂), and correlated the changes observed with preoperative ABGs, and with pre-and postoperative pulmonary function. The mean ± SD change in Pa_O2 and AaPO₂ was +3 ± 10 mm Hg (p = 0.058) and +1 ± 11 mm Hg (p = NS), respectively, and the range of change was large (17 to +29 mm Hg and 24 to +23 mm Hg, respectively). The mean change in Pa_CO2 was 3 ± 5 mm Hg (p < 0.05) and ranged from 11 to +5 mm Hg. Changes in Pa_O2 and AaPO₂ were poorly correlated with changes in Pa_CO2 or with pre- or postoperative pulmonary function. Although some patients had a marked improvement in ABGs following LVRS, almost as many deteriorated. On average, only minimal effects were seen. Although mean alveolar ventilation improved somewhat, the effect of LVRS on Pa_O2 primarily resulted from alterations in ventilation-perfusion heterogeneity.

This article has been cited by other articles:

				E. P. Ingenito, R. L. Berger, A. C. Henderson, J. J. Reilly, L. Tsai, and A. Hoffman Bronchoscopic Lung Volume Reduction Using Tissue Engineering Principles Am. J. Respir. Crit. Care Med., March 1, 2003; 167(5): 771 - 778. [Abstract] [Full Text] [PDF]

				S. Homan, S. Porter, M. Peacock, N. Saccoia, A. M. Southcott, and R. Ruffin Increased Effective Lung Volume Following Lung Volume Reduction Surgery in Emphysema Chest, October 1, 2001; 120(4): 1157 - 1162. [Abstract] [Full Text] [PDF]

				C. W. Butler, M. Snyder, D. E. Wood, J. R. Curtis, R. K. Albert, and J. O. Benditt Underestimation of Mortality Following Lung Volume Reduction Surgery Resulting From Incomplete Follow-up Chest, April 1, 2001; 119(4): 1056 - 1060. [Abstract] [Full Text] [PDF]

				J. M. Travaline, A. H. Maurer, N. D. Charkes, J. L. Urbain, S. Furukawa, and G. J. Criner Quantitation of Regional Ventilation During the Washout Phase of Lung Scintigraphy : Measurement in Patients With Severe COPD Before and After Bilateral Lung Volume Reduction Surgery Chest, September 1, 2000; 118(3): 721 - 727. [Abstract] [Full Text] [PDF]

				P. M. A. Calverley COPD : Early Detection and Intervention Chest, May 1, 2000; 117(5_suppl_2): 365S - 371S. [Abstract] [Full Text] [PDF]

				R. K. Albert and J. O. Benditt RELATIONSHIP BETWEEN RESTING HYPERCAPNIA AND PHYSIOLOGIC PARAMETERS BEFORE AND AFTER LUNG VOLUME REDUCTION SURGERY IN SEVERE CHRONIC OBSTRUCTIVE PULMONARY DISEASE Am. J. Respir. Crit. Care Med., February 1, 2000; 161(2): 674 - 674. [Full Text]

				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]

				G. J. CRINER, F. C. CORDOVA, S. FURUKAWA, A. M. KUZMA, J. M. TRAVALINE, V. LEYENSON, and G. M. O'BRIEN Prospective Randomized Trial Comparing Bilateral Lung Volume Reduction Surgery to Pulmonary Rehabilitation in Severe Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., December 1, 1999; 160(6): 2018 - 2027. [Abstract] [Full Text]