Am. J. Respir. Crit. Care Med., Volume 158, Number 5, November 1998, 1424-1431

Ventilatory Mechanics and Gas Exchange during Exercise before and after Lung Volume Reduction Surgery

EDDA M. TSCHERNKO, EVA M. GRUBER, PETER JAKSCH, OLIVER JANDRASITS, URSULA JANTSCH, THOMAS BRACK, HEINZ LAHRMANN, WALTER KLEPETKO, and THEODOR WANKE

Departments of Clinical Pharmacology, Cardiothoracic Anesthesia and Critical Care Medicine, and Cardiothoracic Surgery, University of Vienna, General Hospital; and Department of Pulmonology, Lainz Hospital, Vienna, Austria; and Division of Pulmonology and Critical Care Medicine, Edward Hines, Jr. Veterans Administration Hospital and Loyola University of Chicago Stritch School of Medicine, Hines, Illinois

Many patients with emphysema are able to meet ventilatory demands during resting conditions, but they show severe limitations during exercise. To examine the effect of lung volume reduction (LVR) surgery on exercise performance and the mechanism of possible improvement, we measured ventilatory mechanics (pulmonary resistance [RL], work of breathing [WOB], dynamic intrinsic positive end-expiratory pressure [PEEPi,dyn], peak expiratory flow rate [PEFR]), breathing pattern, oxygen uptake ( O₂), and carbon dioxide removal ( CO₂) at rest and during cycle ergometry in eight patients before and 3 mo after LVR surgery. Ventilatory mechanics were evaluated assessing esophageal pressure and air flow. Three months after LVR surgery, the tolerated workload was doubled when compared with the preoperative value (p < 0.0005), associated with a reduction of RL (p < 0.05), PEEPi,dyn (p < 0.005), and WOB (p < 0.005) at comparable workloads. Maximal ventilatory capacity and maximal tidal volume (VT) increased significantly (p < 0.01). Maximal O₂ increased from 474 ± 23 to 601 ± 16 ml/min (p < 0.005) and maximal CO₂ from 401 ± 13 to 558 ± 21 ml/min (p < 0.005), though no significant difference at comparable workloads could be observed. In conclusion, emphysema surgery leads to an improvement of ventilatory mechanics at rest and during exercise. Higher maximal VT and minute ventilation were observed, resulting in improvement of maximal O₂ and CO₂ and exercise capacity.

This article has been cited by other articles:

				G. J. Criner, P. Belt, A. L. Sternberg, Z. Mosenifar, B. J. Make, J. P. Utz, F. Sciurba, and for the National Emphysema Treatment Trial Researc Effects of Lung Volume Reduction Surgery on Gas Exchange and Breathing Pattern During Maximum Exercise Chest, May 1, 2009; 135(5): 1268 - 1279. [Abstract] [Full Text] [PDF]

				C. Vassaux, L. Torre-Bouscoulet, S. Zeineldine, F. Cortopassi, H. Paz-Diaz, B. R. Celli, and V. M. Pinto-Plata Effects of hyperinflation on the oxygen pulse as a marker of cardiac performance in COPD Eur. Respir. J., November 1, 2008; 32(5): 1275 - 1282. [Abstract] [Full Text] [PDF]

				K. Jorgensen, M. F. Muller, J. Nel, R. N. Upton, E. Houltz, and S.-E. Ricksten Reduced Intrathoracic Blood Volume and Left and Right Ventricular Dimensions in Patients With Severe Emphysema: An MRI Study Chest, April 1, 2007; 131(4): 1050 - 1057. [Abstract] [Full Text] [PDF]

				K. Jorgensen, E. Houltz, U. Westfelt, and S.-E. Ricksten Left Ventricular Performance and Dimensions in Patients with Severe Emphysema Anesth. Analg., April 1, 2007; 104(4): 887 - 892. [Abstract] [Full Text] [PDF]

				M. I. Polkey Surgical procedures in emphysema: any impact on dynamic hyperinflation? Eur. Respir. Rev., December 1, 2006; 15(100): 96 - 99. [Abstract] [Full Text] [PDF]

				S. L. Krachman, W. Chatila, U. J. Martin, T. Nugent, J. Crocetti, J. Gaughan, G. J. Criner, and for the National Emphysema Treatment Trial Researc Effects of Lung Volume Reduction Surgery on Sleep Quality and Nocturnal Gas Exchange in Patients With Severe Emphysema Chest, November 1, 2005; 128(5): 3221 - 3228. [Abstract] [Full Text] [PDF]

				Z J McKeoughl, J A Alison, M S Bayfield, and P T.P Bye Supported and unsupported arm exercise capacity following lung volume reduction surgery: a pilot study Chronic Respiratory Disease, April 1, 2005; 2(2): 59 - 65. [Abstract] [PDF]

				K. Jorgensen, E. Houltz, U. Westfelt, F. Nilsson, H. Schersten, and S.-E. Ricksten Effects of Lung Volume Reduction Surgery on Left Ventricular Diastolic Filling and Dimensions in Patients With Severe Emphysema Chest, November 1, 2003; 124(5): 1863 - 1870. [Abstract] [Full Text] [PDF]

				T. C. MINEO, E. POMPEO, P. ROGLIANI, M. DAURI, F. TURANI, P. BOLLERO, and N. MAGLIOCCHETTI Effect of Lung Volume Reduction Surgery for Severe Emphysema on Right Ventricular Function Am. J. Respir. Crit. Care Med., February 15, 2002; 165(4): 489 - 494. [Abstract] [Full Text] [PDF]

				E. M. Gruber, E. M. Tschernko, M. Kritzinger, E. Deviatko, W. Wisser, D. Zurakowski, and W. Haider The Effects of Thoracic Epidural Analgesia with Bupivacaine 0.25% on Ventilatory Mechanics in Patients with Severe Chronic Obstructive Pulmonary Disease Anesth. Analg., April 1, 2001; 92(4): 1015 - 1019. [Abstract] [Full Text] [PDF]

				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]