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Published ahead of print on June 5, 2008, doi:10.1164/rccm.200712-1826OC

Am. J. Respir. Crit. Care Med., Volume 178, Number 4, August 2008, 339-345

A more recent version of this article appeared on August 15, 2008
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Submitted on December 13, 2007
Accepted on June 5, 2008

Changes in Arterial Oxygenation and Self-reported Oxygen use Following Lung Volume Reduction Surgery

Margaret L Snyder1, Christopher H Goss1, Blazej Neradilek2, Nayak L Polissar2, Zab Mosenifar3, Robert A Wise4, Alfred P Fishman5, and Joshua O Benditt1*

1 Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA, USA, 2 The Mountain-Whisper-Light Statistical Consulting, Seattle, WA, USA, 3 Division of Pulmonary Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA, 4 Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA, 5 Office of Program Development, University of Pennsylvania, Philadelphia, PA, USA

* To whom correspondence should be addressed. E-mail: benditt{at}u.washington.edu.

Rationale and Objectives: Lung volume reduction surgery is inconsistently reported to improve arterial oxygenation in COPD patients. We studied the effects of surgery on oxygenation in a large cohort and identified predictors of postoperative oxygenation improvement. Methods: We evaluated oxygenation in 1078 COPD subjects enrolled in the National Emphysema Treatment Trial following lung volume reduction surgery compared to medical controls including: arterial blood gases, use of supplemental oxygen during treadmill walking and self-reported use of oxygen during rest, exertion and sleep. Measurements and Main Results: PaO2 breathing room air was equal in medical and surgical subjects at baseline (64.8 vs 65.0 mmHg, p= n.s.), but lower in medical subjects at 6 months (63.6 vs. 70.0 mmHg, p < .001), 12 months (63.9 vs. 68.7 mmHg, p < .001) and 24 months (62.4 vs. 68.0 mmHg, p < .001). Fewer medical subjects required oxygen for treadmill walking at baseline compared with surgical subjects (46 % vs. 53 %, p= .02). However, more medical subjects required oxygen for this activity at 6 months (49 % vs. 33 %, p < .001), 12 months (50 % vs. 36%, p < .001) and 24 months (52% vs. 42%, p= .02). Self-reported oxygen use was greater in medical than surgical subjects at 6, 12 and 24 months. Multivariate modeling of pre-operative characteristics showed baseline oxygenation status was the best predictor of post-operative oxygenation. Conclusions: Lung volume reduction surgery increases PaO2, and decreases treadmill and self-reported use of oxygen for up to 24 months post-procedure. Clinical Trials Registry Information: ID# NCT00000606 registered at www.clinicaltrials.gov
Key words: oxygen inhalation therapy, emphysema, lung diseases obstructive






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