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    Effects of Lung Volume Reduction Surgery on Gas Exchange and Breathing Pattern During Maximum Exercise

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    Name:
    Criner-JournalArticle-2008-11- ...
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    Genre
    Journal article
    Date
    2008-11-11
    Author
    Criner, Gerard J.
    Belt, Patricia
    Sternberg, Alice L.
    Mosenifar, Zab
    Make, Barry J.
    Utz, James P.
    Sciurba, Frank C.
    Group
    National Emphysema Treatment Trial Research Group
    Subject
    Cardiopulmonary exercise
    COPD
    Emphysema
    Permanent link to this record
    http://hdl.handle.net/20.500.12613/6400
    
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    DOI
    https://doi.org/10.1378/chest.08-1625
    Abstract
    Background: The National Emphysema Treatment Trial studied lung volume reduction surgery (LVRS) for its effects on gas exchange, breathing pattern, and dyspnea during exercise in severe emphysema. Methods: Exercise testing was performed at baseline, and 6, 12, and 24 months. Minute ventilation (e), tidal volume (Vt), carbon dioxide output (co2), dyspnea rating, and workload were recorded at rest, 3 min of unloaded pedaling, and maximum exercise. Pao2, Paco2, pH, fraction of expired carbon dioxide, and bicarbonate were also collected in some subjects at these time points and each minute of testing. There were 1,218 patients enrolled in the study (mean [± SD] age, 66.6 ± 6.1 years; mean, 61%; mean FEV1, 0.77 ± 0.24 L), with 238 patients participating in this substudy (mean age, 66.1 ± 6.8 years; mean, 67%; mean FEV1, 0.78 ± 0.25 L). Results: At 6 months, LVRS patients had higher maximum e (32.8 vs 29.6 L/min, respectively; p = 0.001), co2, (0.923 vs 0.820 L/min, respectively; p = 0.0003), Vt (1.18 vs 1.07 L, respectively; p = 0.001), heart rate (124 vs 121 beats/min, respectively; p = 0.02), and workload (49.3 vs 45.1 W, respectively; p = 0.04), but less breathlessness (as measured by Borg dyspnea scale score) [4.4 vs 5.2, respectively; p = 0.0001] and exercise ventilatory limitation (49.5% vs 71.9%, respectively; p = 0.001) than medical patients. LVRS patients with upper-lobe emphysema showed a downward shift in Paco2 vs co2 (p = 0.001). During exercise, LVRS patients breathed slower and deeper at 6 months (p = 0.01) and 12 months (p = 0.006), with reduced dead space at 6 months (p = 0.007) and 24 months (p = 0.006). Twelve months after patients underwent LVRS, dyspnea was less in patients with upper-lobe emphysema (p = 0.001) and non-upper-lobe emphysema (p = 0.007). Conclusion: During exercise following LVRS, patients with severe emphysema improve carbon dioxide elimination and dead space, breathe slower and deeper, and report less dyspnea.
    Citation
    Criner GJ, Belt P, Sternberg AL, et al. for the National Emphysema Treatment Trial Research Group. Effects of Lung Volume Reduction Surgery on Gas Exchange and Breathing Pattern During Maximum Exercise. Chest. 2009;135(5):1268-1279. doi.10.1378/chest.08-1625.
    Citation to related work
    Elsevier
    Has part
    Chest, Vol. 135, Iss. 5, May 2008
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    ae974a485f413a2113503eed53cd6c53
    http://dx.doi.org/10.34944/dspace/6382
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