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Successful treatment of ventilator dependent emphysema with Chartis treatment planning and endobronchial valves.
MedLine Citation:
PMID:  22096755     Owner:  NLM     Status:  PubMed-not-MEDLINE    
INTRODUCTION: Emphysema is a leading cause of disability and death. Patients who require ventilator support as a result of respiratory failure have limited treatment options. We report a successful outcome for a ventilator dependent patient in whom endobronchial valves were inserted into lobes assessed as being without collateral ventilation.
PRESENTATION OF CASE: A 54 year old male patient had been ventilator dependent for two months due to respiratory insufficiency from emphysema. Prior to admission, FEV(1) was 0.89L (25% predicted) and RV was 4.5L (205% predicted). CT scan showed destruction of right lower and middle lobes and left lower lobe. Chartis assessment showed the absence of collateral ventilation. Zephyr endobronchial valves were placed in left and right lower lobes. Lung volume reduction bilaterally was confirmed on chest X-ray and CT scan the following day. On day three, ventilator support was discontinued and there was no requirement for supplementary oxygen. At 30 days post procedure, the RV reduced to 3.2L (142% predicted) and the FEV(1) increased to 1.32L (38% predicted).
DISCUSSION: Hyperinflation in emphysema compromises lung function. For this ventilator dependent patient, there were no other treatment options. Endoscopic lung volume reduction was successfully achieved by bilateral lower lobe placement of Zephyr endobronchial valves with a prior assessment using Chartis to determine the absence of collateral flow in the targeted lobes. The patient achieved an impressive 48% improvement in FEV(1) and a 29% reduction in RV.
CONCLUSION: Endoscopic lung volume reduction assisted by Chartis to plan treatment resulted in a clinical and a health-economic benefit.
J Votruba; J Collins; F J F Herth
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Publication Detail:
Type:  Journal Article     Date:  2011-09-21
Journal Detail:
Title:  International journal of surgery case reports     Volume:  2     ISSN:  2210-2612     ISO Abbreviation:  Int J Surg Case Rep     Publication Date:  2011  
Date Detail:
Created Date:  2011-11-18     Completed Date:  2011-11-23     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101529872     Medline TA:  Int J Surg Case Rep     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  285-7     Citation Subset:  -    
Na Homolce, Interni Oddeleni-Pneumologie, Roentgenova 2, 150 30 Prague 5, Czech Republic.
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