title: Functional improvements in ventilatory mechanics after lung volume reduction surgery for homogeneous emphysema.
abstract: OBJECTIVE
  Between September 1994 and August 1996 Lung Volume Reduction Surgery (LVRS) was performed through median sternotomy, videoendoscopically or by thoracotomy in 54 consecutive patients (age 34-69 years, mean 48 years).
  
  
  METHODS
  The areas with the most destroyed lung parenchyma were resected by means of linear stapling devices. A total of 5 patients died postoperatively due to aspiration pneumonia, multiorgan failure and acute hepatic failure respectively. A marked functional improvement and increase in quality of life was observed in the remaining patients.
  
  
  RESULTS
  Residual volume decreased from 317.0 +/- 12.4% of predicted (%p) preoperatively to 226.2 +/- 8.8%p within the first month (P = 0.0001). FeV1 significantly increased from 23.7 +/- 1.3%p preoperatively to 36.3 +/- 4.1%p during the first 6 months postoperatively (P = 0.0016). Radiological signs of hyperinflation and distention of the thorax preoperatively improved to a more dome shaped diaphragm and narrowed intercostal spaces. These morphologic changes resulted in better ventilatory muscle function. The intrinsic PEEP significantly decreased from 5.92 +/- 0.64 cm H2O preoperatively to 1.70 +/- 0.25 cm H2O postoperatively (P = 0.0001). The work of breathing decreased from 1.58 +/- 0.09 J/l preoperatively to 0.99 +/- 0.07 J/l postoperatively (P = 0.0001).
  
  
  CONCLUSIONS
  In conclusion, LVRS is an excellent therapeutic option for patients with homogeneous emphysema with additional signs of severe hyperinflation.
authors.affiliation: Department of Cardio-Thoracic Surgery, University Clinics of Surgery, Vienna, Austria.
authors.forename: W
authors.initials: W
authors.lastname: Wisser
authors.forename: E
authors.initials: E
authors.lastname: Tschernko
authors.forename: T
authors.initials: T
authors.lastname: Wanke
authors.forename: O
authors.initials: O
authors.lastname: Senbaclavaci
authors.forename: M
authors.initials: M
authors.lastname: Kontrus
authors.forename: E
authors.initials: E
authors.lastname: Wolner
authors.forename: W
authors.initials: W
authors.lastname: Klepetko
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D012123:Pulmonary Ventilation / Q000502:physiology; D012129:Respiratory Function Tests; D016896:Treatment Outcome