title: Effects of lung volume reduction surgery for emphysema on oxygen cost of breathing.
abstract: BACKGROUND
  Patients with severe pulmonary emphysema have a greatly increased oxygen cost of breathing (O(2) cost), and this is the cause of serious malnutrition, or respiratory cachexia, in such patients.
  
  
  OBJECTIVE
  To clarify the effect of lung volume reduction surgery (LVRS) on respiratory function and the nutritional state of these patients through a reduction in the O(2) cost of the respiratory muscles.
  
  
  METHODS
  Prospective cohort study. Setting, patients, and interventions: Twenty-three patients who underwent LVRS in Tohoku University Hospital.
  
  
  METHODS
  Pulmonary function and O(2) cost were measured perioperatively by utilizing a method of continuous dead space. In addition, we calculated the proportion of oxygen consumption (O(2)) of respiratory muscles to total O(2) (%O(2)resp) from the measured energy expenditure and the predicted values.
  
  
  RESULTS
  FEV(1) and arterial oxygen pressure increased after surgery while lung volume and dyspnea decreased (p < 0.01), and O(2) cost was also reduced from 0.044 to 0.026 log(mL/min)/(L/min) [p < 0.001]. Moreover, the change in O(2) cost had a strong negative correlation with that of FEV(1) (r = - 0.70, p < 0.001), and a moderate positive correlation with that of the ratio of residual volume to total lung capacity (r = 0.54, p < 0.01). %O(2)resp was 23.1% at rest and 55.5% at maximal ventilation. LVRS reduced %O(2)resp at maximal ventilation to 49.0% (p < 0.05), but %O(2)resp at rest did not decrease after surgery.
  
  
  CONCLUSIONS
  LVRS reduces energy expenditure of respiratory muscles especially during exercise by decreasing small airway obstruction and hyperinflated lung volume. This may reverse the malnourished state in end-stage emphysema.
authors.affiliation: Division of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan. takayama@gonryo.med.tohoku.ac.jp
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Takayama
authors.forename: Chiyohiko
authors.initials: C
authors.lastname: Shindoh
authors.forename: Yoshimochi
authors.initials: Y
authors.lastname: Kurokawa
authors.forename: Wataru
authors.initials: W
authors.lastname: Hida
authors.forename: Hajime
authors.initials: H
authors.lastname: Kurosawa
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Ogawa
authors.forename: Susumu
authors.initials: S
authors.lastname: Satomi
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004417:Dyspnea / Q000503:physiopathology; D004734:Energy Metabolism / Q000502:physiology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D009748:Nutrition Disorders / Q000503:physiopathology; D010100:Oxygen / Q000097:blood; D010101:Oxygen Consumption / Q000502:physiology*; D011013:Pneumonectomy; D011446:Prospective Studies; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D015656:Respiratory Mechanics / Q000502:physiology*; D012132:Respiratory Muscles / Q000503:physiopathology*; D014109:Total Lung Capacity / Q000502:physiology
chemical_list: D010100:Oxygen