Changes in arterial oxygenation and self-reported oxygen use after lung volume reduction surgery.
BACKGROUND
Lung volume reduction surgery (LVRS) is inconsistently reported to improve arterial oxygenation in patients with chronic obstructive pulmonary disease.


OBJECTIVE
We studied the effects of surgery on oxygenation in a large cohort and identified predictors of postoperative oxygenation improvement.


METHODS
We evaluated oxygenation in 1,078 subjects with chronic obstructive pulmonary disease enrolled in the National Emphysema Treatment Trial after LVRS compared with medical control subjects, including arterial blood gases, use of supplemental oxygen during treadmill walking, and self-reported use of oxygen during rest, exertion, and sleep.


RESULTS
Pa(O(2)) breathing room air was equal in medical and surgical subjects at baseline (64.8 vs. 65.0 mm Hg, P = not significant), but lower in medical subjects at 6 months (63.6 vs. 70.0 mm Hg, P < 0.001), 12 months (63.9 vs. 68.7 mm Hg, P < 0.001), and 24 months (62.4 vs. 68.0 mm Hg, P < 0.001). Fewer medical subjects required oxygen for treadmill walking at baseline compared with surgical subjects (46 vs. 53%, P = 0.02). However, more medical subjects required oxygen for this activity at 6 months (49 vs. 33%, P < 0.001), 12 months (50 vs. 36%, P < 0.001), and 24 months (52 vs. 42%, P = 0.02). Self-reported oxygen use was greater in medical than in surgical subjects at 6, 12, and 24 months. Multivariate modeling of preoperative characteristics showed baseline oxygenation status was the best predictor of postoperative oxygenation.


CONCLUSIONS
LVRS increases Pa(O(2)), and decreases treadmill and self-reported use of oxygen for up to 24 months post-procedure. Clinical trial registered with www.clinicaltrials.gov (NCT 00000606).
Snyder
Margaret L
ML
Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington 98195-6522, USA.
Goss
Christopher H
CH
Neradilek
Blazej
B
Polissar
Nayak L
NL
Mosenifar
Zab
Z
Wise
Robert A
RA
Fishman
Alfred P
AP
Benditt
Joshua O
JO
D000203:Activities of Daily Living; D000368:Aged; D015331:Cohort Studies; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008176:Lung Volume Measurements; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data*; D011013:Pneumonectomy; D011653:Pulmonary Diffusing Capacity; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000601:surgery*; D011656:Pulmonary Emphysema / Q000097:blood / Q000601:surgery*; D015996:Survival Rate; D016896:Treatment Outcome
D010100:Oxygen