title: Bronchoscopic Lung Volume Reduction with Endobronchial Valves in Low-FEV1 Patients.
abstract: BACKGROUND
  Bronchoscopic lung volume reduction (BLVR) with valves has been shown to improve lung function, exercise capacity, and quality of life in patients with emphysema, but only few patients with forced expiratory volume in 1 s (FEV1) ≤20% predicted have been included in former studies. Although the procedure can be performed safely, pneumothorax is a frequent complication, which can be critical for these very severely diseased patients.
  
  
  OBJECTIVE
  The aim of the study was to assess the safety of BLVR in patients with a very advanced stage of emphysema, as indicated by FEV1 ≤20% predicted.
  
  
  METHODS
  Patients in whom BLVR was performed between January 2013 and August 2015 were included in this analysis if their baseline predicted FEV1 was ≤20%. BLVR, performed only if collateral ventilation was absent, achieved complete occlusion of the target lobe. All patients were closely monitored and were not discharged before the fourth day after BLVR.
  
  
  RESULTS
  Twenty patients with FEV1 ≤20% predicted were included in the analysis. Lung volume reduction was achieved in 65% of the cases. Pneumothorax occurred in 4 cases (20%). No patient died. Lung function and exercise tolerance improved after 1 and 3 months, respectively.
  
  
  CONCLUSIONS
  BLVR with valves can be safely performed in patients with FEV1 ≤20% predicted when close postprocedural monitoring is provided. Improvement in lung function and exercise capacity can be achieved.
authors.affiliation: Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
authors.forename: Kaid
authors.initials: K
authors.lastname: Darwiche
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Karpf-Wissel
authors.forename: Stephan
authors.initials: S
authors.lastname: Eisenmann
authors.forename: Clemens
authors.initials: C
authors.lastname: Aigner
authors.forename: Stefan
authors.initials: S
authors.lastname: Welter
authors.forename: Paul
authors.initials: P
authors.lastname: Zarogoulidis
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Hohenforst-Schmidt
authors.forename: Lutz
authors.initials: L
authors.lastname: Freitag
authors.forename: Filiz
authors.initials: F
authors.lastname: Oezkan
mesh_terms: D000368:Aged; D001999:Bronchoscopy / Q000379:methods*; D017079:Exercise Tolerance; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011013:Pneumonectomy / Q000379:methods*; D011030:Pneumothorax / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D019919:Prosthesis Implantation / Q000379:methods*; D011656:Pulmonary Emphysema / Q000503:physiopathology / Q000601:surgery*; D012720:Severity of Illness Index; D016896:Treatment Outcome