Chest. 2009 May;135(5):1268-79.

Effects of lung volume reduction surgery on gas exchange and breathing pattern during maximum exercise.

Criner GJ, Belt P, Sternberg AL, Mosenifar Z, Make BJ, Utz JP, Sciurba F; National Emphysema Treatment Trial Research Group.

Collaborators (434)

Katz M, Wheeler C, Baker E, Barnard P, Carter S, Chatziioannou S, Congejo-Gonzales K, Haddad J, Hicks D, Kleiman N, Milburn-Barnes M, Nguyen C, Reardon M, Reeves-Viets J, Sax S, Sharafkhaneh A, Young C, Espada R, Butanda R, Dubose K, Ellisor M, Fox P, Hale K, Hood E, Jahn A, Jhingran S, King K, Miller C, Nizami I, Officer T, Ricketts J, Rodarte J, Teague R, Williams K, Reilly J, Sugarbaker D, Fanning C, Body S, Duffy S, Formanek V, Fuhlbrigge A, Hartigan P, Hooper S, Hunsaker A, Jacobson F, Moy M, Peterson S, Russell R, Saunders D, Swanson S, McKenna R, Mohsenifar Z, Geaga C, Biring M, Clark S, Frantz R, Julien P, Lewis M, Minkoff-Rau J, Yegyan V, Joyner M, DeCamp M, Stoller J, Meli Y, Apostolakis J, Atwell D, Chapman J, DeVilliers P, Dweik R, Kraenzler E, Lann R, Kurokawa N, Marlow S, McCarthy K, McCreight P, Mehta A, Meziane M, Minai O, O'Donovan P, Steiger M, White K, Maurer J, Hearn C, Lubell S, Schilz R, Durr T, Ginsberg M, Thomashow B, Jellen P, Austin J, Bartels M, Berkman Y, Berkoski P, Brogan F, Chong A, DeMercado G, DiMango A, Kachulis B, Khan A, Mets B, O'Shea M, Pearson G, Pfeffer J, Rossoff L, Scharf S, Shiau M, Simoneli P, Stavrolakes K, Tsang D, Vilotijevic D, Yip C, Mantinaos M, McKeon M, MacIntyre N, Davis RD, Howe J, Coleman RE, Crouch R, Greene D, Grichnik K, Harpole D, Krichman A, Lawlor B, McAdams H, Plankeel J, Rinaldo-Gallo S, Smith J, Stafford-Smith M, Tapson V, Steele M, Norten J, Utz J, Deschamps C, Mieras K, Abel M, Allen M, Andrist D, Aughenbaugh G, Bendel S, Edell E, Edgar M, Edwards B, Elliot B, Garrett J, Gillespie D, Gurney J, Hammel B, Hanson K, Hanson L, Harms G, Hart J, Hartman T, Hyatt R, Jensen E, Jenson N, Kalra S, Karsell P, Midthun D, Mottram C, Swensen S, Sykes AM, Taylor K, Torres N, Hubmayr R, Miller D, Bartling S, Bradt K, Make B, Pomerantz M, Gillmartin M, Canterbury J, Carlos M, Dibbern P, Fernandez E, Geyman L, Hudson C, Lynch D, Newell J, Quaife R, Propst J, Raymond C, Whalen-Price J, Winner K, Zamora M, Cherniack R, Diaz P, Ross P, Bees T, Awad J, Drake J, Emery C, Gerhardt M, Kelsey M, King M, Rittinger D, Rittinger M, Naunheim K, Alvarez F, Osterloh J, Borosh S, Chamberlain W, Frese S, Hibbit A, Kleinhenz ME, Ruppel G, Stolar C, Willey J, Keller C, Criner G, Furukawa S, Kuzma AM, Barnette R, Brister N, Carney K, Chatila W, Cordova F, D'Alonzo G, Keresztury M, Kirsch K, Kwak C, Lautensack K, Lorenzon M, Martin U, Rising P, Schartel S, Travaline J, Vance G, Boiselle P, O'Brien G, Ries A, Kaplan R, Ramirez C, Frankville D, Friedman P, Harrell J, Johnson J, Kapelanski D, Kupferberg D, Larsen C, Limberg T, Magliocca M, Papatheofanis FJ, Sassi-Damron D, Weeks M, Krasna M, Fessler H, Moskowitz I, Gilbert T, Orens J, Scharf S, Shade D, Siegelman S, Silver K, Weir C, White C, Martinez F, Iannettoni M, Meldrum C, Bria W, Campbell K, Christensen P, Flaherty K, Gay S, Gill P, Kazanjian P, Kazerooni E, Knieper V, Ojo T, Poole L, Qunit L, Rysso P, Sisson T, True M, Woodcock B, Zaremba L, Kaiser L, Hansen-Flaschen J, Geraghty ML, Alavi A, Alcorn T, Aronchick J, Aukberg S, Benedict B, Craemer S, Daniele R, Edelman J, Gefter W, Kotler-Klein L, Kotloff R, Lipson D, Miller W Jr, O'Connell R, Opelman S, Russell W, Sheaffer H, Simcox R, Snedeker S, Stone-Wynne J, Tino G, Wahl P, Walter J, Ward P, Zisman D, Mendez J, Wurster A, Sciurba F, Luketich J, Witt C, Ayres G, Donahoe M, Fuhrman C, Hoffman R, Lacomis J, Sexton J, Slivka W, Strollo D, Sullivan E, Simon T, Wrona C, Bauldoff G, Brown M, George E, Keenan R, Kopp T, Silfies L, Benditt J, Wood D, Snyder M, Anable K, Battaglia N, Boitano L, Bowdle A, Chan L, Chawalik C, Culver B, Gillespy T, Godwin D, Hoffman J, Ibrahim A, Lockhart D, Marglin S, Martay K, McDowell P, Oxorn D, Roessler L, Toshima M, Golden S, Boxco L, Chiang YP, Clancy C, Hadelsman H, Shengold S, Carino T, Chin J, Farrell J, McVearry K, Norris A, Shirey S, Sikora C, Piantadosi S, Tonascia J, Belt P, Collins K, Collison B, Dodge J, Donithan M, Edmonds V, Fuller J, Harle J, Jackson R, Koppelman H, Lee S, Levine C, Livingston H, Meinert J, Meyers J, Nowakowski D, Owens K, Qi S, Smith M, Simon B, Smith P, Sternberg A, Van Natta M, Wilson L, Wise R, Kaplan RM, Schwartz JS, Chiang YP, Fahs MC, Fendrick AM, Moskowitz AJ, Pathak D, Ramsey S, Sheingold S, Shroyer AL, Wagner J, Yusen R, Ramsey S, Etzioni R, Sullivan S, Wood D, Schroeder T, Smith R, Berry K, Myers N, Hoffman E, Cook-Granroth J, Delsing A, Guo J, McLennan G, Mullan B, Piker C, Reinhardt J, Sieren J, Stanford W, Waldhausen JA, Bernard G, DeMets D, Ferguson M, Hoover E, Levine R, Mahler D, MCSweeny AJ, Wiener-Kronish J, Williams OD, Younes M, Criner G, Soltoff C, Weinmann G, Deshler J, Follmann D, Kiley J, Wu M.

Source

Division of Pulmonary & Critical Care Medicine, Temple Lung Center, Temple University School of Medicine, Philadelphia, PA 19140, USA. crinerg@tuhs.temple.edu

Abstract

BACKGROUND:

The National Emphysema Treatment Trial studied lung volume reduction surgery (LVRS) for its effects on gas exchange, breathing pattern, and dyspnea during exercise in severe emphysema.

METHODS:

Exercise testing was performed at baseline, and 6, 12, and 24 months. Minute ventilation (Ve), tidal volume (Vt), carbon dioxide output (Vco(2)), dyspnea rating, and workload were recorded at rest, 3 min of unloaded pedaling, and maximum exercise. Pao(2), Paco(2), pH, fraction of expired carbon dioxide, and bicarbonate were also collected in some subjects at these time points and each minute of testing. There were 1,218 patients enrolled in the study (mean [+/- SD] age, 66.6 +/- 6.1 years; mean, 61%; mean FEV(1), 0.77 +/- 0.24 L), with 238 patients participating in this substudy (mean age, 66.1 +/- 6.8 years; mean, 67%; mean FEV(1), 0.78 +/- 0.25 L).

RESULTS:

At 6 months, LVRS patients had higher maximum Ve (32.8 vs 29.6 L/min, respectively; p = 0.001), Vco(2), (0.923 vs 0.820 L/min, respectively; p = 0.0003), Vt (1.18 vs 1.07 L, respectively; p = 0.001), heart rate (124 vs 121 beats/min, respectively; p = 0.02), and workload (49.3 vs 45.1 W, respectively; p = 0.04), but less breathlessness (as measured by Borg dyspnea scale score) [4.4 vs 5.2, respectively; p = 0.0001] and exercise ventilatory limitation (49.5% vs 71.9%, respectively; p = 0.001) than medical patients. LVRS patients with upper-lobe emphysema showed a downward shift in Paco(2) vs Vco(2) (p = 0.001). During exercise, LVRS patients breathed slower and deeper at 6 months (p = 0.01) and 12 months (p = 0.006), with reduced dead space at 6 months (p = 0.007) and 24 months (p = 0.006). Twelve months after patients underwent LVRS, dyspnea was less in patients with upper-lobe emphysema (p = 0.001) and non-upper-lobe emphysema (p = 0.007).

CONCLUSION:

During exercise following LVRS, patients with severe emphysema improve carbon dioxide elimination and dead space, breathe slower and deeper, and report less dyspnea.

PMID:: 19420196; [PubMed - indexed for MEDLINE]
PMCID: PMC2818416

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