Feasibility and Safety of a Transthoracic Pneumostoma Airway Bypass in Severe Emphysema Patients
| Autor: | Sadie Khorramnia, Silvana Marasco, Gregory I Snell, Trevor Williams, Glen P. Westall, Julian Gooi, Lynda Holsworth |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
Spirometry medicine.medical_specialty Lung medicine.diagnostic_test Decompression business.industry medicine.disease Surgery 03 medical and health sciences 0302 clinical medicine medicine.anatomical_structure 030228 respiratory system Pneumothorax Quality of life Diffusing capacity Anesthesia medicine 030212 general & internal medicine business Airway Prospective cohort study |
| Zdroj: | Respiration. 93:236-246 |
| ISSN: | 1423-0356 0025-7931 |
| Popis: | Background: Emphysema is characterised by airflow obstruction, hyperinflation, and resultant dyspnoea. It is worth investigating whether decompression improves lung mechanics and enhances quality of life (QoL). Objectives: The purpose of this study was to describe the feasibility and safety of creating a transthoracic pneumostoma to enable lung reduction. Methods: A transthoracic 10-mm diameter Portaero Access Tube (Portaero™, Cupertino, CA, USA) was implanted via a third intercostal space incision in 15 severe emphysema patients [mean age 63 years, forced expiratory volume in 1 s 54% predicted, diffusing capacity for carbon monoxide 31% predicted, residual volume 246% predicted, Six-Minute Walk Test 296 m]. Four weeks later, an 8-mm Portaero Disposable Tube (3-8 cm in length) was substituted and changed daily thereafter. The targeted primary endpoints were a ≥12% increase in forced expiratory volume in 1 s and a decrease of ≥4 points in Saint George's Respiratory Questionnaire score at 6 months. Results: Sixteen procedures were performed on 15 patients, complicated by 1 intercostal haemorrhage, 1 pneumothorax, and universal mild surgical emphysema. Early patency issues were common, but often responded to external endoscopic debridement or argon plasma laser. Three-month patency was achieved in 9 of 15 patients, and 6 of these had long-term patency (mean of 4 years). Patency was associated with potentially useful long-term improvements or stability in spirometry, residual volume, and QoL. However, the primary endpoints were not met at 6 months. Conclusion: The creation and maintenance of a transthoracic pneumostoma appears feasible and safe in patients with severe emphysema. Further studies refining patient selection (perhaps via chest computed tomography collateral ventilation and fissure assessments), techniques, and tube materials are suggested. |
| Databáze: | OpenAIRE |
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