Surgical Lung Volume Reduction

Surgical Lung Volume Reduction

Rationale and design of The National Emphysema Treatment Trial: a prospective randomized trial of lung volume reduction surgery. The National Emphysema Treatment Trial Research Group

https://www.ncbi.nlm.nih.gov/pubmed/10593802

Landmark Article 

Reference: Rationale and design of The National Emphysema Treatment Trial: a prospective randomized trial of lung volume reduction surgery. The National Emphysema Treatment Trial Research Group. Chest. 1999;116(6):1750-61.

Summary: 

  • Background: This was the publication that laid the foundations and rationale for selecting specific screening criteria for surgical lung volume reduction.
  • Take Home: Reasoning and rationale for the clinical design of the NETT. These foundations were later incorporated into bronchoscopic lung volume reduction studies.

A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema

https://www.ncbi.nlm.nih.gov/pubmed/12759479

Landmark Article

Reference: Fishman A, Martinez F, Naunheim K, et al. A randomized trial comparing lung-volume-reduction surgery with medical therapy for severe emphysema. N Engl J Med. 2003;348(21):2059-73.

Background: Foundational study demonstrating the benefit of lung volume reduction surgery in upper lobar emphysema

PICO:

Populations:

  • Patients with severe emphysema
  • Post-bronchodilator TLC > 100%
  • Post-bronchodilator RV ≥ 150%
  • FEV1 ≤ 45%
  • PaCO2 < 60 mmHg
  • PaO2 ≥ 45 mmHg
  • Completion of Pulmonary Rehabilitation
  • Non-smoker for > 4 months

Intervention:

  • Lung volume reduction surgery

Comparison:

  • Maximal medical therapy without surgical or procedural interventions

Outcome:

  • There was a mortality benefit with lung volume reduction surgery in selected patient populations

Take Home: In patients with upper lobe emphysema and low baseline exercise capacity, surgical lung volume reduction can have a  protentional for a mortality benefit. In all comers however, there is only an improvement in exercise capacity.


Lung volume reduction surgery since the National Emphysema Treatment Trial: study of Society of Thoracic Surgeons Database

https://www.ncbi.nlm.nih.gov/pubmed/24631312

Clinical Trial 

Reference: Decker MR, Leverson GE, Jaoude WA, Maloney JD. Lung volume reduction surgery since the National Emphysema Treatment Trial: study of Society of Thoracic Surgeons Database. J Thorac Cardiovasc Surg. 2014;148(6):2651-8.e1.

Background: This was a registry study reviewing real world implementation of surgical lung volume reduction

PICO:

Populations:

  • Patients with severe emphysema

Intervention:

  • Lung volume reduction surgery

Comparison:

  • Maximal medical therapy

Outcome:

  • There was a mortality benefit with lung volume reduction surgery in selected patient populations; however, there were limited total surgeries performed nationally

Take Home: In patients with upper lobe emphysema and low baseline exercise capacity, surgical lung volume reduction can have a significant mortality benefit


 Lung Volume Reduction Surgery on Extracorporeal Life Support

https://www.ncbi.nlm.nih.gov/pubmed/28109366

Case Report

Reference: Tzafos S, Collaud S, Wilhelm M, Wieser S, Weder W, Inci I. Lung Volume Reduction Surgery on Extracorporeal Life Support. Ann Thorac Surg. 2017;103(2):e115-e117.

Background: This is a case report on the safety and efficacy of lung volume reduction surgery on a patient requiring veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) support

PICO:

Populations:

  • One patient with severe emphysema and respiratory failure

Intervention:

  • Lung volume reduction surgery

Comparison:

  • None

Outcome:

  • The patient survived and made a full recovery

Take Home: In selected patients, surgical lung volume reduction can be considered for patients on VA ECMO.