Jorrit B A Welling1,2, Karin Klooster3,4, Jean-Paul Charbonnier5, Eva M Van Rikxoort5, Clemens R M Barends6, Huib A M Kerstjens3,4, Nick H T Ten Hacken3,4, Jorine E Hartman3,4, Dirk-Jan Slebos3,4. 1. Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, j.b.a.welling@umcg.nl. 2. Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, j.b.a.welling@umcg.nl. 3. Department of Pulmonary Diseases, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 4. Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 5. Thirona, Nijmegen, The Netherlands. 6. Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Abstract
BACKGROUND: Adequate target lobe selection for endobronchial valve (EBV) treatment in patients with severe emphysema is essential for treatment success and can be based on emphysema destruction, lobar perfusion, lobar volume, and collateral ventilation. As some patients have >1 target lobe for EBV treatment, we were interested whether we could identify the least functional lobe. OBJECTIVES: The objective of this study was to investigate the relationship between endoscopic lobar measurement of oxygen uptake, lobar destruction, and vascular volume, and whether this could help in identifying the least functional lobe and thus optimal target for EBV treatment. METHOD: We prospectively included patients who were scheduled for EBV treatment in our hospital. A customized gas analysis setup was used to measure lobar O2 uptake after lobar balloon occlusion. Quantitative CT analysis was performed to assess the degree of emphysematous destruction and lobar arterial and venous volumes. RESULTS: Twenty-one (5 male/16 female) patients with emphysema (median age 63 years, FEV1 25% of predicted, residual volume 234% of predicted) were included, and 49 endoscopic lobar measurements were performed. A lower O2 uptake significantly correlated with a higher degree of emphysematous lobar destruction (Spearman's ρ: 0.39, p < 0.01), and lower arterial and venous vascular volumes of the lobes (-0.46 and -0.47, respectively; both p < 0.001). CONCLUSIONS: Endoscopic measurement of lobar O2 uptake is feasible in patients with emphysema. Measurement of lobar O2 uptake helped to identify the least functional lobe and can be used as additional tool for EBV target lobe selection.
BACKGROUND: Adequate target lobe selection for endobronchial valve (EBV) treatment in patients with severe emphysema is essential for treatment success and can be based on emphysema destruction, lobar perfusion, lobar volume, and collateral ventilation. As some patients have >1 target lobe for EBV treatment, we were interested whether we could identify the least functional lobe. OBJECTIVES: The objective of this study was to investigate the relationship between endoscopic lobar measurement of oxygen uptake, lobar destruction, and vascular volume, and whether this could help in identifying the least functional lobe and thus optimal target for EBV treatment. METHOD: We prospectively included patients who were scheduled for EBV treatment in our hospital. A customized gas analysis setup was used to measure lobar O2 uptake after lobar balloon occlusion. Quantitative CT analysis was performed to assess the degree of emphysematous destruction and lobar arterial and venous volumes. RESULTS: Twenty-one (5 male/16 female) patients with emphysema (median age 63 years, FEV1 25% of predicted, residual volume 234% of predicted) were included, and 49 endoscopic lobar measurements were performed. A lower O2 uptake significantly correlated with a higher degree of emphysematous lobar destruction (Spearman's ρ: 0.39, p < 0.01), and lower arterial and venous vascular volumes of the lobes (-0.46 and -0.47, respectively; both p < 0.001). CONCLUSIONS: Endoscopic measurement of lobar O2 uptake is feasible in patients with emphysema. Measurement of lobar O2 uptake helped to identify the least functional lobe and can be used as additional tool for EBV target lobe selection.
Authors: Jorrit B A Welling; Jorine E Hartman; Nick H T Ten Hacken; Ina Franz; Jean-Paul Charbonnier; Eva M van Rikxoort; Huib A M Kerstjens; Karin Klooster; Dirk-Jan Slebos Journal: Respiration Date: 2018-08-16 Impact factor: 3.580
Authors: Jorrit B A Welling; Jorine E Hartman; Eva M van Rikxoort; Nick H T Ten Hacken; Huib A M Kerstjens; Karin Klooster; Dirk-Jan Slebos Journal: Respirology Date: 2017-09-15 Impact factor: 6.424
Authors: Gerard J Criner; Richard Sue; Shawn Wright; Mark Dransfield; Hiram Rivas-Perez; Tanya Wiese; Frank C Sciurba; Pallav L Shah; Momen M Wahidi; Hugo Goulart de Oliveira; Brian Morrissey; Paulo F G Cardoso; Steven Hays; Adnan Majid; Nicholas Pastis; Lisa Kopas; Mark Vollenweider; P Michael McFadden; Michael Machuzak; David W Hsia; Arthur Sung; Nabil Jarad; Malgorzata Kornaszewska; Stephen Hazelrigg; Ganesh Krishna; Brian Armstrong; Narinder S Shargill; Dirk-Jan Slebos Journal: Am J Respir Crit Care Med Date: 2018-11-01 Impact factor: 21.405
Authors: Felix J F Herth; Dirk-Jan Slebos; Gerard J Criner; Arschang Valipour; Frank Sciurba; Pallav L Shah Journal: Respiration Date: 2019-03-05 Impact factor: 3.580
Authors: Karin Klooster; Nick H T ten Hacken; Jorine E Hartman; Huib A M Kerstjens; Eva M van Rikxoort; Dirk-Jan Slebos Journal: N Engl J Med Date: 2015-12-10 Impact factor: 91.245
Authors: Samuel V Kemp; Dirk-Jan Slebos; Alan Kirk; Malgorzata Kornaszewska; Kris Carron; Lars Ek; Gustav Broman; Gunnar Hillerdal; Herve Mal; Christophe Pison; Amandine Briault; Nicola Downer; Kaid Darwiche; Jagan Rao; Ralf-Harto Hübner; Christof Ruwwe-Glosenkamp; Valéry Trosini-Desert; Ralf Eberhardt; Felix J Herth; Eric Derom; Thomas Malfait; Pallav L Shah; Justin L Garner; Nick H Ten Hacken; Hazem Fallouh; Sylvie Leroy; Charles H Marquette Journal: Am J Respir Crit Care Med Date: 2017-12-15 Impact factor: 21.405
Authors: Christian Thomsen; Dorothea Theilig; Dominik Herzog; Alexander Poellinger; Felix Doellinger; Nils Schreiter; Vera Schreiter; Dirk Schürmann; Bettina Temmesfeld-Wollbrueck; Stefan Hippenstiel; Norbert Suttorp; Ralf-Harto Hubner Journal: Int J Chron Obstruct Pulmon Dis Date: 2016-06-09