The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

The Screening Process: Who Qualifies ?

Richard K. Albert, MD Tuesday, November 5, 1996

Lung Volume Reduction Surgery: Patient Selection Criteria

Definition of Emphysema:

Severe airflow limitation (defined by an FEV_{1} < 35% of the predicted value with an FEV_{1}/FVC < 50%), plus Marked air-trapping (defined as a residual volume > 165% of the predicted value*), plus Evidence of emphysema on chest CT_{+}

Exclusion Criteria:

Cigarette smoking within three months Co-morbid illnesses thought to increase surgical risk (e.g., symptomatic coronary artery disease or left ventricular dysfunction defined as an ejection fraction < 50%) Age > 75 PaCO_{2} > 55 mm Hg§ FEV_{1} < 15% predicted§ History of chronic bronchitis (defined as producing > 1/3 cup of sputum/day most days of the week) Previous bilateral thoractomy or pleurodesis Use of > 15 mg/day of systemic corticosteroids on a regular basis Marked obesity (defined as > 130% of ideal body weight) Mean pulmonary arterial pressure > 35 mmHg or pulmonary arterial systolic pressure > 45 mm Hg (defined by transthoracic echocardiogram or right heart catheterization) Inability or unwillingness to return for frequent follow-up examinations Debilitating degenerative arthritis sufficient to interfere with the physical or mental activities of daily living History of psychiatric disorder, dementia, or cognitive impairment sufficient to preclude use of quality of life instruments Ongoing alcohol abuse

* Lung volumes measured in a body plethysmograph. + Homogenous or heterogeneous § Some exceptions have been made for patients failing to meet this isolated criterion if other indicators predict a high likelihood of success

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