The Science Journal of the American Association for Respiratory Care

1997 OPEN FORUM Abstracts

Five Things I Learned about Lung Volume Reduction Surgery

Catherine M. Foss, BSRRT, RPFT, Monday, December 8, 1997.

Lung Volume Reduction Surgery (LVRS) is an evolving and promising procedure for the treatment of emphysema. Despite the initial excitement generated by this surgical operation though, it must be tempered by questions concerning the unknown long term outcomes. A multi-centered 18 site randomized study sponsored jointly by the National Heart Lung and Blood Institute and HCFA called NETT, has just begun. The study will evaluate patients using scientific, coordinated methods. Patients who qualify based on physical parameters including the presence of emphysema, will be randomized to either a medical alone or a combination medical and surgical arm of the study. Results concerning the risks and benefits of this procedure will be officially released at the end on the trial. There are opportunities for respiratory therapists in several roles throughout the various stages of LVRS evaluation and treatment. Five important aspects of LVRS are discussed to expand your knowledge of the current trends in LVRS to better prepare yourself and your patients.

1. Patient selection evaluation is vitally important to maximize positive outcomes with low morbidity and mortality. a. Team members: Respiratory Therapists, Pulmonologists, Thoracic surgeons, and Radiologists have a role in the team process to evaluate patient data. b. Evaluation criteria U of M's patient evaluation criteria, which is similar to that used at many leading centers performing LVRS will be presented. This is not the NETT protocol, it is that used at University of Michigan prior to beginning the NETT.

2. Outcomes in LVRS from the previous three years from the top US centers will be reviewed. a. Morbidity and mortality b. Graded Exercise results with work load and VO2 max data c. 6 minute walk data d. PFT data including FEV1, FVC and TLC e. Concerns of comparing % predicteds from many centers f. Surgical methods comparison and the effect on outcomes

3. Patient compliance is vital to outcome studies and patient well being. a. RCP's are vital in their role in pre-op teaching, pulmonary rehab and post-op care. b. Patients tend to drop out from follow up studies for a variety of reasons. c. Patients sometimes do not comply with ongoing medical therapy because they feel better. RCP's can reinforce the physician orders for O2 therapy, rehabilitation and medication while in pulmonary rehabilitation. d. RCP's play a role in patient instructions for ongoing care before leaving the hospital. e. Smoking cessation f. Desperate patients

4. Pulmonary Rehabilitation is an important feature to the LVRS continuum of care Staff work with patients pre and post surgery to change their sedentary lifestyle to maintain optimal response. Proper diet, breathing techniques, and the proper use of inhaled medications all help the patients in addition to the therapy they receive. Education on their disease state and the social interaction with staff and fellow patients is an important feature to Pulmonary rehab.

5. The role of Diagnostic testing for pre and post LVRs surgery is discussed. a. ATS standards do not yet exist for all the diagnostic studies being performed on LVRs patients. This makes it difficult to compare studies form across the country. b. Tests commonly performed at leading centers will be covered c. Quality of testing varies across the centers. d. Technical difficulties exist for the RCP when working with patients that have advanced emphysema.

Working with LVRS patients can be both challenging and rewarding for the Respiratory Care practitioner.

AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.

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