1997 OPEN FORUM Abstracts
LUNG VOLUME REDUCTION -OBJECTIVE AND SUBJECTIVE EVALUATION BY:
Deborah J. Hughes, BS, R.R.T., C.P.F.T., University of Rochester Medical Center, Rochester, N.Y.
Advances in technology and surgical techniques have caused a renewed interest in lung volume reduction (LVR) for the treatment of severe emphysema. Data from the LVR Registry and the Society of Thoracic Surgeons has been encouraging, citing improvements in pulmonary function, exercise endurance, and subjective symptoms. A retrospective study provided a means to evaluate the benefits of this procedure. Preoperative selection criteria included: disabling emphysema unrelieved by medical therapy; severe hyperinflation as evidenced by CXR and CT scan; and FeVl < 35% predicted. Data from 20 patients was obtained preoperatively and at 3 and 6 months postoperatively. Those excluded from the study were: 1 death, 1 ventilator dependent, 2 former laser procedures, 1 Alpha 1-antitrypsin, and 3 due to noncompliance with follow up. Preoperative and 6 month assessments were compared for the remaining 12. Objective data showed improvement in pulmonary function. Mean spirometry values revealed the following changes: FVC 2.39L ±.80 to 2.80L ±.84, p=.022; FeVl .658L±.21 to .873L ±.380, p=.014; TLC 8.80L±1.91 to 7.21L ±1.94, p=.000 and RV 6.13L±1.40 to 4.34L±1.43, p=.000. Endurance assessed per the 6 minute walk increased from a mean of 718 feet ±335 to 907 feet ±411, p=0.58. Subjective evaluation was accomplished by the use of dyspnea scales including the Modified Medical Research Scale(MRC) and Baseliene\Transition Dyspena Indices (BDI). The mean MRC score was 3.0±1.0 preoperatively, corresponding to: "Stops for breath after walking 100 yards or a few minutes on the level, breathless with daily activities." The mean score at 6 months was 1.5 ±1.12, corresponding to: "Troubled by S.O.B. when hurrying on the level or walking up a slight hill. "The mean BDI for function preoperatively was .58 ±1.24 corresponding to: "Severe to very severe impairment, unable to work or has given up almost all activities due to S.O.B." Mean score at 6 months was increased by 1.0 ±.95 grades indicating: "Minor improvement, able to return to work at a reduced pace or has resumed some activities with more vigor." The mean BDI for magnitude of task preoperatively was 1.08 ±.79, corresponding to: "Becomes S.O.B. with light activities walking on the level, washing, or standing." Mean score at 6months increased by 1.92 ±.67 grades indicating: "Moderate improvement, becomes S.O.B. with moderate tasks such as walking up a gradual hill or carrying a light load on the level." The mean BDI for magnitude of effort preoperatively was 1.25 ±.62 corresponding to: "Becomes S.O.B. with little effort, tasks often performed with frequent pauses." Mean score at 6 months increased by 1.00 ±1.41 grades indicating: "Minor improvements, able to do things of greater effort with out S.O.B.." Conclusion: LVR offers emphysema patients improved quality of life through increased functional ability and decreased feelings of dyspnea.