Abstract
Objectives: We assessed whether hypercapnia patients with an extremely high level of PaCO2≧60 mm Hg were suitable candidates for lung volume reduction in the treatment of severe pulmonary emphysema.Methods: Of 65 patients undergoing lung volume reduction surgery between May 1993 and August 1997, 6 (9.23%) who had a preoperative rest room air blood gas level of PaCO2≧60mm Hg were selected for study. All patients underwent video-assisted thoracoscopic surgery. Of the 6 with severe hypercapnia, 5 underwent the unilateral procedure and 1 the bilateral procedure.Results: All severe hypercapnia patients showed significant clinical improvement. When assessed at 3 to 6 months after lung volume reduction surgery, significant improvements were seen in mean forced expiratory volume in 1 second (preop: 0.44±0.04 L; postop: 0.74±0.20 L; p<0.01), for a magnitude improvement of 69.8%, and in trapped gas volume (preop: 3.28±1.11 L; postop: 1.61±1.02 L; p<0.05). Arterial blood gas analysis showed significant improvement in PaO2 from 51.1±6.68 mmHg to 69.8±7.87 mmHg (p<0.001) with a decrease in PaCO2 from 70.4±9.41 mmHg to 46.9±3.44 mmHg (p<0.01). Postoperative follow-up averaged 55 months (43–69 months). All but 1 patient remain alive and well.Conclusion: Patients with severe pulmonary emphysema accompanied by hypercapnia can gain relief and a better quality of life through volume reduction surgery and should not be excluded from surgical treatment simply based on this condition. Selection should involve a comprehensive view of the patient's condition that includes criteria such as the results of radiographic diagnosis and detailed pulmonary function tests.
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Mitsui, K., Kurokawa, Y., Kaiwa, Y. et al. Thoracoscopic lung volume reduction surgery for pulmonary emphysema patients with severe hypercapnia. Jpn J Thorac Caridovasc Surg 49, 481–488 (2001). https://doi.org/10.1007/BF02919542
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DOI: https://doi.org/10.1007/BF02919542