Unilaterale Lungenvolumenreduktion mit intrabronchialen Ventilen nach Selektion mittels endoskopischer Kollateralventilationsmessung

Zusammenfassung

Hintergrund: Mittels endoskopischer Kollateralventilationsmessung (ECVA) können Emphysempatienten für eine Ventilanlage zur Lungenvolumenreduktion selektiert werden. Wünschenswert ist eine post interventionell resultierende, klinisch relevante Verbesserung der körperlichen Leistungsfähigkeit der selektierten Klientel.

Methode: Patienten mit einer fortgeschrittenen COPD wurden einem Screening zur Lungenvolumenreduktion unterzogen. Selektierte Patienten erhielten eine ECVA, bei Patienten mit einem Anstieg des Kollateralwiderstandes Rkoll auf > 10 cmH₂O/(ml/s) innerhalb einer Messdauer von bis zu 300 s wurden unilateral lobär intrabronchiale Ventile (IBV) platziert. Die Differenzen ?>von Residualvolumen (RV) und Gehstrecke im 6-Minuten-Gehtest (6MWT) zwischen den Zeitpunkten TX (nach Ventilanlage) minus T1 (vor Ventilanlage) wurden errechnet.

Ergebnisse: Von 310 Emphysempatienten erfüllten 17 die Kriterien zur ECVA, 10/17 eigneten sich zur Ventilanlage. Nach 312 ± 170 Tagen (TX-T1) betrug die Zunahme der Gehstrecke 44 ± 89,7 m, 7/10 Patienten profitierten klinisch relevant (> 25 m). Die RV-Differenz korrelierte mit der Gehstreckendifferenz, nicht aber mit der ECVA-Messdauer.

Schlussfolgerungen: Nur ein geringer Teil der Patienten mit einem fortgeschrittenen Lungenemphysem scheint für eine endoskopische Lungenvolumenreduktion mittels Ventilanlage in Frage zu kommen. Eine unilaterale lobäre IBV-Anlage kann zu einer dauerhaften, klinisch relevanten Verbesserung der körperlichen Leistungsfähigkeit führen. Die ECVA-Messdauer sollte zumindest 300 s betragen.

Abstract

Background: Endoscopic collateral ventilation assessment (ECVA) can be used to select patients suffering from emphysema for application of valves to achieve a reduction of lung volume. The objective is to obtain a post-operatively minimal clinically important improvement of the selected patient’s physical capacity.

Methods: Patients with severe chronic obstructive pulmonary disease (COPD) underwent examination for a possible reduction of lung volume. Those selected got ECVA. Patients whose collateral resistance (Rcoll) increased to Rcoll > 10 cm H₂O/(mL/s) within a measurement duration of up to 300 s, were submitted to unilateral lobar application of intrabronchial valves (IBV). Differences in residual volume (RV) as well as distances in 6 minute walk tests (6MWT) between the time after application of valves (TX) and that before (T1) were calculated (TX minus T1).

Results: Of a tested 310 emphysema patients, 17 met criteria allowing ECVA; 10 of 17 proved eligible for valve application. After 312 ± 170 days (TX – T1) the increase in walking distance was 44 ± 89.7 m; 7 of 10 patients achieved clinically relevant improvements (> 25 m). Differences in RV proved to correlate with differences in walking distances, but not yet with differences in measurement duration in ECVA.

Conclusions: Only a small portion of patients with progressive emphysema of the lung seem suitable for endoscopic reduction of lung volume by application of valves. Unilateral lobar application of IBV can result in durable, clinically relevant improvements of the patient’s physical capacity. ECVA measurements should take a minimum of 300 s.

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