LUNG-VOLUME REDUCTION SURGERY IN VENTILATOR-DEPENDENT COPD PATIENTS

Background: Lung volume reduction surgery has been advocated recently as adjunctive surgical therapy to improve lung and chest wall mechanic s in selected patients with diffuse emphysema, Although clear-cut guid elines to select candidates have not been fully established, patients decompensated with significant pulmonary artery hypertension and hyper capnic respiratory failure are currently not considered suitable subje cts. Accordingly, ventilator-dependent COPD patients are not considere d candidates for this procedure. However, because ventilator-dependent COPD patients have an exceptionally poor prognosis, we elected to off er them this promising, but unproved surgical intervention. Herein, we describe the outcome of these three patients. Patients: The 3 patient s had recurrent exacerbations of COPD precipitating respiratory failur e, and following aggressive medical therapy remained mechanically vent ilated for 11 to 16 weeks (1 patient had a brief period of successful weaning before returning to mechanical ventilation). Prior to surgery, the patients had severe hypercapnia and cor pulmonale. Compared with preoperative values, surgery resulted in improvements in PaO2/FIo(2), 304+/-80 (SD) vs 229+/-48 mm Hg, reductions in PaCO2, 44+/-3 vs 60+/-9 mm Hg, increases in FVC, 1.63+/-0.52 vs 1.09+/-0.05 L, and maximum in spiratory pressure, 57+/-22 vs 29+/-12 cm H2O. Postoperative complicat ions included persistent air leaks and one tension pneumothorax. Patie nts weaned from mechanical ventilation after 10 to 21 days all were di scharged home and they continue to demonstrate improved gas exchange a nd functional status. Conclusions: Lung volume reduction surgery in se lect, ventilator-dependent COPD patients can result in improved gas ex change and respiratory mechanics that enable successful weaning and ov erall improved functional status.