The role of non-invasive positive pressure ventilation in lung volume reduction surgery - A survey in German hospitals

Background: since the first publication by Cooper et al. in 1994 of lung vo lume reduction surgery (LVRS) of emphysema a marked respiratory failure wit h hyperkapnia (PaCO2 > 55 Torr) has been regarded as an exclusion criterion for LVRS. Patients and Methods: In a survey in German hospitals the question was aske d whether non-invasive nasal ventilation (NIPPV) has a role in the manageme nt of LVRS. Of 12 hospitals 6 had experience with NIPPV and LVRS in a total of 19 patients with a mean FEV1 of 0.64 +/- 0.101. Results: LVRS improved FEV1 by 0.20 +/- 0.18 l. Preoperative NIPPV was shor t (< 6 months) in 8 patients and resulted in improvement of physical condit ion and getting the patient used to NIPPV for better perioperative manageme nt. In 5 cases NIPPV was used on a long-term basis in order to allow the pa tient to be included in the LVRS program. In fact 7 of these 13 patients ne eded ventilation perioperatively and 4 had to continue long-term NIPPV afte r surgery. In further 3 patients NIPPV was applied only perioperatively. On e patient had to resume NIPPV after 15 months. Two patients started NIPPV 1 resp. 12 months after surgery. Two patients had bronchial cancer which was resected. Four patients died; 1 perioperatively after intubation, 2 after 3 resp. 13 months due to respiratory failure, 1 for cancer relapse after 20 months. Conclusion: NIPPV may be helpful in the planning and management of LVRS in patients with ventilatory failure with hypercarbia.