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1 From the Pulmonary Division, Department of Medicine, Lakewood (Calif) Regional Medical Center; and the University of California Los Angeles (UCLA), School of Medicine
2 From Division of Thoracic Surgery, University of Southern California, School of Medicine, Los Angeles; and Department of Thoracic Surgery, Chapman Medical Center, Orange, Calif.
3 From the University of California, Irvine, School of Medicine
4 From the University of California Los Angeles (UCLA), School of Medicine; and the Department of Thoracic Surgery, Chapman Medical Center, Orange, Calif.
5 From the Division of Pulmonary and Critical Care Medicine
6 From the University of Toronto, School of Medicine
Objective: To determine the contributions of (1) chest wall (Pcw) and (2) lung elastic recoil pressure (PL) to (3) total elastic recoil pressure exerted by the respiratory system (Prs) in 18 patients (12 men) aged 66±6 years (mean±1 SD) with severe emphysema who underwent video-assisted thoracoscopic bilateral lung volume reduction surgery under paralyzed (vecuronium) general anesthesia (isoflurane).
Design: We measured preoperative and 6-week postoperative lung function studies, and intraoperative inspiratory lung conductance (GL), PL, Pcw, and Prs (cm H2O) at end-expiratory lung volume (EELV), EELV plus 0.60±0.0 L, and EELV plus 1.15±0.0 L. All values are mean±SEM.
Results: Preoperative vs postoperative FVC was 1.9±0.1 L vs 2.3±0.1 L (p=0.03); FEV1 was 0.6±0.1 L vs 0.9±0.1 L (p<0.02); total lung capacity was 7.4±0.4 L vs 5.9±0.3 L (p<0.001); functional residual capacity was 5.7±0.4 L vs 4.4±0.2 L (p=0.001). At EELV preoperative vs postoperative, PL was 0.0±0.3 vs 1.1±0.05 (p=0.04), Pcw was 5.0±0.7 vs 2.4±0.9 (p=0.02), and Prs was 5.0±0.8 vs 3.5±0.7 (p=0.08). At EELV plus 0.60 L, PL was 3.2±+0.6 vs 6.1±0.9 (p<0.001), Pcw was 8.8±0.8 vs 7.0±0.9 (p=0.12), and Prs was 12.0±0.8 vs 13.1±0.7 (p=0.80). At EELV plus 1.15 L, PL was 6.8±0.9 vs 10.3±1.1 (p<0.001), Pcw was 13.5±1.0 vs 11.2±1.2 (p=0.12), and Prs was 20±1.2 vs 21.5±1.0 p=0.93). At EELV plus 0.60 L, GL was 0.09±0.00 L/S/cm H2O vs 0.16±0.01 (p<0.01). At EELV plus 1.15 L, GL was 0.12±0.01 vs 0.21±0.03 (p<0.05) with similar preoperative vs postoperative GL/PL slopes.
Conclusion: The increase in PL and decrease in Pcw following LVRS for emphysema may be responsible for the increase in spirometry and airway conductance.
Key Words: emphysema surgery • lung elastic recoil • lung function • lung volume reduction surgery
Submitted on March 1, 1996
Accepted on April 30, 2007
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