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1 From the Pulmonary Division, Department of Medicine, Lakewood (California) Regional Medical Center, University of California Los Angeles; and the School of Medicine, University of California, Irvine
2 From the School of Medicine, University of Toronto, Chapman Medical Center, Orange, Calif, and University of California, Los Angeles
3 From the School of Medicine
4 From the School of Medicine, and Department of Thoracic Surgery, Chapman Medical Center, Orange, Calif, and University of California, Los Angeles
5 From the Pulmonary Division, Department of Medicine, Lakewood (California) Regional Medical Center, University of California Los Angeles
Objective: To investigate the mechanism of airflow limitation before and 6 and 12 months after targeted emphysematous resection in 10 male patients aged 67±8 years (mean±SD) with very severe COPD undergoing bilateral thoracoscopic stapling techniques.
Design: Lung function, including static lung elastic recoil, was measured 2 weeks before and 6 and 12 months after surgery.
Results: Twelve months after surgery, there was a significant (p<0.001) reduction in total lung capacity (TLC), 9.5±0.3 L (mean±SEM) to 8.5±0.3 L, functional residual capacity, and residual volume. Airway conductance and FEV1, 0.71±0.1 L (mean±SEM) to 0.95±0.1 L, improved significantly (p<0.01). Lung elastic recoil increased markedly at TLC from 11.7±0.7 cm H2O (mean±SEM) to 15.0±1.0 cm H2O (p<0.01) as did maximum expiratory airflow in every patient. However, when compared with data obtained in each patient at 6 months, lung volumes are significantly increased, and expiratory airflow and lung elastic recoil pressures are significantly reduced (p
0.05). Analysis of maximum expiratory flow-static elastic recoil pressure curve indicates conductance of the S airway segment (Gs) increased from 0.20±0.03 L/s/cm H2O (mean±SEM) to 0.28±0.04 L/s/cm H2O (p<0.02), and critical transmural pressure in the collapsible segment (Ptm') decreased from 3.2±0.2 cm H2O (mean±SEM) to 2.5±0.2 cm H2O (p<0.01).
Conclusion: The improvement in maximal expiratory airflow can be attributed primarily to increased lung elastic recoil and its secondary effect on enlarging airway diameter causing increased airway conductance, increased Gs, and decreased Ptm'. The improvement in lung function and elastic recoil peaks at 6 months.
Key Words: emphysema surgery • lung elastic recoil • lung volume reduction surgery • pulmonary function
Submitted on August 9, 1996
Accepted on September 10, 2007
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