Chest ACCP Member Benefits
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Celli, B. R.
Right arrow Articles by Stetz, J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Celli, B. R.
Right arrow Articles by Stetz, J.
(Chest. 1997;112:902-906.)
© 1997 American College of Chest Physicians

Lung Reduction Surgery in Severe COPD Decreases Central Drive and Ventilatory Response to CO2

Bartolome R. Celli MD, FCCP1; Maria Montes de Oca MD1; Reina Mendez MD1; and Joseph Stetz MD, FCCP1

1 From the Division of Pulmonary/Critical Care and Cardiovascular Surgery, St. Elizabeth's Medical Center, Tufts University, Boston

Background and objectives: Lung volume reduction surgery (LVRS) improves ventilatory function in selected patients with severe COPD. The reasons for the observed benefits include the following: increased elastic recoil, improved airflow, and lesser dynamic hyperinflation and decreased lung volumes. We reasoned that these changes could also alter respiratory drive.

Methods: Respiratory central drive was prospectively assessed using the mouth occlusion pressure (P0.1), and the P0.1 response to increasing CO2 (P0.1/PETCO2 [end-tidal CO2 pressure]), in eight sequential patients before and 3 to 5 months after LVRS. Results were compared with those from 13 control subjects.

Results: LVRS decreased total lung capacity from 7.44±1.8 L to 5.92±1.3 L (p<0.05) and residual volume from 4.97±1.5 L to 3.56±1.1 L (p<0.05). It also significantly improved FEV1 from 0.85±0.26 L to 0.99±0.26 L (p<0.05). Baseline P0.1 (3.4±1.8 vs 1.4±0.4 cm H2O, p<0.01) and P0.1/PETCO2 (0.24±0.07 vs 0.11±0.04 cm H2O/mm Hg, p<0.05) were higher in patients than in control subjects. After LVRS, P0.1 decreased from 3.4±1.8 to 1.3±0.75 cm H2O (p<0.01) and P0.1/PETCO2 from 0.24±0.07 to 0.16±0.06 cm H2O/mm Hg (p<0.05). These postoperative values were similar to those of control subjects. There were no correlations between changes in the factors known to influence central drive (PaO2, PaCO2, age, weight, height, FVC, and FEV1) and changes in P0.1.

Conclusions: We conclude that decreased ventilatory drive should be added to the list of benefits of LVRS, and may help explain the symptomatic improvement reported by many patients after this surgery.

Key Words: central drive • COPD • emphysema • lung volume reduction surgery

Submitted on December 27, 1996
Accepted on June 11, 1997




This article has been cited by other articles:


Home page
 ChestHome page
B. R. Celli
Update on the Management of COPD
Chest, June 1, 2008; 133(6): 1451 - 1462.
[Abstract] [Full Text] [PDF]

Home page
 Proc Am Thorac SocHome page
B. R. Celli
Chronic Obstructive Pulmonary Disease: From Unjustified Nihilism to Evidence-based Optimism.
Proceedings of the ATS, January 1, 2006; 3(1): 58 - 65.
[Abstract] [Full Text] [PDF]

Home page
 JAMAHome page
B. R. Celli
A 62-Year-Old Woman With Chronic Obstructive Pulmonary Disease
JAMA, November 26, 2003; 290(20): 2721 - 2729.
[Full Text] [PDF]

Home page
 ChestHome page
S. Homan, S. Porter, M. Peacock, N. Saccoia, A. M. Southcott, and R. Ruffin
Increased Effective Lung Volume Following Lung Volume Reduction Surgery in Emphysema
Chest, October 1, 2001; 120(4): 1157 - 1162.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
E. P. INGENITO, S. H. LORING, M. L. MOY, S. J. MENTZER, S. J. SWANSON, and J. J. REILLY
Interpreting Improvement in Expiratory Flows after Lung Volume Reduction Surgery in Terms of Flow Limitation Theory
Am. J. Respir. Crit. Care Med., April 1, 2001; 163(5): 1074 - 1080.
[Abstract] [Full Text]

Home page
 ChestHome page
R. M. Rogers, H. O. Coxson, F. C. Sciurba, R. J. Keenan, K. P. Whittall, and J. C. Hogg
Preoperative Severity of Emphysema Predictive of Improvement After Lung Volume Reduction Surgery : Use of CT Morphometry
Chest, November 1, 2000; 118(5): 1240 - 1247.
[Abstract] [Full Text] [PDF]

Home page
 ChestHome page
H. Lahrmann, M. Wild, T. Wanke, E. Tschernko, W. Wisser, W. Klepetko, and H. Zwick
Neural Drive to the Diaphragm After Lung Volume Reduction Surgery*
Chest, December 1, 1999; 116(6): 1593 - 1600.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
D. SHADE Jr., F. CORDOVA, Y. LANDO, J. M. TRAVALINE, S. FURUKAWA, A. M. KUZMA, and G. J. CRINER
Relationship between Resting Hypercapnia and Physiologic Parameters before and after Lung Volume Reduction Surgery in Severe Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., May 1, 1999; 159(5): 1405 - 1411.
[Abstract] [Full Text] [PDF]

Home page
 Am. J. Respir. Crit. Care Med.Home page
Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease . A Statement of the American Thoracic Society and European Respiratory Society
Am. J. Respir. Crit. Care Med., April 1, 1999; 159(4): S2 - 40.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1997 by the American College of Chest Physicians.