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2016 ; 2016
(ä): 6462352
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Update on Nonsurgical Lung Volume Reduction Procedures
#MMPMID27445557
Neder JA
; O'Donnell DE
Can Respir J
2016[]; 2016
(ä): 6462352
PMID27445557
show ga
There has been a surge of interest in endoscopic lung volume reduction (ELVR)
strategies for advanced COPD. Valve implants, coil implants, biological LVR
(BioLVR), bronchial thermal vapour ablation, and airway stents are used to induce
lung deflation with the ultimate goal of improving respiratory mechanics and
chronic dyspnea. Patients presenting with severe air trapping (e.g., inspiratory
capacity/total lung capacity (TLC) < 25%, residual volume > 225% predicted) and
thoracic hyperinflation (TLC > 150% predicted) have the greatest potential to
derive benefit from ELVR procedures. Pre-LVRS or ELVR assessment should ideally
include cardiological evaluation, high resolution CT scan, ventilation and
perfusion scintigraphy, full pulmonary function tests, and cardiopulmonary
exercise testing. ELVR procedures are currently available in selected Canadian
research centers as part of ethically approved clinical trials. If a decision is
made to offer an ELVR procedure, one-way valves are the first option in the
presence of complete lobar exclusion and no significant collateral ventilation.
When the fissure is not complete, when collateral ventilation is evident in
heterogeneous emphysema or when emphysema is homogeneous, coil implants or BioLVR
(in that order) are the next logical alternatives.