Journal article
Incomplete fissures are associated with increased alveolar ventilation via spiracles in severe emphysema
Interactive cardiovascular and thoracic surgery, Vol.25(6), pp.851-855
12/01/2017
DOI: 10.1093/icvts/ivx220
PMID: 29106562
Abstract
Abstract
OBJECTIVES
In emphysema, air can flow preferentially via collateral pathways, which can connect an entire lung when incomplete fissures are present. Spiracles are openings through the chest wall into the lung parenchyma. We previously observed increased alveolar ventilation (VA) in subjects with severe emphysema, when spiracles occurred during lung transplant operations. In this study, we set out to identify a computed tomography (CT) imaging phenotype associated with improved VA via spiracles in severe emphysema.
METHODS
We retrospectively reviewed 4 patients with severe emphysema who exhaled ≥75% of the inhaled tidal volume via transpleural spiracles during a lung transplant operation. We used quantitative image analysis via VIDA VISION CT software to describe emphysema severity and distribution and fissure integrity from pretransplant CT scans of the chest. We analysed partial pressure of carbon dioxide and calculated estimates of VA at baseline and during spiracle ventilation.
RESULTS
All 4 subjects demonstrated severe hyperinflation (total lung capacity 148 ± 24%predicted, residual volume 296 ± 79% predicted). On CT imaging, severe emphysema was present, with an average 38.7 ± 9% (range 28–50%) of lung parenchyma showing low-attenuation areas of − 950 Hounsfield units or less. Lung fissure integrity analysis demonstrated evidence of incomplete fissures (average detectable fissure integrity 67 ± 19%, range 40 ± 11–90 ± 10%). During spiracle ventilation on unchanged ventilator settings, there was a significant reduction in partial pressure of carbon dioxide (61 ± 4–35 ± 4 mmHg, P < 0.001) and increase in estimated VA (2.1 ± 0.5–3.8 ± 0.8 l/min, P < 0.001).
CONCLUSIONS
Incomplete lung fissures on quantitative CT analysis seem to be a key image phenotype associated with substantial improvements in VA during transpleural ventilation via spiracles in severe emphysema.
Details
- Title: Subtitle
- Incomplete fissures are associated with increased alveolar ventilation via spiracles in severe emphysema
- Creators
- Samih Khauli - aDepartment of Internal Medicine, University of Iowa, Iowa City, IA, USAEric Abston - aDepartment of Internal Medicine, University of Iowa, Iowa City, IA, USAHassan Sajjad - bDivision of Pulmonary, Critical Care and Occupational Medicine, University of Iowa, Iowa City, IA, USAServet Bolukbas - cDepartment of Thoracic Surgery, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, GermanyJulio Mott Ancona Lopez - dFaculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, BrazilRoberto Saad Jr - dFaculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, BrazilSurya P Bhatt - eDivision of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham, AL, USAMichael Eberlein - aDepartment of Internal Medicine, University of Iowa, Iowa City, IA, USA
- Resource Type
- Journal article
- Publication Details
- Interactive cardiovascular and thoracic surgery, Vol.25(6), pp.851-855
- Publisher
- Oxford University Press
- DOI
- 10.1093/icvts/ivx220
- PMID
- 29106562
- ISSN
- 1569-9293
- eISSN
- 1569-9285
- Language
- English
- Date published
- 12/01/2017
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984094522302771
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