Journal article
Supranormal Expiratory Airflow after Bilateral Lung Transplantation Is Associated with Improved Survival
American journal of respiratory and critical care medicine, Vol.183(1), pp.79-87
2011
DOI: 10.1164/rccm.201004-0593OC
PMID: 20693376
Abstract
Rationale: flow volume loops (FVL) in some bilateral lung transplant (BLT) and heart-lung transplant (HLT) patients suggest variable extrathoracic obstruction in the absence of identifiable causes. These FVLs usually have supranormal expiratory and normal inspiratory flow rates (SUPRA pattern).
Objectives: characterize the relationship of the SUPRA pattern to predicted donor and recipient lung volumes, airway size, and survival.
Methods: we performed a retrospective review of adult BLT/HLT patients. We defined the SUPRA FVL pattern as: (1) mid-vital capacity expiratory to inspiratory flow ratio (Ve50:Vi50) > 1.0, (2) absence of identifiable causes of extrathoracic obstruction, and (3) Ve50/FVC ≥ 1.5 s(-1). We calculated predicted total lung capacity (pTLC) ratio by dividing the donor pTLC by the recipient pTLC. We measured airway luminal areas on thoracic computer tomographic scans. We compared survival in patients with and without the SUPRA pattern.
Measurements and main results: the SUPRA FVL pattern occurred in 56% of the 89 patients who qualified for the analysis. The pTLC ratio of SUPRA and non-SUPRA patients was 1.11 and 0.99, respectively (P = 0.004). A higher pTLC ratio was correlated with increased probability of the SUPRA pattern (P = 0.0072). Airway luminal areas were larger in SUPRA patients (P = 0.009). Survival was better in the SUPRA cohort (P = 0.009).
Conclusions: the SUPRA FVL pattern was frequent in BLT/HLT patients. High expiratory flows in SUPRA patients could result from increased lung elastic recoil or reduced airway resistance, both of which could be caused by the pTLC mismatch. Improved survival in the SUPRA cohort suggests potential therapeutic approaches to improve outcomes in BLT/HLT patients.
Details
- Title: Subtitle
- Supranormal Expiratory Airflow after Bilateral Lung Transplantation Is Associated with Improved Survival
- Creators
- Michael EBERLEIN - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United StatesSolbert PERMUTT - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United StatesRobert H BROWN - Division of Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United StatesAllison BROOKER - Division of Physiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United StatesMayy F CHAHLA - Division of Hospital Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United StatesServet BOLUKBAS - Department of Thoracic Surgery, Dr.-Horst-Schmidt-Klinik, Wiesbaden, GermanySteven D NATHAN - Advanced Lung Disease Program, Inova Fairfax Hospital, Falls Church, Virginia, United StatesDavid B PEARSE - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United StatesJonathan B ORENS - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United StatesRoy G BROWER - Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Resource Type
- Journal article
- Publication Details
- American journal of respiratory and critical care medicine, Vol.183(1), pp.79-87
- Publisher
- American Thoracic Society
- DOI
- 10.1164/rccm.201004-0593OC
- PMID
- 20693376
- ISSN
- 1073-449X
- eISSN
- 1535-4970
- Language
- English
- Date published
- 2011
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984094574102771
Metrics
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