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Unilateral extrapulmonary airway bypass in advanced emphysema
Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
Department of Thoracic Surgery, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
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2010 (Engelska)Ingår i: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 89, nr 3, s. 899-906Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

BACKGROUND: Gas trapping in emphysema results in resting and dynamic hyperinflation. We tested the hypothesis that a direct connection between the lung parenchyma and the atmosphere could increase expiratory flow and thereby potentially improve dyspnea through the relief of gas trapping.

METHODS: Ex vivo we studied 7 emphysematous lungs and 3 fibrotic lungs (as controls) and measured expiratory flow before and after airway bypass insertion during a forced maneuver in an artificial thorax. Pilot studies were conducted in vivo in 6 patients with advanced emphysema using a size 9 endotracheal tube as a bypass surgically placed through the chest wall into the upper lobe.

RESULTS: In the ex vivo emphysematous lungs the volume expelled during a forced expiratory maneuver increased from 169 to 235 mL (p < 0.05). In the in vivo group 4 patients retained the bypass tube for 3 months or more; total lung capacity was reduced, and the forced expiratory volume in 1 second increased by 23% (mean percent predicted at baseline versus 3 months, 24.4% versus 29.5%).

CONCLUSIONS: An extrapulmonary airway bypass increases expiratory flow in emphysema. This may be a useful approach in hyperinflated patients with homogeneous emphysema.

Ort, förlag, år, upplaga, sidor
Elsevier, 2010. Vol. 89, nr 3, s. 899-906
Nyckelord [en]
emphysema
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Identifikatorer
URN: urn:nbn:se:rkh:diva-488DOI: 10.1016/j.athoracsur.2009.10.067OAI: oai:DiVA.org:rkh-488DiVA, id: diva2:606335
Tillgänglig från: 2013-02-19 Skapad: 2013-02-18 Senast uppdaterad: 2019-08-30Bibliografiskt granskad

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