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  • 1.
    Moore, Alastair J
    et al.
    Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Cetti, Edward
    Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Haj-Yahia, Saleem
    Department of Thoracic Surgery, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Carby, Martin
    Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Björling, Gunilla
    Division of Anaesthesia and Intensive Care, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm.
    Karlsson, Sigbritt
    Fibre and Polymer Technology, School of Chemical Science and Engineering, Royal Institute of Technology, Stockholm.
    Shah, Pallav
    Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Goldstraw, Peter
    Department of Thoracic Surgery, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Moxham, John
    Department of Respiratory Medicine, Kings College Hospital, London, United Kingdom.
    Jordan, Simon
    Department of Thoracic Surgery, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Polkey, Michael I
    Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom.
    Unilateral extrapulmonary airway bypass in advanced emphysema2010In: Annals of Thoracic Surgery, ISSN 0003-4975, E-ISSN 1552-6259, Vol. 89, no 3, p. 899-906Article in journal (Refereed)
    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.

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