Reducing lung volume in emphysema Surgical Aspects
|
|
|
- Rodger Smith
- 5 years ago
- Views:
Transcription
1 Reducing lung volume in emphysema Surgical Aspects Simon Jordan Consultant Thoracic Surgeon Royal Brompton Hospital Thirteenth Cambridge Chest Meeting April 2015
2 Surgical aspects of LVR Why we should NOT perform LVRS Physiology behind LVRS Role of the MDT Spiracle trial Patient selection for LVRS Surgical approach Outcome
3 Why we should NOT perform LVRS From a surgical perspective.. High risk population? High risk procedure Surgeon specific mortality reporting Increase in Thoracic surgeons Complications -
4 Why we should NOT perform LVRS
5 Physiology behind LVRS Alveolar destruction Loss of elastic recoil Gas trapping Dynamic hyperinflation Chest wall and diaphragm function
6 Physiology behind LVRS Brantigan 1957 Joel Cooper 1990s Geddes and Goldstraw NEJM 2000 NETT
7 Role of the MDT Better patient selection Increase in patients being treated Peri-operrative management Consideration for all available treatments - The outcomes of a successful LVRS programme are not only dependent on good surgical technique and post-operative care. Case selection and work-up by a dedicated multidisciplinary approach for emphysema patients plays an invaluable and integral part in an LVRS programme Rathinatham S. Eur J Cardiothoracic Surg 2014
8 Role of the MDT Better patient selection Increase in patients being treated Peri-operrative management Consideration for all available treatments The outcomes of a successful LVRS programme are not only dependent on good surgical technique and post-operative care. Case selection and work-up by a dedicated multidisciplinary approach for emphysema patients plays an invaluable and integral part in an LVRS programme LVRS Bullectomy Intracavity drainage EBV Coils Steam Blood Transplantation Rehabilitation etc Rathinatham S. Eur J Cardiothoracic Surg 2014
9 Spiracle trial Homogenous Emphysema Extra-pulmonary bypass
10 Effect Of A Single Extra-Pulmonary Pathway After Inflation After Deflation
11 Effect Of A Single Extra-Pulmonary Pathway After Inflation After Deflation 26 Fr Urinary catheter
12 Average Flow (litres/minute) Effect Of A Single Extra-Pulmonary Pathway No Effect In Pulmonary Fibrosis Time (seconds) Moore A. Annals of Thoracic Surgery. 2010
13 Average Flow (litres/min) Effect Of A Single Extra-Pulmonary Pathway Increased Air Flow in Emphysema Time (seconds) Moore A. Annals of Thoracic Surgery. 2010
14 Open Label Pilot of Extrapulmonary Bypass Entry Criteria Homogenous emphysema FEV % predicted Hyperinflation RV:TLC ratio >0.6 1 Exclusion criteria >2 exacerbations requiring admission /year Other significant disease Pulmonary hypertension (PAP>35 mmhg if measured) TLCO<20% predicted and FEV 1 <20% predicted SWT <150m PaO2<8kPa or use of NIV BMI<20 kg/m 2 This point is the cohort with the greatest mortality in our cohort: approximately 30% at 4 years with no treatment.
15 Spiracle Trial Homogenous emphysema Completed PR Maximal medical therapy N=5 2 Baseline visits 1 month apart Routine PFT, 6MW VO2 max Collateral ventilation Insertion Size 9 armoured ET tube FU 1 & 3 Mo (primary end point)
16 Spiracle Trial Mini Axillary Thoracotomy Short segment rib resection ET tube inserted into Upper Lobe Talc Pleurodesis Single Drain
17 Spiracle Trial
18 Spiracle Trial
19 Spiracle Trial
20 Spiracle Trial
21
22
23 Spiracle Trial
24 FEV 1
25 RV / TLC Ratio
26 ISW Distance
27 Spiracle Trial
28 Spiracle trial Extra-Pulmonary Bypass is possible (one patient still had air leak after 18 months) TLC and RV/TLC can be reduced FEV1 can be increased (by 23% in 4 patients) Very Small number of cases performed worldwide
29 Spiracle trial Homogenous Emphysema Transplant Heterogeneous Emphysema LVRS Bullectomy Intra-cavity drainage Endobronchial LVRS
30 Patient selection for LVRS Bullectomy Breathless / Single large bulla on CT / FEV1 < 50% LVRS Severe COPD with marked restriction of ADL despite max med therapy Pulm rehab FEV1 > 20% TLCO > 20% PaCO2 < 7.3 Upper lobe predominant emphysema NICE guidelines [CG101]. 2010
31 Patient selection for LVRS 1.1 million patients with COPD in UK (Quality Outcomes Framework data, If 10% have severe or very severe disease If only 15% of these meet LVRS criteria (US database study) 16,000 potentially eligible individuals SCTS UK data 96 LVRS cases in 2009/10 90 LVRS cases in 2010/11 >1/3 of these cases were performed by thoracotomy
32 Patient selection for LVRS Clinical review PFT ABG (FEV1 / TLCO / RV-TLC ratio) Pattern of disease on CT (Heterogenous /?just COPD) VQ scan with lobar quantification Consideration of all treatment modalities / trials Clinical review and consent
33 Patient selection for LVRS
34 Patient selection for LVRS
35 Surgical approach Unilateral vs Bilateral NETT studied Bilateral LVRS? Reduced benefit with Unilateral Reduced morbidity / more rapid recovery with Unilateral LVRS Longer lasting benefit with staged Bilateral LVRS Mckenna R. J Thorac Cardiovasc Surg Oey I. Eur J Cardiothorac Surg. 2010
36 Surgical approach Lobar resection Unilateral Lobe Resection by Video-Assisted Thoracoscopy Leads to the Most Optimal Functional Improvement in Severe Emphysema 0% mortality Similar effect on PFT Similar recovery Improved Exercise Capacity Di Chiara F. SCTS Manchester 2015 Beckers F. Thorac Cardiovasc Surg. 2014
37 Surgical approach Lobar resection 19 / 99 patients Similar pt charcteristics Prolonged air leak (>7 days) reduced from 50% (40 cases) to 21% (4 cases) (P<0.05) Complications reduced (P<0.05) Length of stay similar Di Chiara F. SCTS Manchester 2015
38 Outcomes - NETT 3777 pts assessed at 17 centres 1218 randomised 29 month follow up Mortality in 2 groups same overall Survival benefit in het, upper lobe with poor Ex capacity - 15% at 5 years High risk group: FEV1 <20% and Homogenous or TLCO <20% LVRS improves Spirometry / RV / TLCO / O2 & CO2 / QoL / Ex capacity NETT research group
39 Peri-operative Survival NETT 5.5 % at 90 days Better pt. selection and peri-operative care Unilateral approach? Exclusion of high risk cases Many authors reporting mortality rates1-2% Our own series of 115 unilateral procedures 0% mortality at 90 days Median Length of stay 12 days Clark S. Clin Med. 2014
40 Future BTS Survey in responses (82% resp physicians) ½ were unsure or overestimated mortality 30% did not have access to COPD MDT McNulty W. BMJ Open Respir Res. 2014
41 Alison Jan 2014 Jan 2015 FEV (37%) FVC TLCO (42%) RV/TLC 71% 65%
42 Frank
43 FRANK NSCLC / Chest Wall Invasion FEV1 23% TLCO 25% Right Upper Lobectomy & Chest wall resection (ribs 1-2) Post-op FEV1 32% TLCO 35%
44 Future
45 Surgery for N2 Disease Peri-operative mortality has fallen from 3.8 to 2.1 % over the past decade Number of resections are increasing year on year 60 % increase in 4 years to 5265 resections
Lung Volume Reduction Surgery. February 2013
Lung Volume Reduction Surgery February 2013 Presentation Outline Lung Volume Reduction Surgery (LVRS) Rationale & Historical Perspective NETT Results Current LVRS Process (from referral to surgery) Diagnostic
Interventional procedures guidance Published: 20 December 2017 nice.org.uk/guidance/ipg600
Endobronchial valve insertion to reduce lung volume in emphysema Interventional procedures guidance Published: 20 December 2017 nice.org.uk/guidance/ipg600 Your responsibility This guidance represents
UWE has obtained warranties from all depositors as to their title in the material deposited and as to their right to deposit such material.
Clark, S. J., Zoumot, Z., Bamsey, O., Polkey, M. I., Dusmet, M., Lim, E., Jordan, S. and Hopkinson, N. S. (2014) Surgical approaches for lung volume reduction in emphysema. Clinical medicine (London, England),
SURGERY FOR GIANT BULLOUS EMPHYSEMA
SURGERY FOR GIANT BULLOUS EMPHYSEMA Dr. Carmine Simone Head, Division of Critical Care & Thoracic Surgeon Department of Surgery December 15, 2006 OVERVIEW Introduction Classification Patient selection
Referring for specialist respiratory input. Dr Melissa Heightman Consultant respiratory physician, UCLH,WH, CNWL
Referring for specialist respiratory input Dr Melissa Heightman Consultant respiratory physician, UCLH,WH, CNWL Respiratory Specialist- who? GPSI Community Team Secondary Care Respiratory physician and
Emphysema. Endoscopic lung volume reduction. PhD. Chief, department of chest diseases and thoracic oncology. JM VERGNON M.D, PhD.
Emphysema Endoscopic lung volume reduction JM VERGNON M.D, PhD. PhD. Chief, department of chest diseases and thoracic oncology Genève 2010 INSERM IFR 143 Physiological concepts EMPHYSEMA Slide of Ch H
Surgery has been proven to be beneficial for selected patients
Thoracoscopic Lung Volume Reduction Surgery Robert J. McKenna, Jr, MD Surgery has been proven to be beneficial for selected patients with severe emphysema. Compared with medical management, lung volume
Endobronchial valve insertion to reduce lung volume in emphysema
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Interventional procedure consultation document Endobronchial valve insertion to reduce lung volume in emphysema Emphysema is a chronic lung disease that
Attitudes and access to lung volume reduction surgery for COPD: a survey by the British Thoracic Society
Chronic obstructive pulmonary disease Attitudes and access to lung volume reduction surgery for COPD: a survey by the British Thoracic Society William McNulty, Simon Jordan, Nicholas S Hopkinson on behalf
The role of the multidisciplinary emphysema team meeting in the provision of lung volume reduction
Review Article The role of the multidisciplinary emphysema team meeting in the provision of lung volume reduction Inger Oey 1, David Waller 2 1 Department of Thoracic Surgery, Glenfield Hospital, Leicester,
LVRS and Endobronchial Therapy for Emphysema: Is it Still Viable?
LVRS and Endobronchial Therapy for Emphysema: Is it Still Viable? Malcolm M. DeCamp, MD Fowler McCormick Professor of Surgery Feinberg School of Medicine Chief, Division of Thoracic Surgery Disclosures
Preoperative assessment for lung resection. RA Dyer
Preoperative assessment for lung resection RA Dyer 2016 The ideal assessment of operative risk would identify every patient who could safely tolerate surgery. This ideal is probably unattainable... Mittman,
LUNG VOLUME REDUCTION SURGERY IN PATIENTS WITH COPD
LUNG VOLUME REDUCTION SURGERY IN PATIENTS WITH COPD Walter WEDER, Ilhan INCI, Michaela TUTIC Division of Thoracic Surgery University Hospital, Zurich, Switzerland e-mail: walter.weder@usz.ch INTRODUCTION
LVRS And Bullectomy. Dr. AKASHDEEP SINGH DEPARTMENT OF PULMONARY AND CRITICAL CARE MEDICINE PGIMER CHANDIGARH
LVRS And Bullectomy Dr. AKASHDEEP SINGH DEPARTMENT OF PULMONARY AND CRITICAL CARE MEDICINE PGIMER CHANDIGARH Outline History of Lung Surgery Lung-Volume-Reduction Surgery Overview of LVRS History Clinical
Five Consecutive Cases of Non-Pharmacologic Therapy for COPD
Five Consecutive Cases of Non-Pharmacologic Therapy for COPD Michael Jantz, MD Director of Interventional Pulmonology University of Florida Michael.Jantz@medicine.ufl.edu Emphysema: Background Loss of
Clinical pulmonary physiology. How to report lung function tests
Clinical pulmonary physiology or How to report lung function tests Lung function testing A brief history Why measure? What can you measure? Interpretation/ reporting Examples and case histories Exercise
Protocol. Lung Volume Reduction Surgery for Severe Emphysema
Protocol Lung Volume Reduction Surgery for Severe Emphysema (70171) Medical Benefit Effective Date: 01/01/12 Next Review Date: 09/14 Preauthorization Yes Review Dates: 02/07, 01/08, 11/08, 09/09, 09/10,
Description. Section: Medicine Effective Date: October 15, 2014 Subsection: Medicine Original Policy Date: December 7, 2011 Subject:
Page: 1 of 9 Last Review Status/Date: September 2014 Description Lung volume reduction surgery (LVRS) is proposed as a treatment option for patients with severe emphysema who have failed optimal medical
Lung volume reduction surgery in selected patients with severe emphysema: significant benefit with low peri-operative risk
Mini-Review Page 1 of 6 Lung volume reduction surgery in selected patients with severe emphysema: significant benefit with low peri-operative risk Claudio Caviezel Department of Thoracic Surgery, University
Chronic obstructive pulmonary disease in over 16s: diagnosis and management
National Institute for Health and Care Excellence Draft for consultation Chronic obstructive pulmonary disease in over 16s: diagnosis and management [G] Referral criteria for lung volume reduction procedures,
Assessing perioperative risk
Assessing perioperative risk Chronic Obstructive Pulmonary Disease Dr. Michelle Caldecott Respiratory & Sleep Physician Epworth Healthcare Austin Health Impact of COPD on Postoperative Outcomes: Results
The role of a multidisciplinary severe chronic obstructive pulmonary disease hyperinflation service in patient selection for lung volume reduction
Review Article The role of a multidisciplinary severe chronic obstructive pulmonary disease hyperinflation service in patient selection for lung volume reduction Joyce Chew, Ravi Mahadeva Cambridge COPD
A perspective on lung volume reduction surgery for pulmonary emphysema
Perspective Page 1 of 9 A perspective on lung volume reduction surgery for pulmonary emphysema Mariano Di Martino, Prity Gupta, David A. Waller Barts Thorax Centre, Barts Health NHS Trust, London, UK Correspondence
Pathophysiology of COPD 건국대학교의학전문대학원
Pathophysiology of COPD 건국대학교의학전문대학원 내과학교실 유광하 Rate per 100 0,000 population 550 500 450 400 350 300 250 200 150 100 50 0 Heart disease Cancer Stroke 1970 1974 1978 1982 1986 1990 1994 1998 2002 Year of
Supplementary Online Content
Supplementary Online Content Deslée G, Mal H, Dutau H, et al; REVOLENS Study Group. Lung volume reduction coil treatment vs usual care in patients with severe emphysema: the REVOLENS randomized clinical
POLICIES AND PROCEDURE MANUAL
POLICIES AND PROCEDURE MANUAL Policy: MP060 Section: Medical Benefit Policy Subject: Lung Volume Reduction Surgery I. Policy: Lung Volume Reduction Surgery II. Purpose/Objective: To provide a policy of
VANISHING LUNG SYNDROME AND LUNG VOLUME REDUC- TION SURGERY - A CASE REPORT
Cheng-Hsiung Chen et al. VANISHING LUNG SYNDROME AND LUNG VOLUME REDUC- TION SURGERY - A CASE REPORT Cheng-Hsiung Chen 1, Chin-Shui Yeh 1, Cheng-Huag Tsai 1, Bin-Chuan Ji 1, Fu-Yuan Siao 2, Jing-Lan Liu
Facing Surgery for Lung Cancer? Learn about minimally invasive da Vinci Surgery
Facing Surgery for Lung Cancer? Learn about minimally invasive da Vinci Surgery Treatments & Surgery Options: The treatment and surgical options for the most common lung cancer, non-small cell lung cancer,
History of Surgery for Lung Cancer
Welcome to Master Class for Oncologists Session 1: 7:30 AM - 8:15 AM San Francisco, CA October 23, 2009 Innovations in The Surgical Treatment of Lung Cancer Speaker: Scott J. Swanson, MD 2 Presenter Disclosure
Complex Thoracoscopic Resections for Locally Advanced Lung Cancer
Complex Thoracoscopic Resections for Locally Advanced Lung Cancer Duke Thoracoscopic Lobectomy Workshop March 21, 2018 Thomas A. D Amico MD Gary Hock Professor of Surgery Section Chief, Thoracic Surgery,
Cost-Effectiveness of Lung Volume Reduction Surgery
Cost-Effectiveness of Lung Volume Reduction Surgery The Health Industry Forum October 24, 2007 - Washington DC The National Emphysema Treatment Trial National Emphysema Treatment Trial (NETT) Multicenter,
Treatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard
Treatment of Clinical Stage I Lung Cancer: Thoracoscopic Lobectomy is the Standard AATS General Thoracic Surgery Symposium May 5, 2010 Thomas A. D Amico MD Professor of Surgery, Duke University Medical
Bullectomy is comparable to lung volume reduction in patients with end-stage emphysema
European Journal of Cardio-thoracic Surgery 22 (2002) 357 362 www.elsevier.com/locate/ejcts Bullectomy is comparable to lung volume reduction in patients with end-stage emphysema Abstract Tiziano De Giacomo*,
Thoracoscopic Lobectomy for Locally Advanced Lung Cancer. Masters of Minimally Invasive Thoracic Surgery Orlando September 19, 2014
for Locally Advanced Lung Cancer Masters of Minimally Invasive Thoracic Surgery Orlando September 19, 2014 Thomas A. D Amico MD Gary Hock Endowed Professor and Vice Chair of Surgery Chief Thoracic Surgery
Lung Volume Reduction Surgery for Severe Emphysema. Original Policy Date
MP 7.01.55 Lung Volume Reduction Surgery for Severe Emphysema Medical Policy Section Surgery Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature search/12:2013 Return
The History and Future Treatment of Emphysema Emphysema Valves, Emphysema Coils and Volume Reduction Surgery
The History and Future Treatment of Emphysema Emphysema Valves, Emphysema Coils and Volume Reduction Surgery Dr Nabil Jarad PhD FRCP Consultant Respiratory Physician Bristol Royal Infirmary Bristol BS2
The role of lung function testing in the assessment of and treatment of: AIRWAYS DISEASE
The role of lung function testing in the assessment of and treatment of: AIRWAYS DISEASE RHYS JEFFERIES ARTP education Learning Objectives Examine the clinical features of airways disease to distinguish
Journal of the COPD Foundation. Journal Club - Endobronchial Valve Bronchoscopic Lung Volume Reduction Ron Balkissoon, MD, MSc, DIH, FRCPC 1
118 Journal Club: Endobronchial Valve Lung Volume Reduction Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation Journal Club Journal Club - Endobronchial Valve Bronchoscopic Lung Volume
Service Evaluation: Bronchoscopic lung volume reduction using endobronchial valves for the symptomatic improvement of emphysema
Service Evaluation: Bronchoscopic lung volume reduction using endobronchial valves for the symptomatic improvement of emphysema Saveria Di Gerlando, University of Bristol INTRODUCTION Chronic Obstructive
Introduction to Interventional Pulmonology
Introduction to Interventional Pulmonology Alexander Chen, M.D. Director, Interventional Pulmonology Assistant Professor of Medicine and Surgery Divisions of Pulmonary and Critical Care Medicine and Cardiothoracic
Corporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: lung_volume_reduction_surgery 4/1996 3/2018 3/2019 3/2018 Description of Procedure or Service Emphysema is
OPTIMIZING MANAGEMENT OF COPD IN THE PRACTICE SETTING 10/16/2018 DISCLOSURES I have no financial or other disclosures
OPTIMIZING MANAGEMENT OF COPD IN THE PRACTICE SETTING J. Michael Fuller, MD, MEd, FACP, FCCP Associate Professor of Medicine University of South Carolina Greenville DISCLOSURES I have no financial or other
T3 NSCLC: Chest Wall, Diaphragm, Mediastinum
for T3 NSCLC: Chest Wall, Diaphragm, Mediastinum AATS Postgraduate Course April 29, 2012 Thomas A. D Amico MD Professor of Surgery, Chief of Thoracic Surgery Duke University Health System Disclosure No
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of insertion of endobronchial valves (with or without assessment for collateral
Chronic obstructive pulmonary disease. Lung volume reduction for severe emphysema: do we need a scalpel or a scope?
Eur Respir Rev 2010; 19: 117, 242 247 DOI: 1183/09059180005810 CopyrightßERS 2010 REVIEW: ENDOSCOPY Lung volume reduction for severe emphysema: do we need a scalpel or a scope? D. Van Raemdonck* and V.
Patient selection for lung volume reduction surgery. Patient Selection for Lung Volume Reduction Surgery*
Patient Selection for Lung Volume Reduction Surgery* An Objective Model Based on Prior Clinical Decisions and Quantitative CT Analysis David S. Gierada, MD; Roger D. Yusen, MD; Ian A. Villanueva, BS; Thomas
RESPIRATORY PHYSIOLOGY Pre-Lab Guide
RESPIRATORY PHYSIOLOGY Pre-Lab Guide NOTE: A very useful Study Guide! This Pre-lab guide takes you through the important concepts that where discussed in the lab videos. There will be some conceptual questions
Influence of lung volume reduction surgery (LVRS) on health related quality of life in patients with chronic obstructive pulmonary disease
405 CHRONIC OBSTRUCTIVE PULMONARY DISEASE Influence of lung volume reduction surgery (LVRS) on health related quality of life in patients with chronic obstructive pulmonary disease R S Goldstein, TRJTodd,
Lung-Volume Reduction Surgery ARCHIVED
Lung-Volume Reduction Surgery ARCHIVED Policy Number: Original Effective Date: MM.06.008 04/15/2005 Line(s) of Business: Current Effective Date: PPO; HMO; QUEST 03/22/2013 Section: Surgery Place(s) of
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedure overview of insertion of endobronchial nitinol coils to improve lung function in emphysema
Bronchoscopic lung volume reduction using endobronchial valves for the symptomatic improvement of severe emphysema.
WEMJ Volume 115 No 4 Article 5 December 2016 Bronchoscopic lung volume reduction using endobronchial valves for the symptomatic improvement of severe emphysema. Saveria Di Gerlando, Dr Bethannie McIntyre,
Interventional Pulmonology
Interventional Pulmonology The Division of Thoracic Surgery Department of Cardiothoracic Surgery New York Presbyterian/Weill Cornell Medical College p: 212-746-6275 f: 212-746-8223 https://weillcornell.org/eshostak
Fariba Rezaeetalab Associate Professor,Pulmonologist
Fariba Rezaeetalab Associate Professor,Pulmonologist rezaitalabf@mums.ac.ir Patient related risk factors Procedure related risk factors Preoperative risk assessment Risk reduction strategies Age Obesity
Buttressing the Staple Line in Lung Volume Reduction Surgery: A Randomized Three-Center Study
Buttressing the Staple Line in Lung Volume Reduction Surgery: A Randomized Three-Center Study Uz Stammberger, MD, Walter Klepetko, MD, Georgios Stamatis, MD, Jürg Hamacher, MD, Ralph A. Schmid, MD, Wilfried
Thoracic Surgery; An Overview
Thoracic Surgery What we see Thoracic Surgery; An Overview James P. Locher, Jr, MD Methodist Cardiovascular and Thoracic Surgery Lung cancer Mets Fungus and TB Lung abcess and empyema Pleural based disease
Prapaporn Pornsuriyasak, M.D. Pulmonary and Critical Care Medicine Ramathibodi Hospital
Prapaporn Pornsuriyasak, M.D. Pulmonary and Critical Care Medicine Ramathibodi Hospital Only 20-30% of patients with lung cancer are potential candidates for lung resection Poor lung function alone ruled
SPIRATION. VALVE SYSTEM For the Treatment of Emphysema or Air Leaks.
SPIRATION VALVE SYSTEM For the Treatment of Emphysema or Air Leaks. 0000 ENGINEERED FOR AIRWAY MANAGEMENT Inspired by aerodynamics, the Spiration Valve redirects air away from diseased or damaged lung
COPD: early detection, screening and case-finding: what is the evidence? Prof. Jan-Willem Lammers, Md PhD Department of Respiratory Diseases
COPD: early detection, screening and case-finding: what is the evidence? Prof. Jan-Willem Lammers, Md PhD Department of Respiratory Diseases «If you test one smoker with cough every day You will diagnose
Queeny Tower, One approach remain in use in high risk patients, the Barnes-Jewish Hospital general approach has evolved to include resection
634 REVIEW SERIES Chronic obstructive pulmonary disease v 1: Bullectomy, lung volume reduction surgery, and transplantation for patients with chronic obstructive pulmonary disease B F Meyers, G A Patterson...
The Role of CPET (cardiopulmonary exercise testing) in Assessing Lung Disease in CF
The Role of CPET (cardiopulmonary exercise testing) in Assessing Lung Disease in CF Dr. Meir Mei-Zahav Kathy and Lee Graub CF Center Schneider CMCI 1 תאריך Exercise in CF You are probably quite sure that
The diagnosis and management of pneumothorax
Respiratory 131 The diagnosis and management of pneumothorax Pneumothorax is a relatively common presentation in patients under the age of 40 years (approximately, 85% of patients are younger than 40 years).
Endobronchial coil therapy in severe emphysema: 6-month outcomes from a Swiss National Registry
Original Article Endobronchial coil therapy in severe emphysema: 6-month outcomes from a Swiss National Registry Jean-Marc Fellrath 1, Thomas Scherer 2, Daniel P. Franzen 3, Alban Lovis 4, Christophe von
Description. Regulatory Status
Last Review Status/Date: September 2016 Page: 1 of 10 Description Lung volume reduction surgery (LVRS) is proposed as a treatment option for patients with severe emphysema who have failed optimal medical
Cystic Fibrosis Complications ANDRES ZIRLINGER, MD STANFORD UNIVERSITY MEDICAL CENTER MARCH 3, 2012
Cystic Fibrosis Complications ANDRES ZIRLINGER, MD STANFORD UNIVERSITY MEDICAL CENTER MARCH 3, 2012 INTRODUCTION PNEUMOTHORAX HEMOPTYSIS RESPIRATORY FAILURE Cystic Fibrosis Autosomal Recessive Genetically
Keywords: bronchoscopy; emphysema; lung volume reduction
Endoscopic Lung Volume Reduction An American Perspective Hans J. Lee 1 *, Samira Shojaee 2 *, and Daniel H. Sterman 3 1 Interventional Pulmonology, Pulmonary Disease, and Critical Care Medicine, The Johns
Emphysema is a debilitating lung disease with a significant
Bronchoscopic Lung-Volume Reduction With One-Way Valves in Patients With Heterogenous Emphysema Federico Venuta, MD, Tiziano de Giacomo, MD, Erino A. Rendina, MD, Anna Maria Ciccone, MD, Daniele Diso,
Post Pneumonic Empyema: Is There Still a Role for Surgery?
Post Pneumonic Empyema: Is There Still a Role for Surgery? M. Blair Marshall, MD Ismael Matus, MD Chief, Thoracic Surgery Interventional Pulmonary Professor of Surgery Medicine MedStar Georgetown University
A RANDOMIZED, PROSPECTIVE TRIAL OF STAPLED LUNG REDUCTION VERSUS LASER BULLECTOMY FOR DIFFUSE EMPHYSEMA
A RANDOMIZED, PROSPECTIVE TRIAL OF STAPLED LUNG REDUCTION VERSUS LASER BULLECTOMY FOR DIFFUSE EMPHYSEMA Two procedures (laser bullectomy and lung reduction surgery with staples) are currently available
PFT Interpretation and Reference Values
PFT Interpretation and Reference Values September 21, 2018 Eric Wong Objectives Understand the components of PFT Interpretation of PFT Clinical Patterns How to choose Reference Values 3 Components Spirometry
Objectives. Objectives. Definition. Physiology. Evaluation of the Dyspneic Patient. B. Celli Disclaimer
Evaluation of the Dyspneic Patient Bartolome R. Celli Harvard Medical School Brigham and Women s Hospital Boston B. Celli Disclaimer No stocks or ownership in any company. No Tobacco funds No promotional
Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy
Original Article Long-term respiratory function recovery in patients with stage I lung cancer receiving video-assisted thoracic surgery versus thoracotomy Tae Yun Park 1,2, Young Sik Park 2 1 Division
FEV1 predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery
EUROPEAN SOCIETY OF CARDIOLOGY CONGRESS 2010 FEV1 predicts length of stay and in-hospital mortality in patients undergoing cardiac surgery Nicholas L Mills, David A McAllister, Sarah Wild, John D MacLay,
Commissioning for Better Outcomes in COPD
Commissioning for Better Outcomes in COPD Dr Matt Kearney Primary Care & Public Health Advisor Respiratory Programme, Department of Health General Practitioner, Runcorn November 2011 What are the Commissioning
Two-year results after lung volume reduction surgery in α 1 - antitrypsin deficiency versus smoker's emphysema
Eur Respir J 1998; : 128 132 DOI: 1.13/931936.98.5128 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1998 European Respiratory Journal ISSN 93-1936 Two-year results after lung volume reduction
Basic approach to PFT interpretation. Dr. Giulio Dominelli BSc, MD, FRCPC Kelowna Respiratory and Allergy Clinic
Basic approach to PFT interpretation Dr. Giulio Dominelli BSc, MD, FRCPC Kelowna Respiratory and Allergy Clinic Disclosures Received honorarium from Astra Zeneca for education presentations Tasked Asked
Surgical treatment of bullous lung disease
Surgical treatment of bullous lung disease PD POTGIETER, SR BENATAR, RP HEWITSON, AD FERGUSON Thorax 1981 ;36:885-890 From the Respiratory Clinic, Groote Schuur Hospita', and Departments of Medicine, Anaesthetics,
SPIRATION VALVE SYSTEM Patient Selection for the Treatment of Emphysema Based on Clinical Literature.
SPIRATION VALVE SYSTEM Patient Selection for the Treatment of Emphysema Based on Clinical Literature. SPIRATION VALVE SYSTEM The Spiration Valve System is a device placed in the lung airway to treat severely
Early-stage locally advanced non-small cell lung cancer (NSCLC) Clinical Case Discussion
Early-stage locally advanced non-small cell lung cancer (NSCLC) Clinical Case Discussion Pieter Postmus The Clatterbridge Cancer Centre Liverpool Heart and Chest Hospital Liverpool, United Kingdom 1 2
Pulmonary Rehabilitation
Pulmonary Rehabilitation What do these patients have in common? Factors contributing to exercise intolerance Factors contributing to exercise intolerance Factors contributing to exercise intolerance Factors
Thoracic anaesthesia. Simon May
Thoracic anaesthesia Simon May Contents Indications for lung isolation Ways of isolating lungs Placing a DLT Hypoxia on OLV Suitability for surgery Analgesia Key procedures Indications for lung isolation
Dr. Kshama Wechalekar Lead Consultant in Nuclear Medicine Royal Brompton and Harefield NHS Foundation Trust London
Dr. Kshama Wechalekar Lead Consultant in Nuclear Medicine Royal Brompton and Harefield NHS Foundation Trust London Royal Brompton Hospital PIOPED criteria indeterminate results and different probability
Chronic Obstructive Pulmonary Disease (COPD)
Chronic Obstructive Pulmonary Disease (COPD) Definition of COPD Airflow obstruction that is: o Not fully reversible o Progressive o Does not change markedly over several months Combination of airway and
Preoperative Workup for Pulmonary Resection. Kristen Bridges, M.D. Richmond University Medical Center January 21, 2016
Preoperative Workup for Pulmonary Resection Kristen Bridges, M.D. Richmond University Medical Center January 21, 2016 Patient Presentation 50 yo male with 70 pack year smoking history Large R hilar lung
Akihiro Hayashi, MD, Shinzo Takamori, MD, Masahiro Mitsuoka, MD, Keisuke Miwa, MD, Mari Fukunaga, MD, Keiko Matono, MD, and Kazuo Shirouzu, MD
Case Report The UPAO Test in Preoperative Evaluation for Major Pulmonary Resection: An Operative Case with Markedly Improved Ventilatory Function after Radical Pulmonary Resection for Lung Cancer Associated
Long-term follow-up after bronchoscopic lung volume reduction in patients with emphysema
Eur Respir J 2012; 39: 1084 1089 DOI: 10.1183/09031936.00071311 CopyrightßERS 2012 Long-term follow-up after bronchoscopic lung volume reduction in patients with emphysema Federico Venuta, Marco Anile,
ORIGINAL ARTICLE. Thoracoscopic minimally invasive surgery for non-small cell lung cancer in patients with chronic obstructive pulmonary disease
ORIGINAL ARTICLE Thoracoscopic minimally invasive surgery for non-small cell lung cancer in patients with chronic obstructive pulmonary disease Fei Cui 1,2*, Jun Liu 1,2*, Wenlong Shao 1,2, Jianxing He
Relationship Between Amount of Lung Resected and Outcome After Lung Volume Reduction Surgery
Relationship Between Amount of Lung and Outcome After Lung Volume Reduction Surgery Matthew Brenner, MD, Robert J. McKenna Jr, MD, John C. Chen, MD, Dan L. Serna, MD, Ledford L. Powell, MD, Arthur F. Gelb,
Understanding the mode of action of a drug using Functional Respiratory Imaging (FRI) Roflumilast Study. Jan De Backer, MSc, PhD, MBA CEO
Understanding the mode of action of a drug using Functional Respiratory Imaging (FRI) Roflumilast Study Jan De Backer, MSc, PhD, MBA CEO IPAC RS/UF Orlando Inhalation Conference March 20, 2014 OVERVIEW
Clinical management of lung volume reduction in end stage emphysema patients
Review Article Clinical management of lung volume reduction in end stage emphysema patients Kaid Darwiche 1, Clemens Aigner 2 1 Department of Pneumology, Division of Interventional Bronchology, 2 Department
Lung volume reduction surgery (LVRS) for chronic obstructive pulmonary disease (COPD) with underlying severe emphysema
Thorax 1999;54:779 789 779 ARIF, Division of Primary Care, Public and Occupational Health of the School of Medicine, Department of Public Health and Epidemiology, The University of Birmingham, Birmingham
The History and Future Treatment of Emphysema Emphysema Valves, Emphysema Coils and Volume Reduction Surgery
The History and Future Treatment of Emphysema Emphysema Valves, Emphysema Coils and Volume Reduction Surgery Dr Nabil Jarad PhD FRCP Consultant Respiratory Physician Bristol Royal Infirmary Bristol BS2
Sagar Damle, MD University of Colorado Denver May 23, 2011
Sagar Damle, MD University of Colorado Denver May 23, 2011 We have debated many times. Here are the topics, and a recap of the last few Pre-operative nutrition Babu pro; Damle con Utility of ECMO Babu
Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients
Bi-Level Therapy: Boosting Comfort & Compliance in Apnea Patients Objectives Describe nocturnal ventilation characteristics that may indicate underlying conditions and benefits of bilevel therapy for specific
Protocol. Lung Volume Reduction Surgery for Severe Emphysema
Protocol Lung Volume Reduction Surgery for Severe Emphysema (70171) Medical Benefit Effective Date: 01/01/15 Next Review Date: 09/18 Preauthorization Yes Review Dates: 02/07, 01/08, 11/08, 09/09, 09/10,
LOBECTOMY COMBINED WITH VOLUME REDUCTION FOR PATIENTS WITH LUNG CANCER AND ADVANCED EMPHYSEMA
LOBECTOMY COMBINED WITH VOLUME REDUCTION FOR PATIENTS WITH LUNG CANCER AND ADVANCED EMPHYSEMA Steven R. DeMeester, MD* G. Alexander Patterson, MD R. Sudhir Sundaresan, MD Joel D. Cooper, MD Objective:
Lung volume reduction surgery (LVRS) is a successful palliative
General Thoracic Surgery Tutic et al Long-term results after lung volume reduction surgery in patients with 1 -antitrypsin deficiency Michaela Tutic, MD a Konrad E. Bloch, MD b Didier Lardinois, MD a Thomas
Lung Cancer Clinical Guidelines: Surgery
Lung Cancer Clinical Guidelines: Surgery 1 Scope of guidelines All Trusts within Manchester Cancer are expected to follow this guideline. This guideline is relevant to: Adults (18 years and older) with
Robotic-assisted right upper lobectomy
Robotic Thoracic Surgery Column Robotic-assisted right upper lobectomy Shiguang Xu, Tong Wang, Wei Xu, Xingchi Liu, Bo Li, Shumin Wang Department of Thoracic Surgery, Northern Hospital, Shenyang 110015,
Short- and long-term functional results after lung volume reduction surgery for severe emphysema
Eur Respir J 1999; 13: 1170±1176 Printed in UK ± all rights reserved Copyright #ERS Journals Ltd 1999 European Respiratory Journal ISSN 0903-1936 SERIES 'LUNG VOLUME REDUCTION SURGERY' Edited by E. Russi
COILS FOR THE TREATMENT OF ADVANCED EMPHYSEMA: A GROWING BODY OF EVIDENCE AND ROUTINE EXPERIENCE
COILS FOR THE TREATMENT OF ADVANCED EMPHYSEMA: A GROWING BODY OF EVIDENCE AND ROUTINE EXPERIENCE *Jean-Marc Fellrath Internal Medicine Department/Service of Pneumology, Pourtalès Hospital, Neuchâtel, Switzerl