Περίληψη:
Background: Endoscopic valve implantation is an effective treatment for patients with advanced emphysema. Despite the minimally invasive procedure, valve placement is associated with risks, the most common of which is pneumothorax. This study was designed to identify predictors of pneumothorax following endoscopic valve implantation. Methods: Preinterventional clinical measures (vital capacity, forced expiratory volume in 1 second, residual volume, total lung capacity, 6-minute walk test), qualitative computed tomography (CT) parameters (fissure integrity, blebs/bulla, subpleural nodules, pleural adhesions, partial atelectasis, fibrotic bands, emphysema type) and quantitative CT parameters (volume and low attenuation volume of the target lobe and the ipsilateral untreated lobe, target air trapping, ipsilateral lobe volume/hemithorax volume, collapsibility of the target lobe and the ipsilateral untreated lobe) were retrospectively evaluated in patients who underwent endoscopic valve placement (n=129). Regression analysis was performed to compare those who developed pneumothorax following valve therapy (n=46) with those who developed target lobe volume reduction without pneumothorax (n=83). Finding: Low attenuation volume% of ipsilateral untreated lobe (odds ratio [OR] =1.08, P=0.001), ipsilateral untreated lobe volume/hemithorax volume (OR =0.93, P=0.017), emphysema type (OR =0.26, P=0.018), pleural adhesions (OR =0.33, P=0.012) and residual volume (OR =1.58, P=0.012) were found to be significant predictors of pneumothorax. Fissure integrity (OR =1.16, P=0.075) and 6-minute walk test (OR =1.05, P=0.077) were also indicative of pneumothorax. The model including the aforementioned parameters predicted whether a patient would experience a pneumothorax 84% of the time (area under the curve =0.84). Interpretation: Clinical and CT parameters provide a promising tool to effectively identify patients at high risk of pneumothorax following endoscopic valve therapy. © 2016 Gompelmann et al.
Συγγραφείς:
Gompelmann, D.
Lim, H.-J.
Eberhardt, R.
Gerovasili, V.
Herth, F.J.F.
Heussel, C.P.
Eichinger, M.
Λέξεις-κλειδιά:
adult; aged; Article; atelectasis; clinical feature; computer assisted tomography; controlled study; emphysema; endoscopic valve implantation; female; forced expiratory volume; human; lung surgery; major clinical study; male; pleura disease; pleural adhesion; pneumothorax; prediction; residual volume; total lung capacity; vital capacity; walking; adverse effects; area under the curve; bronchoscopy; devices; diagnostic imaging; exercise tolerance; lung; middle aged; multidetector computed tomography; odds ratio; pathophysiology; pneumothorax; predictive value; Pulmonary Emphysema; receiver operating characteristic; retrospective study; risk factor; severity of illness index; statistical model; treatment outcome; very elderly; walk test, Adult; Aged; Aged, 80 and over; Area Under Curve; Bronchoscopy; Exercise Tolerance; Female; Forced Expiratory Volume; Humans; Linear Models; Logistic Models; Lung; Male; Middle Aged; Multidetector Computed Tomography; Odds Ratio; Pneumothorax; Predictive Value of Tests; Pulmonary Emphysema; Retrospective Studies; Risk Factors; ROC Curve; Severity of Illness Index; Treatment Outcome; Vital Capacity; Walk Test
