Lung deflation and oxygen pulse in COPD: Results from the NETT randomized trial

被引：32
作者：
Come, Carolyn E. [1 ]
Divo, Miguel J.
Estepar, Raul San Jose [2 ]
Sciurba, Frank C. [3 ]
Criner, Gerard J. [4 ]
Marchetti, Nathaniel [4 ]
Scharf, Steven M. [5 ]
Mosenifar, Zab [6 ]
Make, Barry J. [7 ]
Keller, Cesar A. [8 ]
Minai, Omar A. [9 ]
Martinez, Fernando J. [10 ]
Han, MeiLan K. [10 ]
Reilly, John J. [3 ]
Celli, Bartolome R.
Washko, George R.
机构：
[1] Harvard Univ, Dept Med, Div Pulm & Crit Care, Brigham & Womens Hosp,Med Sch, Boston, MA 02115 USA
[2] Harvard Univ, Dept Radiol, Brigham & Womens Hosp, Sch Med, Boston, MA 02115 USA
[3] Univ Pittsburgh, Div Pulm & Crit Care Med, Pittsburgh, PA USA
[4] Temple Univ, Div Pulm & Crit Care Med, Sch Med, Philadelphia, PA 19122 USA
[5] Univ Maryland, Sch Med, Div Pulm & Crit Care Med, Baltimore, MD 21201 USA
[6] Univ Calif Los Angeles, David Geffen Sch Med, Div Pulm & Crit Care Med, Cedars Sinai Med Ctr, Los Angeles, CA 90095 USA
[7] Univ Colorado, Sch Med, Div Pulm Sci & Crit Care Med, Denver, CO USA
[8] Mayo Clin, Dept Pulm Med, Jacksonville, FL 32224 USA
[9] Cleveland Clin, Dept Pulm Allergy & Crit Care, Cleveland, OH 44106 USA
[10] Univ Michigan, Med Ctr, Div Pulm & Crit Care, Ann Arbor, MI USA
来源：
RESPIRATORY MEDICINE | 2012年 / 106卷 / 01期
基金：
美国医疗保健研究与质量局;
关键词：
Cardiac function; Hyperinflation; Lung volume reduction surgery; Oxygen pulse; VOLUME-REDUCTION SURGERY; OBSTRUCTIVE PULMONARY-DISEASE; SEVERE EMPHYSEMA; GAS-EXCHANGE; EXERCISE PERFORMANCE; BREATHING PATTERN; HYPERINFLATION; HEMODYNAMICS; CONSUMPTION; REST;
D O I：
10.1016/j.rmed.2011.07.012
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Background: In COPD patients, hyperinflation impairs cardiac function. We examined whether lung deflation improves oxygen pulse, a surrogate marker of stroke volume. Methods: In 129 NETT patients with cardiopulmonary exercise testing (CPET) and arterial blood gases (ABG substudy), hyperinflation was assessed with residual volume to total lung capacity ratio (RV/TLC), and cardiac function with oxygen pulse (O(2) pulse = VO(2)/HR) at baseline and 6 months. Medical and surgical patients were divided into "deflators" and "non-deflators" based on change in RV/TLC from baseline (Delta RV/TLC). We defined deflation as the Delta RV/TLC experienced by 75% of surgical patients. We examined changes in O(2) pulse at peak and similar (iso-work) exercise. Findings were validated in 718 patients who underwent CPET without ABGs. Results: In the ABG substudy, surgical and medical deflators improved their RV/TLC and peak O(2) pulse (median Delta RV/TLC -18.0% vs. -9.3%, p = 0.0003; median Delta O(2) pulse 13.6% vs. 1.8%, p = 0.12). Surgical deflators also improved iso-work O(2) pulse (0.53 mL/beat, p = 0.04 at 20 W). In the validation cohort, surgical deflators experienced a greater improvement in peak 02 pulse than medical deflators (mean 18.9% vs. 1.1%). In surgical deflators improvements in O(2) pulse at rest and during unloaded pedaling (0.32 mL/beat, p < 0.0001 and 0.47 mL/beat, p < 0.0001, respectively) corresponded with significant reductions in HR and improvements in VO(2). On multivariate analysis, deflators were 88% more likely than non-deflators to have an improvement in O(2) pulse (OR 1.88, 95% CI 1.30-2.72, p = 0.0008). Conclusion: In COPD, decreased hyperinflation through lung volume reduction is associated with improved O(2) pulse. (C) 2011 Elsevier Ltd. All rights reserved.
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页码：109 / 119
页数：11
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