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

被引：31

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.

引用

页码：109 / 119

页数：11

共 30 条

[1]

[Anonymous], 1999, J THORAC CARDIOVASC, V118, P518

[2] Percent Emphysema, Airflow Obstruction, and Impaired Left Ventricular Filling [J].