Interpreting improvement in expiratory flows after lung volume reduction surgery in terms of flow limitation theory

American Journal of Respiratory and Critical Care Medicine
E P IngenitoJ J Reilly

Abstract

Spirometry and pulmonary mechanics were measured pre- and postoperatively in 37 patients undergoing bilateral lung volume reduction surgery (LVRS). The relative contributions of changes in compliance (CL), recoil pressures (PTLC), small airway conductance (Gu), and airway closing pressures (Ptm') to changes in expiratory flows were examined with a Taylor series expansion of the Pride- Permutt model of flow limitation. The resulting variational expression, deltaVmax = GudeltaPel + PeldeltaGu - GudeltaPtm' - Ptm'deltaGu - deltaGudeltaPtm', was then used to describe how the peak flow rate (Vmax) depends on preoperative Gu, P TLC, Ptm', and on changes (delta) in these parameters after surgery. After LVRS, both FEV(1) and Vmax increased significantly ( DeltaFEV(1) = 28 +/- 44%; DeltaVmax = 78 +/- 132%), and changes in FEV(1) and Vmax correlated closely (r = 0.74, p < 0.001). Among responders (DeltaFEV(1) > or = 12%; n = 19; DeltaFEV(1) = 60 +/- 38%), PTLC increased (8.8 +/- 2.8 to 12.2 +/- 4.7 cm H2O) and the time constant for expiration (tau = CL/Gu) decreased (2.67 +/- 0.62 to 2.35 +/- 0.55 s), while Ptm', CL, and Gu did not change. GudeltaPel, the change in recoil weighted by preoperative conductance upstream of the flow-limiting...Continue Reading

References

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Citations

Aug 10, 2005·Respiration; International Review of Thoracic Diseases·Edward P IngenitoAndrew Hoffman
May 6, 2008·Proceedings of the American Thoracic Society·Edward P IngenitoJames P Utz
May 6, 2008·Proceedings of the American Thoracic Society·Henry E FesslerAmir Sharafkhaneh
Nov 30, 2007·International Journal of Chronic Obstructive Pulmonary Disease·Luis Puente-Maestu, William W Stringer
Sep 18, 2007·Seminars in Thoracic and Cardiovascular Surgery·Edward P Ingenito, Larry W Tsai
Aug 22, 2015·Therapeutic Advances in Respiratory Disease·Arschang Valipour, Otto Chris Burghuber
Jul 1, 2017·American Journal of Respiratory and Critical Care Medicine·Anastasios F PalamidasPallav L Shah
Sep 16, 2017·Respirology : Official Journal of the Asian Pacific Society of Respirology·Jorrit B A WellingDirk-Jan Slebos
Dec 7, 2006·COPD·Cynthia D Brown, Henry E Fessler
Oct 23, 2002·Journal of Applied Physiology·Edward P IngenitoJohn J Reilly
May 1, 2021·Thoracic Surgery Clinics·Nathalie ForayPeter White

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