Effects of lung volume reduction surgery on gas exchange and breathing pattern during maximum exercise

Gerard J. Criner, Patricia Belt, Alice L. Sternberg, Zab Mosenifar, Barry J. Make, James P Utz, Frank Sciurba

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Background: The National Emphysema Treatment Trial studied lung volume reduction surgery (LVRS) for its effects on gas exchange, breathing pattern, and dyspnea during exercise in severe emphysema. Methods: Exercise testing was performed at baseline, and 6, 12, and 24 months. Minute ventilation (V̇E), tidal volume (VT), carbon dioxide output (V̇CO2), dyspnea rating, and workload were recorded at rest, 3 min of unloaded pedaling, and maximum exercise. PaO2, PaCO2, pH, fraction of expired carbon dioxide, and bicarbonate were also collected in some subjects at these time points and each minute of testing. There were 1,218 patients enrolled in the study (mean [± SD] age, 66.6 ± 6.1 years; mean, 61%; mean FEV 1, 0.77 ± 0.24 L), with 238 patients participating in this substudy (mean age, 66.1 ± 6.8 years; mean, 67%; mean FEV1, 0.78 ± 0.25 L). Results: At 6 months, LVRS patients had higher maximum V̇E (32.8 vs 29.6 L/min, respectively; p = 0.001), V̇CO2, (0.923 vs 0.820 L/min, respectively; p = 0.0003), VT (1.18 vs 1.07 L, respectively; p = 0.001), heart rate (124 vs 121 beats/min, respectively; p = 0.02), and workload (49.3 vs 45.1 W, respectively; p = 0.04), but less breathlessness (as measured by Borg dyspnea scale score) [4.4 vs 5.2, respectively; p = 0.0001] and exercise ventilatory limitation (49.5% vs 71.9%, respectively; p = 0.001) than medical patients. LVRS patients with upper-lobe emphysema showed a downward shift in PaCO2 vs V̇CO2 (p = 0.001). During exercise, LVRS patients breathed slower and deeper at 6 months (p = 0.01) and 12 months (p = 0.006), with reduced dead space at 6 months (p = 0.007) and 24 months (p = 0.006). Twelve months after patients underwent LVRS, dyspnea was less in patients with upper-lobe emphysema (p = 0.001) and non-upper-lobe emphysema (p = 0.007). Conclusion: During exercise following LVRS, patients with severe emphysema improve carbon dioxide elimination and dead space, breathe slower and deeper, and report less dyspnea.

Original languageEnglish (US)
Pages (from-to)1268-1279
Number of pages12
JournalChest
Volume135
Issue number5
DOIs
StatePublished - May 1 2009

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Pneumonectomy
Respiration
Gases
Emphysema
Exercise
Dyspnea
Carbon Dioxide
Tidal Volume
Workload
Ventilation
Bicarbonates
Foot
Heart Rate

Keywords

  • Cardiopulmonary exercise
  • COPD
  • Emphysema

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Criner, G. J., Belt, P., Sternberg, A. L., Mosenifar, Z., Make, B. J., Utz, J. P., & Sciurba, F. (2009). Effects of lung volume reduction surgery on gas exchange and breathing pattern during maximum exercise. Chest, 135(5), 1268-1279. https://doi.org/10.1378/chest.08-1625

Effects of lung volume reduction surgery on gas exchange and breathing pattern during maximum exercise. / Criner, Gerard J.; Belt, Patricia; Sternberg, Alice L.; Mosenifar, Zab; Make, Barry J.; Utz, James P; Sciurba, Frank.

In: Chest, Vol. 135, No. 5, 01.05.2009, p. 1268-1279.

Research output: Contribution to journalArticle

Criner, GJ, Belt, P, Sternberg, AL, Mosenifar, Z, Make, BJ, Utz, JP & Sciurba, F 2009, 'Effects of lung volume reduction surgery on gas exchange and breathing pattern during maximum exercise', Chest, vol. 135, no. 5, pp. 1268-1279. https://doi.org/10.1378/chest.08-1625
Criner, Gerard J. ; Belt, Patricia ; Sternberg, Alice L. ; Mosenifar, Zab ; Make, Barry J. ; Utz, James P ; Sciurba, Frank. / Effects of lung volume reduction surgery on gas exchange and breathing pattern during maximum exercise. In: Chest. 2009 ; Vol. 135, No. 5. pp. 1268-1279.
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abstract = "Background: The National Emphysema Treatment Trial studied lung volume reduction surgery (LVRS) for its effects on gas exchange, breathing pattern, and dyspnea during exercise in severe emphysema. Methods: Exercise testing was performed at baseline, and 6, 12, and 24 months. Minute ventilation (V̇E), tidal volume (VT), carbon dioxide output (V̇CO2), dyspnea rating, and workload were recorded at rest, 3 min of unloaded pedaling, and maximum exercise. PaO2, PaCO2, pH, fraction of expired carbon dioxide, and bicarbonate were also collected in some subjects at these time points and each minute of testing. There were 1,218 patients enrolled in the study (mean [± SD] age, 66.6 ± 6.1 years; mean, 61{\%}; mean FEV 1, 0.77 ± 0.24 L), with 238 patients participating in this substudy (mean age, 66.1 ± 6.8 years; mean, 67{\%}; mean FEV1, 0.78 ± 0.25 L). Results: At 6 months, LVRS patients had higher maximum V̇E (32.8 vs 29.6 L/min, respectively; p = 0.001), V̇CO2, (0.923 vs 0.820 L/min, respectively; p = 0.0003), VT (1.18 vs 1.07 L, respectively; p = 0.001), heart rate (124 vs 121 beats/min, respectively; p = 0.02), and workload (49.3 vs 45.1 W, respectively; p = 0.04), but less breathlessness (as measured by Borg dyspnea scale score) [4.4 vs 5.2, respectively; p = 0.0001] and exercise ventilatory limitation (49.5{\%} vs 71.9{\%}, respectively; p = 0.001) than medical patients. LVRS patients with upper-lobe emphysema showed a downward shift in PaCO2 vs V̇CO2 (p = 0.001). During exercise, LVRS patients breathed slower and deeper at 6 months (p = 0.01) and 12 months (p = 0.006), with reduced dead space at 6 months (p = 0.007) and 24 months (p = 0.006). Twelve months after patients underwent LVRS, dyspnea was less in patients with upper-lobe emphysema (p = 0.001) and non-upper-lobe emphysema (p = 0.007). Conclusion: During exercise following LVRS, patients with severe emphysema improve carbon dioxide elimination and dead space, breathe slower and deeper, and report less dyspnea.",
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AU - Belt, Patricia

AU - Sternberg, Alice L.

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AU - Make, Barry J.

AU - Utz, James P

AU - Sciurba, Frank

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N2 - Background: The National Emphysema Treatment Trial studied lung volume reduction surgery (LVRS) for its effects on gas exchange, breathing pattern, and dyspnea during exercise in severe emphysema. Methods: Exercise testing was performed at baseline, and 6, 12, and 24 months. Minute ventilation (V̇E), tidal volume (VT), carbon dioxide output (V̇CO2), dyspnea rating, and workload were recorded at rest, 3 min of unloaded pedaling, and maximum exercise. PaO2, PaCO2, pH, fraction of expired carbon dioxide, and bicarbonate were also collected in some subjects at these time points and each minute of testing. There were 1,218 patients enrolled in the study (mean [± SD] age, 66.6 ± 6.1 years; mean, 61%; mean FEV 1, 0.77 ± 0.24 L), with 238 patients participating in this substudy (mean age, 66.1 ± 6.8 years; mean, 67%; mean FEV1, 0.78 ± 0.25 L). Results: At 6 months, LVRS patients had higher maximum V̇E (32.8 vs 29.6 L/min, respectively; p = 0.001), V̇CO2, (0.923 vs 0.820 L/min, respectively; p = 0.0003), VT (1.18 vs 1.07 L, respectively; p = 0.001), heart rate (124 vs 121 beats/min, respectively; p = 0.02), and workload (49.3 vs 45.1 W, respectively; p = 0.04), but less breathlessness (as measured by Borg dyspnea scale score) [4.4 vs 5.2, respectively; p = 0.0001] and exercise ventilatory limitation (49.5% vs 71.9%, respectively; p = 0.001) than medical patients. LVRS patients with upper-lobe emphysema showed a downward shift in PaCO2 vs V̇CO2 (p = 0.001). During exercise, LVRS patients breathed slower and deeper at 6 months (p = 0.01) and 12 months (p = 0.006), with reduced dead space at 6 months (p = 0.007) and 24 months (p = 0.006). Twelve months after patients underwent LVRS, dyspnea was less in patients with upper-lobe emphysema (p = 0.001) and non-upper-lobe emphysema (p = 0.007). Conclusion: During exercise following LVRS, patients with severe emphysema improve carbon dioxide elimination and dead space, breathe slower and deeper, and report less dyspnea.

AB - Background: The National Emphysema Treatment Trial studied lung volume reduction surgery (LVRS) for its effects on gas exchange, breathing pattern, and dyspnea during exercise in severe emphysema. Methods: Exercise testing was performed at baseline, and 6, 12, and 24 months. Minute ventilation (V̇E), tidal volume (VT), carbon dioxide output (V̇CO2), dyspnea rating, and workload were recorded at rest, 3 min of unloaded pedaling, and maximum exercise. PaO2, PaCO2, pH, fraction of expired carbon dioxide, and bicarbonate were also collected in some subjects at these time points and each minute of testing. There were 1,218 patients enrolled in the study (mean [± SD] age, 66.6 ± 6.1 years; mean, 61%; mean FEV 1, 0.77 ± 0.24 L), with 238 patients participating in this substudy (mean age, 66.1 ± 6.8 years; mean, 67%; mean FEV1, 0.78 ± 0.25 L). Results: At 6 months, LVRS patients had higher maximum V̇E (32.8 vs 29.6 L/min, respectively; p = 0.001), V̇CO2, (0.923 vs 0.820 L/min, respectively; p = 0.0003), VT (1.18 vs 1.07 L, respectively; p = 0.001), heart rate (124 vs 121 beats/min, respectively; p = 0.02), and workload (49.3 vs 45.1 W, respectively; p = 0.04), but less breathlessness (as measured by Borg dyspnea scale score) [4.4 vs 5.2, respectively; p = 0.0001] and exercise ventilatory limitation (49.5% vs 71.9%, respectively; p = 0.001) than medical patients. LVRS patients with upper-lobe emphysema showed a downward shift in PaCO2 vs V̇CO2 (p = 0.001). During exercise, LVRS patients breathed slower and deeper at 6 months (p = 0.01) and 12 months (p = 0.006), with reduced dead space at 6 months (p = 0.007) and 24 months (p = 0.006). Twelve months after patients underwent LVRS, dyspnea was less in patients with upper-lobe emphysema (p = 0.001) and non-upper-lobe emphysema (p = 0.007). Conclusion: During exercise following LVRS, patients with severe emphysema improve carbon dioxide elimination and dead space, breathe slower and deeper, and report less dyspnea.

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