Bronchoscopic Biological Lung Volume Reduction Therapy for Patients with Emphysema
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- Category: Vol. 85, September 2017
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Bronchoscopic Biological Lung Volume Reduction Therapy for Patients with Emphysema, IBRAHIM M. RADWAN, ABD EL-HAY I. ABD EL-HAY, MOUSTAFA A. ZEDAN, MOHAMMAD A. ABD EL-LATIF, ABDALLA S. MUBARAK and MAHMOUD A. ABD EL-RAOOF
Abstract
Background: Emphysema is a worldwide leading cause of disability and death. The current standard maximal medical treatment allows improvement in exercise capacity and quality of life. Also lung volume reduction is important in management of emphysema and one of this procedures is using using autologous blood and gelfoam by the bronchoscope and evaluation of this method is important.
Aim of the Work: The aim of this work is to evaluate the safety and efficacy of bronchoscopic biological lung volume reduction using autologous blood and gel foam in patients with emphysema and/or emphysematous bullae.
Patients and Methods: This study was carried out in Bronchoscopy Unite, Chest Department, Al-Azhar University Hospitals in the period from April 2013 to July 2016. And a written informed consent was taken from the patients befor the start of the research.
Thirty patients with heterogeneous emphysema or bullae were recruited in this study. The patients were divided into two groups: The first group: Seventeen patients with emphy-sematous bullae. The second group: Thirteen patients with heterogeneous emphysema. All patients underwent the fol-lowing: Full history taking, clinical examination, pre and one month post bronchoscopic pulmonary function tests (FEV1, FVC, FEV1/FVC and RV), pre and one month post broncho-scopic arterial blood gases, pre and one month post broncho-scopic radiological assessment by plain chest X-ray and high resolution CT chest, pre and one month post bronchoscopic evaluation of dyspnea grade according to Modified Medical Research Council (MMRC) score, Echocardiography for assessment of pulmonary artery pressure before the procedure and Fiberoptic bronchoscopy under local anesthesia and light sedation, in which injection of 10ml of autologous blood, 5ml of tranexamic acid and 10ml of prepared gel foam in the feeding bronchus (first group) and in the most affected four subsegments two in each side (second group).
Results: This study include 30 patients male with emphy-sema age ranged (59.6±8.3) years, FEV1 (% of predicted) (32.9±8.8), RV (% of predicted) 156.0±23.2, 6 MWT (m) 275.7±85.3, PaO2 (mmHg) on room air 66.0±6.0, size of bullae by chest CT (cm) 10.9±2.8 and the outcomes post BLVR shows FEV 1 (% of predicted) (50.6±15.5), with p-value <0.0001 RV (% of predicted) 144.3±22.9 with p-value <0.0001, 6 MWT (m) 343.2±83.1 with p-value <0.0001, PaO2 (mmHg) on room air 70.9±4.7 with p-value <0.0001, size of bullae by chest CT (cm) 9.1±2.5 with p-value <0.0002.
Conclusion: Bronchoscopic biological lung volume re-duction therapy using autologous blood and gelfoam was well tolerated and safe in patients with advanced emphysema especially in heterogeneous type.