Estudio de factores predictivos de mejoría funcional en la cirugía de reducción de volumen en el tratamiento del enfisema avanzado.

by Lloret Pérez, Tomás

ABSTRACT OBJECTIVES: Lung volume reduction surgery has recently been proposed as palliative treatment for advanced emphysema. Some patients improve and others remains the same, being debated at this time the factors that predict improvement. The purpose of this work is to find predictive factors for positive response in patients operated with this surgery. MATERIAL AND METHODS: Patients with positive response (9 patients) and patients without positive response (5 patients) have been compared in our series of lung volume reduction surgery (14 patients). Positive response to surgery was defined as Delta FEV1 > or = 15%, dyspnea transitional index (Mahler scale) > or = 3, and improvement in the scoring surgery of quality of life for chronic respiratory disease questionnaire (Guyatt and Guell) > or = 1.5 3 months after the surgery. Basal values of FEV1, FEF50/FIF50%, hyperinsufflation degree, heterogeneity, PaO2, PaCO2, type of surgery, body mass index (BMI), dyspnea basal index (DBI) and quality of life questionnaire score (QLQS). RESULTS: Patients without and with positive response were different only because their baseline BMI, DBI and QLQS were lower. Other parameters studied (although the population was rather homogeneous) did not show significant differences between the two groups. CONCLUSIONS: Patients with higher subjective problems (dyspnea and quality of life) and more malnourished are those with less benefit from surgery for pulmonary volume reduction.