![]() ![]() This review examined the research published up to the 14th of April, 2016, and identified 11 studies involving 1760 participants. However, this procedure has been the centre of much controversy with its possible benefit being outweighed by potential harms and costs. Lung volume reduction surgery (LVRS) may help improve symptoms by removing the most diseased and non‐functioning parts of the lung. Lung volume reduction surgery for adults with diffuse emphysemaĭoes lung volume reduction surgery improve lung function and quality of life, without leading to an increased chance of death, higher rates of illness after the procedure and higher costs for patients with severe emphysema, and which surgical methods lead to the best results in these patients?Įmphysema causes severe damage to the lungs, which leads to breathing problems. Although LVRS leads to an increase in quality‐adjusted life‐years (QALYs), the procedure is relatively costly overall. Adverse events were more common with LVRS than with control, specifically the occurrence of (persistent) air leaks, pulmonary morbidity (e.g. Trials in this review furthermore provided evidence of low to moderate quality showing that improvements in lung function parameters other than forced expiratory volume in one second (FEV 1), quality of life and exercise capacity were more likely with LVRS than with usual follow‐up. Participants with upper lobe‐predominant emphysema and low baseline exercise capacity showed the most favourable outcomes related to mortality, as investigators reported no significant differences in early mortality between participants treated with LVRS and those in the control group (OR 0.87, 95% CI 0.23 to 3.29 290 participants one study), as well as significantly lower mortality at the end of follow‐up for LVRS compared with control (OR 0.45, 95% CI 0.26 to 0.78 290 participants one study). Participants identified post hoc as being at high risk of death from surgery were those with particularly impaired lung function, poor diffusing capacity and/or homogenous emphysema. Short‐term mortality was higher for LVRS (odds ratio (OR) 6.16, 95% confidence interval (CI) 3.22 to 11.79 1489 participants five studies moderate‐quality evidence) than for control, but long‐term mortality favoured LVRS (OR 0.76, 95% CI 0.61 to 0.95 1280 participants two studies moderate‐quality evidence). Participants completed a mandatory course of pulmonary rehabilitation/physical training before the procedure commenced. Eight of the studies compared LVRS versus standard medical care, one compared two closure techniques (stapling vs laser ablation), one looked at the effect of buttressing the staple line on the effectiveness of LVRS and one compared traditional 'resectional' LVRS with a non‐resectional surgical approach. The quality of evidence ranged from low to moderate owing to an unclear risk of bias across many studies, lack of blinding and low participant numbers for some outcomes. A total of 11 studies (1760 participants) met the entry criteria of the review, one of which accounted for 68% of recruited participants. ![]() The pleural fluid LDH is less than 2/3 of the upper reference limitĪlthough these criteria have been re-evaluated there is no clear cut case for using anything other than Light’s criteria.We identified two new studies (89 participants) in this updated review. The ratio of pleural fluid LDH to plasma LDH less than 0.6 ![]() The ratio of pleural fluid protein to serum protein is less than 0.5 The sample cannot be analysed if it is not suitable for analysis on the blood gas analyser Pleural fluid pH if a specimen in a blood gas syringe is available.Pleural fluid protein, glucose and LDH and serum protein, glucose and LDH if available. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |