Preview

Tuberculosis and Lung Diseases

Advanced search

Changes in ventilatory and gas exchange pulmonary functions when the endobronchial valve block is effectively implanted to those with destructive pulmonary tuberculosis

https://doi.org/10.21292/2075-1230-2018-96-11-35-43

Abstract

The objective of the study: to investigate ventilatory and gas exchange pulmonary functions in the patients with chronic destructive pulmonary tuberculosis after the successful endobronchial valve block.

Subjects and methods. Data of 85 patients with chronic destructive pulmonary tuberculosis were analyzed; in all of them, cavities in the lungs were healed after the endobronchial valve block, which was confirmed by computed tomography. Of them, 45 were men and 40 were women at the age from 18 to 59 years old (the median age made 30.6± 8.8 years). When examining patients prior to implantation of the endobronchial valve block, 49 patients had normal ventilatory lung capacity (forced expiratory volume per second (FEV1) ≥ 80% due values), 17 patients suffered from moderate disorders (FEV1) made 79-60% due values), while 19 ones had severe disorders (FEV1 ≤ 59% due values). The data reflecting respiratory function and blood gases of all patients were compared before implantation of the endobronchial valve and in 7-10 days after its removal.

Results. In the majority of patients (from 65.9 to 84.7% of patients depending on the parameter) with chronic destructive pulmonary tuberculosis in whom the endobronchial valve block was successful, after the endobronchial valve was removed, no changes in ventilatory and gas exchange functions were registered versus the initial ones. The remaining patients had moderate positive or negative changes. The most dynamic rates reflecting ventilatory and gas exchange lung functions were FEV1, vital capacity (VC), peak expiratory flow (PEF), РаО2 and РаСО2, which changed in 27-43% of patients (depending on the parameter).

According to changes in the integral value of FEV1, ventilatory lung capacity deteriorated in 22.3% of patients and improved in 11.8% of them.

VC increased in 22.3% of patients and reduced in 10.6% of them, which often promoted improvement of blood oxygenation rates: РаО2 increased in 25.9% and reduced in 8.2% of patients, SаO2 increased in 15.3%, and reduced in 3.5% of them. The level of PaCO2 increased in 7.0% of patients, and went down in 20.0% of them.

After the successful endobronchial valve block, improvement of ventilatory lung capacity, determined by FEV1 increase, was more frequent in the patients who had it below the norm initially versus the normal level (23.4% versus 6.1%, p < 0.05), the same was observed in VC (47.3 and 14.3%, p < 0.05).

If the endobronchial valve block is implanted for a longer period of time due to disseminated and severe tuberculosis, the frequency of positive changes of functional rates increases (according to values to FEV1, VC, Tiffeneau's test, PEF), as well as gas exchange parameters (according to РаО2, SаO2 and PaCO2). Should there be indications for implantation of the endobronchial valve block, it can promote not only the healing of cavities and tuberculous lesions, but result in certain improvement of respiratory and gas exchange functions.

About the Authors

L. A. Popova
Central Tuberculosis Research Institute
Russian Federation
Candidate of Medical Sciences, Senior Researcher of Clinical Diagnostic Department.
2, Yauzskaya Alleya, Moscow, 107564


E. A. Shergina
Central Tuberculosis Research Institute
Russian Federation
Candidate of Medical Sciences, Head of Functional Diagnostics Unit of Clinical Diagnostics Department.
2, Yauzskaya Alleya, Moscow, 107564


T. R. Bagdasaryan
Central Tuberculosis Research Institute
Russian Federation
Candidate of Medical Sciences, Head of First Therapy Unit of Phthisiology Department.
2, Yauzskaya Alleya, Moscow, 107564


N. A. Chernykh
Central Tuberculosis Research Institute
Russian Federation
Candidate of Medical Sciences, Senior Researcher of Phthisiology Department.
2, Yauzskaya Alleya, Moscow, 107564


N. F. Sidorova
Central Tuberculosis Research Institute
Russian Federation
Candidate of Medical Sciences, Doctor of Endoscopy Department.
2, Yauzskaya Alleya, Moscow, 107564


O. V. Lovacheva
National Medical Research Center of Phthisiopulmonology and Infectious Diseases
Russian Federation
Doctor of Medical Sciences, Professor, Chief Researcher
4, Dostoevsky St., Moscow, 127473


References

1. Kanaev V.V. Obschie voprosy metodiki issledovaniya i kriterii otsenki pokazateley dykhaniya. [General issues of testing methods and evaluation criteria of respiration rates]. L.L. Shik, N.N. Kanaev, eds. Leningrad, 1980, pp. 21-36.

2. Levin А.V., Tseymakh E.А., Zimonin P.E., Krasnov D.V., Yaichnikov V.P. Osteoplastic thoracoplasty and endobronchial valve in the comprehensive treatment of patents with destructive pulmonary drug resistant tuberculosis. Tuberculosis and Lung Diseases, 2011, vol. 88, no. 7, pp. 41-44. (In Russ.)

3. Lovacheva O.V., Shumskaya I.Yu., Turovtseva Yu.V., Vasilyeva I.А., Bagdasaryan T.R., Ergeshov А.E. New opportunities of non-surgery treatment of fibrous cavernous pulmonary tuberculosis patients. Tuberculosis and Lung Diseases, 2013, vol. 90, no. 4, pp. 012-018. (In Russ.)

4. Nefedov V.B., Shergina E.А., Samorukova M.V. Repeatability of testing gases and pH of arterial capillary blood. Tuberculosis and Lung Diseases, 2009, no. 7, pp. 37-41. (In Russ.)

5. Popova L.А., Shergina E.А., Lovacheva O.V., Shabalina I.Yu., Bagdasaryan T.R., Sidorova N.F. Changes in the lung functions in the early period of endobronchial valve block in those suffering from chronic destructive tuberculosis. Pulmonoloiya, 2018, vol. 28, no. 3, pp. 332-340. (In Russ.)

6. Sklyuev S.V., Krasnov D.V. Evaluation of impact by valve bronchial blocking on the external respiration using the example of infiltrate destructive pulmonary tuberculosis patients. Pulmonoloiya, 2013, no. 5, pp. 49-52. (In Russ.)

7. Sklyuev S.V., Krasnov D.V. Use of endobronchial valve in the complex treatment of destructive infiltrative pulmonary tuberculosis patients after treatment failure. Byulleten' Vostochno-Sibirskogo Nauchnogo Tsentra SO RАMN, 2011, no. 2, pp. 101-103. (In Russ.)

8. Federalnye klinicheskiye rekomendatsii po diagnostike i lecheniyu tuberkuleza organov dykhaniya s mnozhestvennoy i shirokoy lekarstennoy ustoichivostyu vozbuditelya. [Federal clinical recommendations for diagnosis and treatment of respiratory tuberculosis with multiple and extensive drug resistance]. 3rd Edition. Vasilyeva I.А., Bagdasaryan T.R., Balasanyants G.S., Bogorodskaya E.M., Borisov S.E., Valiev R.Sh., Kazenny B.Ya., Kazimirova N.E., Krasnov V.А., Lovacheva O.V., Maliev B.M., Maryandyshev А.O., Morozova T.I., Samoylova А.G., Sevastyanova E.V., Skornyakov S.N., Smerdin S.V., Stakhanov V.А., Chernousova L.N., Ergeshov А.E. Moscow, 2015, 68 p. Available at: http://roftb.ru/netcat_files/doks2015/3final.pdf

9. Federalnye klinicheskie rekomendatsii po ispolzovaniyu metoda klapannoy bronkhoblokatsii v lechenii tuberkuleza legkikh i ego oslozhneniy. [Federal clinical recommendations on using valve bronchial block in the treatment of pulmonary tuberculosis and its complications]. Rossiyskoye Obschestvo Ftiziatrov Publ., Lovacheva O.V., Elkin А.V., Zimonin P.E., Krasnov D.V., Krasnov V.А., Levin А.V., Sklyuev S.V., Skornyakov S.N., Stepanov D.V., Tseymakh E.А., Shumskaya I.Yu. Moscow, New Terra Publ., 2015, pp. 25 Available at: http://roftb.ru/netcat_files/doks2015/rec7.pdf

10. Darwiche K., Karpf-Wissel R., Eisenmann S., Aigner C., Welter S., Zarogoulidis P., Hohenforst-Schmidt W., Freitag L., Oezkan F. Bronchoscopic lung volume reduction with endobronchial valves in low-FEV1 patients. Respiration, 2016, vol. 92, no. 6, pp. 414-419.

11. Herth F.J., Noppen M., Valipour A., Leroy S., Vergnon J.M., Ficker J.H., Egan J.J., Gasparini S., Agusti C., Holmes-Higgin D., Ernst A. International VENT Study Group. Efficacy predictors of lung volume reduction with Zephyr valves in a European cohort. Eur. Respir. J., 2012, vol. 39, no. 6.

12. Iftikhar I.H., McGuire F.R., Musani A.I. Predictors of efficacy for endobronchial valves in bronchoscopic lung volume reduction: a meta-analysis. Chron. Respir. Dis., 2014, vol. 11, no. 4, pp. 237-245. doi: 10.1177/1479972314546766. Review

13. Shah P.L., Herth F.J. Current status of bronchoscopic lung volume reduction with endobronchial valves. Thorax, 2014, vol. 69, no. 3, pp. 280-286. doi: 10.1136/thoraxjnl-2013-203743. Review.

14. Slavkovska K. Krvne plyny a acidobazicka rovnovaha. Funkcia dychania v laboratornej a klinickej praxi, Vidavatelstvo Osveta, 1982, pp. 124-156.

15. Standardization of lung function tests. Report Working Party European Community for Steel and Coal. Official statement of European Respiratory Society. Eur. Respir. J., 1993, vol. 6, pp. 1-121.


Review

For citations:


Popova L.A., Shergina E.A., Bagdasaryan T.R., Chernykh N.A., Sidorova N.F., Lovacheva O.V. Changes in ventilatory and gas exchange pulmonary functions when the endobronchial valve block is effectively implanted to those with destructive pulmonary tuberculosis. Tuberculosis and Lung Diseases. 2018;96(11):35-43. (In Russ.) https://doi.org/10.21292/2075-1230-2018-96-11-35-43

Views: 1058


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 2075-1230 (Print)
ISSN 2542-1506 (Online)