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Lung volume reduction surgery in hypercapnic patients: a single-center experience from China.

Background
Lung volume reduction surgery (LVRS) has shown early promise as a palliative therapy in severe emphysema, but with a controversy over its indications. The aim of this study was to evaluate whether patients with hypercapnia should be excluded from LVRS.


Methods
Total 15 cases of severe emphysema with the level of PaCO2 exceeding 50 mmHg were retrospectively studied. Their basic characteristics, pulmonary function, preoperative and postoperative PaCO2 level as well as postoperative complications were calculated statistically.


Results
All of the 15 patients received video-assisted thoracoscopic LVRS and finally discharged uneventfully from hospital after the surgical procedures. Nine cases were supported by mechanical ventilation after surgery with the median duration of 44 hours. One of them was treated by extracorporeal membrane oxygenation (ECMO) both during surgery and the first 4 days after surgery. The result of blood gas analysis on 3 months after hospital discharge decreased than that before surgery (60.07 vs. 55.61 mmHg, P=0.076), but without statistical significance.


Conclusions
The emphysematous patients with hypercapnia should not be excluded from the benefits of LVRS.