Lung Diffusion Capacity

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Alessandro Brunelli - One of the best experts on this subject based on the ideXlab platform.

  • Risk Stratification in Lung Resection
    Current Surgery Reports, 2016
    Co-Authors: Michele Salati, Alessandro Brunelli
    Abstract:

    Purpose of Review Surgery is considered the best treatment option for patients with early stage Lung cancer. Nevertheless, Lung resection may cause a variable functional impairment that could influence the whole cardio-respiratory system with potential life-threatening complications. The aim of the present study is to review the most relevant evidences about the evaluation of surgical risk before Lung resection, in order to define a practical approach for the preoperative functional assessment in Lung cancer patients. Recent Findings The first step in the preoperative functional evaluation of a Lung resection candidate is a cardiac risk assessment. The predicted postoperative values of forced expiratory volume in one second and carbon monoxide Lung Diffusion Capacity should be estimated next. If both values are greater than 60 % of the predicted values, the patients are regarded to be at low surgical risk. If either or both of them result in values lower than 60 %, then a cardiopulmonary exercise test is recommended. Patients with VO2max >20 mL/kg/min are regarded to be at low risk, while those with VO2max 

  • ers ests clinical guidelines on fitness for radical therapy in Lung cancer patients surgery and chemo radiotherapy
    European Respiratory Journal, 2009
    Co-Authors: Alessandro Brunelli, Gaetano Rocco, Anne Charloux, C T Bolliger, Jeanpaul Sculier, Gonzalo Varela, Marc Licker, Mark K Ferguson, Corinne Faivrefinn, R M Huber
    Abstract:

    A collaboration of multidisciplinary experts on the functional evaluation of Lung cancer patients has been facilitated by the European Respiratory Society (ERS) and the European Society of Thoracic Surgery (ESTS), in order to draw up recommendations and provide clinicians with clear, up-to-date guidelines on fitness for surgery and chemo-radiotherapy. The subject was divided into different topics, which were then assigned to at least two experts. The authors searched the literature according to their own strategies, with no central literature review being performed. The draft reports written by the experts on each topic were reviewed, discussed and voted on by the entire expert panel. The evidence supporting each recommendation was summarised, and graded as described by the Scottish Intercollegiate Guidelines Network Grading Review Group. Clinical practice guidelines were generated and finalized in a functional algorithm for risk stratification of the Lung resection candidates, emphasising cardiological evaluation, forced expiratory volume in 1 s, systematic carbon monoxide Lung Diffusion Capacity and exercise testing. Contrary to Lung resection, for which the scientific evidences are more robust, we were unable to recommend any specific test, cut-off value, or algorithm before chemo-radiotherapy due to the lack of data. We recommend that Lung cancer patients should be managed in specialised settings by multidisciplinary teams.

  • the european thoracic database project composite performance score to measure quality of care after major Lung resection
    European Journal of Cardio-Thoracic Surgery, 2009
    Co-Authors: Alessandro Brunelli, Gaetano Rocco, Richard G Berrisford, Gonzalo Varela
    Abstract:

    BACKGROUND: Performance measurement is an essential element of quality improvement initiatives. The objective of this study was to develop a composite performance score (CPS) incorporating processes and outcomes measures available in the European Society of Thoracic Surgeons (ESTS) Database and apply it to stratify performance of participating units. METHODS: A total of 1656 major Lung resections for malignant primary neoplastic disease were collected in the ESTS database from 2001 through 2003 and were analyzed. For the purpose of this study only data collected from units contributing more than 50 consecutive cases were included. Three quality domains were selected: preoperative care, operative care, and postoperative outcome. According to best available evidence the following measures were selected for each domain: preoperative care (% of predicted postoperative carbon monoxide Lung Diffusion Capacity (ppoDLCO) measurement in patients with predicted postoperative forced expiratory volume in one second (ppoFEV1) <40%), operative care (% of systematic lymph node dissection), and outcomes (risk-adjusted cardiopulmonary morbidity and mortality rates). Morbidity and mortality risk models were developed by hierarchical logistic regression and validated by bootstrap analyses. Individual processes and outcomes scores were rescaled according to their standard deviations and summed to generate the CPS, which was used to rate units. RESULTS: CPS ranged from -4.4 to 3.7. Individual scores were poorly correlated with each other. Two units were negative outliers and two positive outliers (outside 95% confidence limits). Compared to the rating obtained by using the risk-adjusted mortality rates, all units changed their positions when ranked by CPS. CONCLUSIONS: The composite performance score methodology may support future peer-based organizational quality benchmarking initiatives and may be used for regulatory and credentialing purposes.

  • original research resectional Lung surgeryevaluation of expiratory volume Diffusion Capacity and exercise tolerance following major Lung resection a prospective follow up analysis
    Chest, 2007
    Co-Authors: Alessandro Brunelli, Francesco Xiume, Majed Refai, Michele Salati, Rita Marasco, Valeria Sciarra, Armando Sabbatini
    Abstract:

    Background:Lung resections determine a variable functional reduction depending on the extent of the resection and the time elapsed from the operation. The objectives of this study were to prospectively investigate the postoperative changes in FEV1, carbon monoxide Lung Diffusion Capacity (Dlco), and exercise tolerance after major Lung resection at repeated evaluation times. Methods:FEV1, Dlco, and peak oxygen consumption (Vo2peak) calculated using the stair climbing test were measured in 200 patients preoperatively, at discharge, and 1 month and 3 months after lobectomy or pneumonectomy. Preoperative and repeated postoperative measures were compared, and a time-series, cross-sectional regression analysis was performed to identify factors associated with postoperative Vo2peak. Results:One month after lobectomy, FEV1, Dlco, and Vo2peak values were 79.5%, 81.5%, and 96% of preoperative values and recovered up to 84%, 88.5%, and 97% after 3 months, respectively. One month after pneumonectomy, FEV1percentage of predicted, Dlcopercentage of predicted, and Vo2peak values were 65%, 75%, and 87% of preoperative values, and were 66%, 80%, and 89% after 3 months, respectively. Three months after lobectomy, 27% of patients with COPD had improved FEV1, 34% had improved Dlco, and 43% had improved Vo2peak compared to preoperative values. The time-series, cross-sectional regression analysis showed that postoperative Vo2peak values were directly associated with preoperative values of Vo2peak, and postoperative values of FEV1and Dlco, and were inversely associated with age and body mass index. Conclusions:Our findings may be used during preoperative counseling and for deciding eligibility for operation along with other more traditional measures of outcome.

  • evaluation of expiratory volume Diffusion Capacity and exercise tolerance following major Lung resection a prospective follow up analysis
    Chest, 2007
    Co-Authors: Alessandro Brunelli, Francesco Xiume, Majed Refai, Michele Salati, Rita Marasco, Valeria Sciarra, Armando Sabbatini
    Abstract:

    Abstract Background: Lung resections determine a variable functional reduction depending on the extent of the resection and the time elapsed from the operation. The objectives of this study were to prospectively investigate the postoperative changes in FEV 1 , carbon monoxide Lung Diffusion Capacity (Dlco), and exercise tolerance after major Lung resection at repeated evaluation times. Methods: FEV 1 , Dlco, and peak oxygen consumption (Vo 2 peak) calculated using the stair climbing test were measured in 200 patients preoperatively, at discharge, and 1 month and 3 months after lobectomy or pneumonectomy. Preoperative and repeated postoperative measures were compared, and a time-series, cross-sectional regression analysis was performed to identify factors associated with postoperative Vo 2 peak. Results: One month after lobectomy, FEV 1 , Dlco, and Vo 2 peak values were 79.5%, 81.5%, and 96% of preoperative values and recovered up to 84%, 88.5%, and 97% after 3 months, respectively. One month after pneumonectomy, FEV 1 percentage of predicted, Dlcopercentage of predicted, and Vo 2 peak values were 65%, 75%, and 87% of preoperative values, and were 66%, 80%, and 89% after 3 months, respectively. Three months after lobectomy, 27% of patients with COPD had improved FEV 1 , 34% had improved Dlco, and 43% had improved Vo 2 peak compared to preoperative values. The time-series, cross-sectional regression analysis showed that postoperative Vo 2 peak values were directly associated with preoperative values of Vo 2 peak, and postoperative values of FEV 1 and Dlco, and were inversely associated with age and body mass index. Conclusions: Our findings may be used during preoperative counseling and for deciding eligibility for operation along with other more traditional measures of outcome.

Oana L Klein - One of the best experts on this subject based on the ideXlab platform.

Lewis J Smith - One of the best experts on this subject based on the ideXlab platform.

Ewa Jassem - One of the best experts on this subject based on the ideXlab platform.

  • Impairment of Lung Diffusion Capacity—a new consequence in the long-term childhood leukaemia survivors
    Annals of Hematology, 2019
    Co-Authors: Eliza Wasilewska, Krzysztof Kuziemski, Marek Niedoszytko, Maciej Niedzwiecki, Barbara Kaczorowska-hać, Sylwia Małgorzewicz, Ewa Jassem
    Abstract:

    Childhood leukaemia survivors (CLS) are known to have developed long-term impairment of Lung function. The reasons for that complication are only partially known. The aims of this study were to assess pulmonary function in CLS and identify (1) risk factors and (2) clinical manifestations for the impairment of airflow and Lung Diffusion. The study group included 74 CLS: 46 treated with chemotherapy alone (HSCT−), 28 with chemotherapy and haematopoietic stem cell transplantation (HSCT+), and 84 healthy subjects (control group (CG)). Spirometry and Diffusion limit of carbon monoxide (DLCO) tests were performed in all subjects. Ten (14%) survivors had restrictive, five (7%) had obstructive pattern, and 47 (66%) had reduced DLCO. The age at diagnosis, type of transplant, and type of conditioning regimen did not significantly affect the pulmonary function tests. The DLCO%pv were lower in CLS than in CG ( p  

  • impairment of Lung Diffusion Capacity a new consequence in the long term childhood leukaemia survivors
    Annals of Hematology, 2019
    Co-Authors: Eliza Wasilewska, Krzysztof Kuziemski, Marek Niedoszytko, Barbara Kaczorowskahac, Maciej Niedzwiecki, Sylwia Malgorzewicz, Ewa Jassem
    Abstract:

    Childhood leukaemia survivors (CLS) are known to have developed long-term impairment of Lung function. The reasons for that complication are only partially known. The aims of this study were to assess pulmonary function in CLS and identify (1) risk factors and (2) clinical manifestations for the impairment of airflow and Lung Diffusion. The study group included 74 CLS: 46 treated with chemotherapy alone (HSCT−), 28 with chemotherapy and haematopoietic stem cell transplantation (HSCT+), and 84 healthy subjects (control group (CG)). Spirometry and Diffusion limit of carbon monoxide (DLCO) tests were performed in all subjects. Ten (14%) survivors had restrictive, five (7%) had obstructive pattern, and 47 (66%) had reduced DLCO. The age at diagnosis, type of transplant, and type of conditioning regimen did not significantly affect the pulmonary function tests. The DLCO%pv were lower in CLS than in CG (p < 0.03) and in the HSCT+ than in the HSCT− survivors (p < 0.05). The pulmonary infection increased the risk of Diffusion impairment (OR 5.1, CI 1.16–22.9, p = 0.019). DLCO was reduced in survivors who experienced CMV Lung infection (p < 0.001). The main symptom of impaired Lung Diffusion was poor tolerance of exercise (p < 0.005). The lower Lung Diffusion Capacity is the most frequent abnormality in CLS. HSCT and pulmonary infection, in particular with CMV infection, are strong risk factors for impairment of Lung Diffusion Capacity in CLS. Clinical manifestation of DLCO impairment is poor exercise tolerance. A screening for respiratory abnormalities in CLS seems to be of significant importance.

D Gendrel - One of the best experts on this subject based on the ideXlab platform.

  • reduced Lung Diffusion Capacity after mycoplasma pneumoniae pneumonia
    Pediatric Infectious Disease Journal, 2000
    Co-Authors: Elizabeth Marc, M Chaussain, Florence Moulin, Jeanluc Iniguez, Gabriel Kalifa, Josette Raymond, D Gendrel
    Abstract:

    Background Mycoplasma pneumoniae is a frequent but underdiagnosed cause of community-acquired pneumonia (CAP) in children, and appropriate macrolide treatment is often given late. The aim of this work was to estimate the frequency of pulmonary involvement in children 6 months after a clinical episode of Mycoplasma CAP. Methods. We measured carbon monoxide Diffusion Capacity (TLCO) and conducted spirometric tests in 35 children without asthma or chronic Lung disease (ages 4.5 to 15 years), 6 months and 1 year after acute CAP caused by M. pneumoniae (23 children), pneumococci (5 children) or viruses (7 children). Only 11 of 23 patients with M. pneumoniae CAP required hospitalization, whereas all the patients with pneumococcal or viral pneumonia were admitted to hospital. Results. Lung volumes and spirometric tests were normal for all children. TLCO was normal 6 months after pneumococcal or viral pneumonia (87 to 112% of expected values for height and sex). After acute M. pneumoniae CAP, 11 of 23 patients (48%) had TLCO values <80% of the expected value. The extent of change in Lung Diffusion Capacity was correlated with the delay to diagnosis and treatment: TLCO was low in 8 of 11 patients given macrolide treatment 10 days or more after the onset of acute symptoms vs. only 3 of 10 patients given appropriate treatment in the first 10 days. TLCO was low in 7 of 7 who received macrolide therapy for <2 weeks. TLCO had increased slightly after 1 year in the 5 patients retested after a new course of macrolide treatment. TLCO reached the lower normal range in 2 patients controlled after 3 years. Conclusions. The abnormal TLCO values suggest that some children with Mycoplasma pneumonia have reduced pulmonary gas Diffusion after recovery from the illness. The reduction is related to delay and short macrolide therapy.

  • alteration of Lung Diffusion Capacity in iga nephropathy
    Archives of Disease in Childhood, 1996
    Co-Authors: S Ravilly, M Chaussain, Jeanluc Iniguez, A Lenhert, G Kalifa, P Brun, Patrick Niaudet, D Gendrel
    Abstract:

    OBJECTIVE: To establish whether changes of Lung transfer for carbon monoxide (TLCO) are related to the phase of IgA nephropathy. METHODS: Respiratory function was tested in 12 children with IgA nephropathy assessed by percutaneous renal biopsy. This was done during acute exacerbations or haematuria-free phases of the disease. RESULTS: TLCO was low in 12/13 measurements made in the haematuric phase of IgA nephropathy or during the month following gross haematuria (mean TLCO 64% of expected values). Lung volumes and blood gas values were normal and only minor radiological signs of interstial Lung involvement were observed in 11/12 patients. When respiratory tests were performed more than three months after gross haematuria, TLCO was low in 4/9 patients, with no relation to the significance of residual proteinuria or severity of findings at renal biopsy. There was a significant difference between tests performed when haematuria was present or recent and those performed more than three months after an episode of gross haematuria (p < 0.01). CONCLUSIONS: The decrease of TLCO in the acute phases of the disease is probably related to alterations of the Lung alveolarcapillary membrane by immune complexes containing IgA. This non-invasive technique, easy to perform and repeat, could be of value in the diagnosis of IgA nephropathy in haematuric children.

  • impairment of Lung Diffusion Capacity in schonlein henoch purpura
    The Journal of Pediatrics, 1992
    Co-Authors: M Chaussain, Gabriel Kalifa, Patrick Niaudet, Delphine De Boissieu, Serge Epelbaum, J Badoual, D Gendrel
    Abstract:

    Twenty-nine children with typical Schonlein-Henoch purpura (SHP) were tested at the initial phase of the disease for respiratory function. Of the 29 patients, 28 had a decrease of Lung transfer for carbon monoxide (TLCO) as measured by a steady-state method. Lung volumes and blood gas values were normal; slight radiologic signs of interstitial Lung involvement were observed in 18 of 26 patients. There was a decrease in TLCO to 56.8% of normal values for height and gender and to 58.5% when normal values were volume-adjusted to functional residual Capacity. In 19 of 25 patients, TLCO measurements were performed at 3-month intervals during follow-up. In all cases, normalization of TLCO values was observed only after complete clinical recovery from SHP. All children with persisting symptoms, even limited to microscopic hematuria or slight proteinuria, had low TLCO values. In one patient low TLCO during follow-up preceded a late relapse of SHP in the form of acute nephritic disease with characteristic IgA deposits on renal biopsy. We conclude that low TLCO in SHP is probably related to alteration of the alveolar-capillary membrane by circulating immune complexes. This noninvasive technique may be useful in diagnosis, and during the follow-up of the disease as an early indicator of reactivation.

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