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Original Articles: General Thoracic

Unilateral Extrapulmonary Airway Bypass in Advanced Emphysema

^a Department of Respiratory Medicine, Royal Brompton and Harefield NHS Trust, London, United Kingdom
^b Department of Thoracic Surgery, Royal Brompton and Harefield NHS Trust, London, United Kingdom
^c Division of Anaesthesia and Intensive Care, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
^d Fibre and Polymer Technology, School of Chemical Science and Engineering, Royal Institute of Technology, Stockholm, Sweden
^e Department of Respiratory Medicine, Kings College Hospital, London, United Kingdom

Accepted for publication October 26, 2009.

^_* Address correspondence to Dr Polkey, Royal Brompton Hospital, Fulham Rd, London, SW3 6NP, United Kingdom (Email: m.polkey{at}rbht.nhs.uk).

Background: Gas trapping in emphysema results in resting and dynamic hyperinflation. We tested the hypothesis that a direct connection between the lung parenchyma and the atmosphere could increase expiratory flow and thereby potentially improve dyspnea through the relief of gas trapping.

Methods: Ex vivo we studied 7 emphysematous lungs and 3 fibrotic lungs (as controls) and measured expiratory flow before and after airway bypass insertion during a forced maneuver in an artificial thorax. Pilot studies were conducted in vivo in 6 patients with advanced emphysema using a size 9 endotracheal tube as a bypass surgically placed through the chest wall into the upper lobe.

Results: In the ex vivo emphysematous lungs the volume expelled during a forced expiratory maneuver increased from 169 to 235 mL (p < 0.05). In the in vivo group 4 patients retained the bypass tube for 3 months or more; total lung capacity was reduced, and the forced expiratory volume in 1 second increased by 23% (mean percent predicted at baseline versus 3 months, 24.4% versus 29.5%).

Conclusions: An extrapulmonary airway bypass increases expiratory flow in emphysema. This may be a useful approach in hyperinflated patients with homogeneous emphysema.

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