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Changes in Arterial Oxygenation and Self-Reported Oxygen Use after Lung Volume Reduction Surgery

¹ Division of Pulmonary and Critical Care Medicine, University of Washington, Seattle, Washington; ² The Mountain-Whisper-Light Statistical Consulting, Seattle, Washington; ³ Division of Pulmonary Medicine, Cedars-Sinai Medical Center, Los Angeles, California; ⁴ Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland; and ⁵ Office of Program Development, University of Pennsylvania, Philadelphia, Pennsylvania

Correspondence and requests for reprints should be addressed to Joshua O. Benditt, M.D., University of Washington Medical Center, Pulmonary and Critical Care Medicine, Box 356522, Seattle, WA 98195-6522. E-mail: benditt{at}u.washington.edu

Rationale: Lung volume reduction surgery (LVRS) is inconsistently reported to improve arterial oxygenation in patients with chronic obstructive pulmonary disease.

Objectives: We studied the effects of surgery on oxygenation in a large cohort and identified predictors of postoperative oxygenation improvement.

Methods: We evaluated oxygenation in 1,078 subjects with chronic obstructive pulmonary disease enrolled in the National Emphysema Treatment Trial after LVRS compared with medical control subjects, including arterial blood gases, use of supplemental oxygen during treadmill walking, and self-reported use of oxygen during rest, exertion, and sleep.

Measurements and Main Results: Pa_O2 breathing room air was equal in medical and surgical subjects at baseline (64.8 vs. 65.0 mm Hg, P = not significant), but lower in medical subjects at 6 months (63.6 vs. 70.0 mm Hg, P < 0.001), 12 months (63.9 vs. 68.7 mm Hg, P < 0.001), and 24 months (62.4 vs. 68.0 mm Hg, P < 0.001). Fewer medical subjects required oxygen for treadmill walking at baseline compared with surgical subjects (46 vs. 53%, P = 0.02). However, more medical subjects required oxygen for this activity at 6 months (49 vs. 33%, P < 0.001), 12 months (50 vs. 36%, P < 0.001), and 24 months (52 vs. 42%, P = 0.02). Self-reported oxygen use was greater in medical than in surgical subjects at 6, 12, and 24 months. Multivariate modeling of preoperative characteristics showed baseline oxygenation status was the best predictor of postoperative oxygenation.

Conclusions: LVRS increases Pa_O2, and decreases treadmill and self-reported use of oxygen for up to 24 months post-procedure.

Clinical trial registered with www.clinicaltrials.gov (NCT 00000606).

Key Words: oxygen inhalation therapy • emphysema • lung diseases, obstructive

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Lung volume reduction surgery is reported to have benefits for patients with emphysema. It has been unclear whether this surgery has ameliorative effects on arterial oxygenation. What This Study Adds to the Field Lung volume reduction surgery improved arterial oxygenation and decreased supplemental oxygen use in a large cohort of subjects with emphysema compared with a medically treated control group.