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  • 1
    Online Resource
    Online Resource
    Predicting Lung Volume Reduction after Endobronchial Valve Therapy Is Maximized Using a Combination of Diagnostic Tools
    S. Karger AG ; 2016
    In:  Respiration Vol. 92, No. 3 ( 2016), p. 150-157
    Details
    In: Respiration, S. Karger AG, Vol. 92, No. 3 ( 2016), p. 150-157
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Bronchoscopic lung volume reduction using one-way endobronchial valves (EBVs) has been proven to be effective in patients with severe emphysema. However, the selection of patients without collateral ventilation prior to treatment is critical for procedural success. Collateral ventilation can be assessed directly with the Chartis system or indirectly using computed tomography (CT) fissure analysis. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 We retrospectively evaluated the diagnostic value of a combination of the quantitative CT interlobar fissure completeness score (FCS) and Chartis in predicting responders to EBV therapy. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 CT data from four prospective studies were pooled and analyzed using semiautomated software to quantify the completeness of interlobar fissures. These FCSs were compared to a reference standard of achieving ≥350 ml of target lobe volume reduction after EBV treatment. Using a receiver operating characteristic curve, optimal thresholds predictive of complete fissures (responders) and incomplete fissures (non-responders) were determined. A subgroup of patients with partially complete fissures was identified, where software had lower accuracy. The complementary value of Chartis was investigated in this group. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A fissure was defined as complete (FCS 〉 95%), incomplete (FCS 〈 80%), or partially complete (80% 〈 FCS 〈 95%). The positive predictive value (PPV) of complete fissures is 88.1%, and the negative predictive value (NPV) is 92.9%, with an overall accuracy of 89.2%. Chartis was utilized in patients with partially complete fissures, with a PPV of 82.3%, an NPV of 84.6%, and an accuracy of 83.3%. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Combining diagnostic tools could reduce the burden on patients and the healthcare system while providing clinicians with a better means for patient selection for EBV therapy.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000448849
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
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  • 2
    Online Resource
    Online Resource
    Bronchoscopic Coil Treatment for Patients with Severe Emphysema: A Meta-Analysis
    S. Karger AG ; 2015
    In:  Respiration Vol. 90, No. 2 ( 2015), p. 136-145
    Details
    In: Respiration, S. Karger AG, Vol. 90, No. 2 ( 2015), p. 136-145
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Bronchoscopic coil treatment has been shown to improve pulmonary function, exercise capacity, and quality of life in patients with severe emphysema. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 To perform a meta-analysis of the results of four independent European clinical trials investigating this coil therapy for emphysema. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Data on all patients included in the four European clinical trials were analyzed for efficacy and safety outcomes. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 2,536 coils were placed during 259 procedures in 140 patients. A total of 37 chronic obstructive pulmonary disease exacerbations and 27 pneumonias were recorded as serious adverse events up to 1 year after treatment. The pneumothorax rate was 6.4%. Both 6 and 12 months after treatment, significant (all p 〈 0.001) improvements were observed for: forced expiratory volume in 1 s [+0.08 liters (±0.19) and +0.08 liters (±0.21)], residual volume [RV; -510 ml (±850) and -430 ml (±720)] , 6-min walking distance [6MWD; +44.1 m (±69.8) and +38.1 m (±71.9)], and St. George's Respiratory Questionnaire score [SGRQ; -9.5 points (±14.3) and -7.7 points (±14.2)] . No differences in any outcome measures were observed between heterogeneous and homogeneous emphysema patients. Only a high baseline RV was found to be an independent predictor of successful treatment. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Bronchoscopic coil treatment improves pulmonary function, 6MWD, and quality of life in patients with severe emphysema up to 1 year after treatment, independent of the distribution of the disease.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000431384
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
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  • 3
    Online Resource
    Online Resource
    Expert Statement: Pneumothorax Associated with One-Way Valve Therapy for Emphysema: 2020 Update
    S. Karger AG ; 2021
    In:  Respiration Vol. 100, No. 10 ( 2021), p. 969-978
    Details
    In: Respiration, S. Karger AG, Vol. 100, No. 10 ( 2021), p. 969-978
    Abstract: For selected patients with advanced emphysema, bronchoscopic lung volume reduction with one-way valves can lead to clinically relevant improvements of airflow obstruction, hyperinflation, exercise capacity, and quality of life. The most common complication of this procedure is pneumothorax with a prevalence of up to ±34% of the treated patients. Patients who develop a pneumothorax also experience meaningful clinical benefits once the pneumothorax is resolved. Timely resolution of a post-valve treatment pneumothorax requires skilled and adequate pneumothorax management. This expert panel statement is an updated recommendation of the 2014 statement developed to help guide pneumothorax management after valve placement. Additionally, mechanisms for pneumothorax development, risk assessment, prevention of pneumothorax, and outcomes after pneumothorax are addressed. This recommendation is based on a combination of the current scientific literature and expert opinion, which was obtained through a modified Delphi method.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000516326
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
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  • 4
    Online Resource
    Online Resource
    Bronchoscopic Lung Volume Reduction Coil Treatment for Severe Emphysema: A Systematic Review and Meta-Analysis of Individual Participant Data
    S. Karger AG ; 2022
    In:  Respiration Vol. 101, No. 7 ( 2022), p. 697-705
    Details
    In: Respiration, S. Karger AG, Vol. 101, No. 7 ( 2022), p. 697-705
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Lung volume reduction coil (LVR-coil) treatment provides a minimally invasive treatment option for severe emphysema patients which has been studied in multiple clinical trials. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 The aim of the study was to assess the effect of LVR-coil treatment on pulmonary function, quality of life, and exercise capacity using individual participant data. 〈 b 〉 〈 i 〉 Method: 〈 /i 〉 〈 /b 〉 PubMed, Web of Science, and EMBASE were searched until May 17, 2021. Prospective single-arm and randomized controlled trials that evaluated the effect of LVR-coil treatment on forced expiratory volume in 1 s (FEV 〈 sub 〉 1 〈 /sub 〉 ), residual volume (RV), St. George Respiratory Questionnaire (SGRQ) total score, and/or 6-min walk distance (6MWD) and were registered in an official clinical trial database were eligible for inclusion. Individual patient data were requested, and a linear mixed effects model was used to calculate overall treatment effects. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Eight trials were included in the final analysis, representing 680 individual patients. LVR-coil treatment resulted in a significant improvement in FEV1 at 3- (0.09 L [95% confidence interval (95% CI): 0.06–0.12]) and 6-month follow-up (0.07 L [95% CI: 0.03–0.10] ), a significant reduction in RV at 3- (−0.45L [95% CI: −0.62 to −0.28]), 6- (−0.33L [95% CI: −0.52 to −0.14] ), and 12-month follow-up (−0.36L [95% CI: −0.64 to −0.08]), a significant reduction in SGRQ total score at 3- (−12.3 points [95% CI: −15.8 to −8.8] ), 6- (−10.1 points [95% CI: −12.8 to −7.3]), and 12-month follow-up (−9.8 points [95% CI: −15.0 to −4.7] ) and a significant increase in 6MWD at 3-month follow-up (38 m [95% CI: 18–58]). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 LVR-coil treatment in emphysema patients results in sustained improvements in pulmonary function and quality of life and shorter lived improvements in exercise capacity. Since the owner of this LVR-coil has decided to stop the production and newer generations LVR-coils are currently being developed, these results can act as a reference for future studies and clinical guidance.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000524148
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
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  • 5
    Online Resource
    Online Resource
    Endobronchial Coil System versus Standard-of-Care Medical Management in the Treatment of Subjects with Severe Emphysema
    S. Karger AG ; 2021
    In:  Respiration Vol. 100, No. 8 ( 2021), p. 804-810
    Details
    In: Respiration, S. Karger AG, Vol. 100, No. 8 ( 2021), p. 804-810
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Bronchoscopic lung volume reduction using endobronchial coils is a new treatment for patients with severe emphysema. To date, the benefits have been modest and have been suggested to be much larger in patients with severe hyperinflation and nonmulti-comorbidity. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 We aimed to evaluate the efficacy and safety of endobronchial coil treatment in a randomized multicenter clinical trial using optimized patient selection. 〈 b 〉 〈 i 〉 Method: 〈 /i 〉 〈 /b 〉 Patients with severe emphysema on HRCT scan with severe hyperinflation (residual volume [RV] ≥200% predicted and RV/total lung capacity [TLC] & #x3e;55%) were randomized to coil treatment or control. Primary outcome measures were differences in the forced expiratory volume in 1 s (FEV 〈 sub 〉 1 〈 /sub 〉 ) and St George’s Respiratory Questionnaire (SGRQ) total score at 6 months. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Due to premature study termination, a total of 120 patients (age 63 ± 7 years, FEV 〈 sub 〉 1 〈 /sub 〉 29 ± 7% predicted, RV 251 ± 41% predicted, RV/TLC 67 ± 6%, and SGRQ 58 ± 13 points), instead of 210 patients, were randomized. At study termination, 91 patients (57 coil and 34 control) had 6-month results available. Analyses showed significantly greater improvements in favor of the coil group. The increase in FEV 〈 sub 〉 1 〈 /sub 〉 was greater in the coil group than that in the control group by + 10.3 [+4.7 to +16.0] % and in SGRQ by −10.6 [−15.9 to −5.4] points. At study termination, there were 5 (6.8%) deaths in the coil cohort reported. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Despite early study termination, coil treatment compared to control results in a significant improvement in the lung function and quality of life benefits for up to 6 months in patients with emphysema and severe hyperinflation. These improvements were of clinical importance but were associated with a higher likelihood of serious adverse events.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000515744
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
    detail.hit.zdb_id: 1464419-8
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