Department of Infectious Diseases and Respiratory Medicine, Charité -Universitätsmedizin Berlin, Berlin, Germany.
Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Respiration. 2022;101(4):408-416. doi: 10.1159/000520082. Epub 2021 Dec 3.
Endobronchial valve therapy has proven to reduce lung hyperinflation and decrease disease burden in patients with severe lung emphysema. Exclusion of collateral ventilation (CV) of the targeted lobe by using an endobronchial assessment system (Chartis; PulmonX, Drive Redwood City, CA, USA) in combination with software-based fissure integrity analysis (FCS [fissure completeness score]) of computed tomography scans of the lung are established tools to select appropriate patients for endobronchial valve treatment. So far, there is no conclusive evidence if the ventilation mode during bronchoscopy impacts the outcome of Chartis assessments.
Patients with Chartis assessments and software-based quantification of FCS (StratX; PulmonX, Drive Redwood City, CA, USA) were enrolled in this retrospective study. During bronchoscopy, pulmonary fissure integrity was evaluated with the Chartis assessment system in each patient first under spontaneous breathing and subsequently under high-frequency (HF) jet ventilation.
In total, 102 patients were analyzed. Four Chartis phenotypes CV positive (CV+), CV negative (CV-), low flow, and low plateau in spontaneous breathing and HF jet ventilation were identified. The frequency of each Chartis phenotype per lobe was similar in both settings. When comparing Chartis assessments in spontaneous breathing and HF jet ventilation, there was an overall good concordance rate for all analyzed fissures. In agreement, receiver operating characteristic analysis of the FCS showed an almost similar prediction for CV+ and CV- status independent of the ventilation modes.
Chartis assessment in spontaneous breathing and HF jet ventilation had similar rates in detecting CV in lung emphysema. Our results suggest that both modes are equivalent for the assessment of CV.
支气管内瓣膜治疗已被证明可减少严重肺气肿患者的肺过度充气并降低疾病负担。通过使用支气管内评估系统（Chartis；PulmonX，Drive Redwood City，CA，USA）排除靶向肺叶的侧支通气（CV），并结合基于软件的肺 CT 扫描裂完整性分析（FCS[裂完整性评分]），这是选择合适的支气管内瓣膜治疗患者的既定工具。到目前为止，尚无确凿证据表明支气管镜检查期间的通气模式会影响 Chartis 评估的结果。
本回顾性研究纳入了接受 Chartis 评估和基于软件的 FCS（StratX；PulmonX，Drive Redwood City，CA，USA）定量评估的患者。在支气管镜检查过程中，首先在每个患者的自主呼吸下，随后在高频（HF）射流通气下，使用 Chartis 评估系统评估肺裂的完整性。
共分析了 102 例患者。在自主呼吸和 HF 射流通气下，确定了四种 Chartis 表型 CV 阳性（CV+）、CV 阴性（CV-）、低流量和低平台。两种设置下每个肺叶的 Chartis 表型频率相似。当比较自主呼吸和 HF 射流通气下的 Chartis 评估时，所有分析的裂之间的总体一致性较好。同样，FCS 的接收者操作特征分析表明，无论通气模式如何，对 CV+和 CV-状态的预测几乎相同。
在自发性呼吸和高频射流通气下，Chartis 评估检测肺气肿中的 CV 具有相似的比率。我们的结果表明，两种模式在评估 CV 时是等效的。
