Ghazi Elshafie

Measuring changes in chest wall motion after lung resection using structured light plethysmography: a feasibility study

OBJECTIVES We describe the use of structured light plethysmography (SLP)-a novel, non-contact, light-based technique for measuring tidal breathing-among a cohort of patients undergoing lung resection. In this feasibility study, we examined whether changes in chest wall motion or in asynchrony between regions of the thoraco-abdominal wall could be identified after surgery. METHODS Fifteen patients underwent wedge resection (n = 8) or lobectomy (n = 7). All patients underwent two SLP assessments (before surgery and on Day 1 post-surgery). Each assessment captured data during 5 min of quiet (tidal) breathing. RESULTS When data were averaged across all patients, motion on the operated side of the thorax was significantly reduced after surgery (mean change from presurgery ± standard deviation: -14.7 ± 16.5%, P = 0.01), while motion on the non-operated side increased (15.9 ± 18.5%, P = 0.01). Thoraco-abdominal asynchrony also increased (mean change ± standard deviation: 43.4 ± 55.1%, P = 0.01), but no significant difference was observed in right-left hemi-thoracic asynchrony (163.7 ± 230.3%, P = 0.08). When analysed by resection type, lobectomy was associated with reduced and increased motion on the operated and non-operated side, respectively, and with an increase in both right-left hemi-thoracic and thoraco-abdominal asynchrony. No significant changes in motion or asynchrony were identified in patients who underwent wedge resection. CONCLUSIONS SLP was able to detect changes in chest wall motion and asynchrony after thoracic surgery. Changes in this small group of patients were consistent with the side of the incision and were most apparent in patients undergoing lobectomy.

Cardiopulmonary benefits of a cosmetic chest wall surgery

There is contradictory evidence regarding improvement in dyspnea and exercise tolerance following corrective surgery for pectus carinatum. It is even more unclear as to the mechanism of any improvement.

The use of structured light plethysmography in assessing the outcome of lung reduction

Lung volume reduction surgery via endobronchial valves (EBV) insertion improves clinical outcomes and quality of life in selected patients with emphysema. The response to this intervention has been inconsistent because collateral ventilation prevents lobar atelectasis. Outcomes of this procedure are measured radiologically. But these radiological methods lack sensitivity and cannot identify non-responders immediately after surgery

THE IMPROVEMENTOF EXERCISE CAPACITY AFTER SURGICAL CORRECTION OF PECTUS CARINATUM IS ASSOCIATED WITH REVERSAL OF DYNAMIC HYPERINFLATION

There is contradictory evidence regarding improvement in dyspnoea and exercise tolerance following corrective surgery for pectus carinatum. It is even more unclear as to the mechanism of any improvement. Thus we observed the changes in chest wall function in response to an incremental load exercise before and after surgery. Methods: Using optoelectronic plethysmography, total and regional chest wall volumes were measured in 3 male patients with pectus carinatum who underwent a Ravitch procedure. Rib cage and abdominal volumes were recorded at rest and during exercise (incremental cycle ergometry), before and after surgery in conjunction with spirometry. Results: Our results shows that the end expiratory volume (EEV) in these patients increased by 14 ± 0.4% compared to quiet breathing during maximal exercise before surgery (P < 0.002). This air trapping during exercise or dynamic hyperinflation was corrected after surgery. Postoperatively their EEV decreased during 100% exercise by 2.3 ± 1.4% at 5 months respectively (P 0.001). The end inspiratory volume did not change significantly. This was associated with a 38% increase in exercise time 5 months after surgical correction (P< 0.05). Conclusions: This is the first published data to show dynamic hyperinflation in pectus carinatum patients and the beneficial effects of corrective surgery. This was associated with a significant improvement in exercise capacity after surgery. Therefore, we conclude that improvement in exercise capacity early after surgery is likely due to correction of dynamic hyperinflation. The longer term effects on chest wall function are yet to be defined. Disclosure: No significant relationships.