Changes in ventilatory and gas exchange pulmonary functions when the endobronchial valve block is effectively implanted to those with destructive pulmonary tuberculosis

Abstract

The objective of the study: to investigate ventilatory and gas exchange pulmonary functions in the patients with chronic destructive pulmonary tuberculosis after the successful endobronchial valve block.Subjects and methods. Data of 85 patients with chronic destructive pulmonary tuberculosis were analyzed; in all of them, cavities in the lungs were healed after the endobronchial valve block, which was confirmed by computed tomography. Of them, 45 were men and 40 were women at the age from 18 to 59 years old (the median age made 30.6± 8.8 years). When examining patients prior to implantation of the endobronchial valve block, 49 patients had normal ventilatory lung capacity (forced expiratory volume per second (FEV1) ≥ 80% due values), 17 patients suffered from moderate disorders (FEV1) made 79-60% due values), while 19 ones had severe disorders (FEV1 ≤ 59% due values). The data reflecting respiratory function and blood gases of all patients were compared before implantation of the endobronchial valve and in 7-10 days after its removal.Results. In the majority of patients (from 65.9 to 84.7% of patients depending on the parameter) with chronic destructive pulmonary tuberculosis in whom the endobronchial valve block was successful, after the endobronchial valve was removed, no changes in ventilatory and gas exchange functions were registered versus the initial ones. The remaining patients had moderate positive or negative changes. The most dynamic rates reflecting ventilatory and gas exchange lung functions were FEV1, vital capacity (VC), peak expiratory flow (PEF), РаО2 and РаСО2, which changed in 27-43% of patients (depending on the parameter).According to changes in the integral value of FEV1, ventilatory lung capacity deteriorated in 22.3% of patients and improved in 11.8% of them.VC increased in 22.3% of patients and reduced in 10.6% of them, which often promoted improvement of blood oxygenation rates: РаО2 increased in 25.9% and reduced in 8.2% of patients, SаO2 increased in 15.3%, and reduced in 3.5% of them. The level of PaCO2 increased in 7.0% of patients, and went down in 20.0% of them.After the successful endobronchial valve block, improvement of ventilatory lung capacity, determined by FEV1 increase, was more frequent in the patients who had it below the norm initially versus the normal level (23.4% versus 6.1%, p < 0.05), the same was observed in VC (47.3 and 14.3%, p < 0.05).If the endobronchial valve block is implanted for a longer period of time due to disseminated and severe tuberculosis, the frequency of positive changes of functional rates increases (according to values to FEV1, VC, Tiffeneau's test, PEF), as well as gas exchange parameters (according to РаО2, SаO2 and PaCO2). Should there be indications for implantation of the endobronchial valve block, it can promote not only the healing of cavities and tuberculous lesions, but result in certain improvement of respiratory and gas exchange functions.

Keywords

• вентиляционная и газообменная функции легких
• хронический деструктивный туберкулез легких
• эндоскопическая клапанная бронхоблокация