Lung volume reduction by bronchoscopic administration of steam. 2010

Michael J Emery, and Randy L Eveland, and Kelly Eveland, and Laurent L Couetil, and Jacob Hildebrandt, and Erik R Swenson
Veterans Affairs Puget Sound Health Care System and Seattle Institute for Biomedical and Clinical Research, Seattle, Washington, USA. mjemery@u.washington.edu

BACKGROUND At present, bronchoscopic approaches to lung volume reduction (LVR) create airway obstruction to achieve parenchyma collapse, avoiding many risks of surgical LVR. However, LVR by these methods is limited by temporary or incomplete collapse and/or residual atelectatic and scarred tissue volumes. Heat-induced ablation of lung tissue is currently under investigation as an alternative LVR methodology. OBJECTIVE We hypothesized that bronchoscopic steam injection can produce safe and effective LVR, and explored potential mechanisms for the effects. METHODS Steam treatments were applied bilaterally to six cranial lobe segments of large dogs. For series 1, 14 dogs received one of three target heat dose levels (1, 4, or 8 cal · ml⁻¹ segment volume), and then 3 months of follow-up including pulmonary function testing and monitoring for complications. For series 2, 12 dogs received a single target dose (4 cal · ml⁻¹) or sham, similar follow-up, and then assessment of lobar mass, volume, and blood flow. Vapor content of series 2 steam was 40% greater than for series 1 (similar heat dose) to attempt more peripheral heat delivery. RESULTS Nineteen of 20 treatment animals survived with minimal evidence of serious risks or reduced pulmonary function testing volumes, but 1 died from pneumothorax 5 days post-treatment. Postmortem processing of animals that survived as planned revealed obvious dose-dependent lobe reductions, additional evidence of risks, and blood flow reduction that occurred immediately post-treatment. CONCLUSIONS Bronchoscopic administration of steam is a potentially safe means to achieve LVR, but substantial risks are present and further research is recommended.

UI MeSH Term Description Entries
D008168 Lung Either of the pair of organs occupying the cavity of the thorax that effect the aeration of the blood. Lungs
D008279 Magnetic Resonance Imaging Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D011013 Pneumonectomy The excision of lung tissue including partial or total lung lobectomy. Bronchoscopic Lung Volume Reduction,Endoscopic Lung Volume Reduction,Lung Volume Reduction,Lung Volume Reduction Surgery,Partial Pneumonectomy,Partial Pneumonectomies,Pneumonectomies,Pneumonectomy, Partial,Reduction, Lung Volume,Volume Reduction, Lung
D011030 Pneumothorax An accumulation of air or gas in the PLEURAL CAVITY, which may occur spontaneously or as a result of trauma or a pathological process. The gas may also be introduced deliberately during PNEUMOTHORAX, ARTIFICIAL. Pneumothorax, Primary Spontaneous,Pressure Pneumothorax,Primary Spontaneous Pneumothorax,Spontaneous Pneumothorax,Tension Pneumothorax,Pneumothorax, Pressure,Pneumothorax, Spontaneous,Pneumothorax, Tension,Spontaneous Pneumothorax, Primary
D012129 Respiratory Function Tests Measurement of the various processes involved in the act of respiration: inspiration, expiration, oxygen and carbon dioxide exchange, lung volume and compliance, etc. Lung Function Tests,Pulmonary Function Tests,Function Test, Pulmonary,Function Tests, Pulmonary,Pulmonary Function Test,Test, Pulmonary Function,Tests, Pulmonary Function,Function Test, Lung,Function Test, Respiratory,Function Tests, Lung,Function Tests, Respiratory,Lung Function Test,Respiratory Function Test,Test, Lung Function,Test, Respiratory Function,Tests, Lung Function,Tests, Respiratory Function
D001921 Brain The part of CENTRAL NERVOUS SYSTEM that is contained within the skull (CRANIUM). Arising from the NEURAL TUBE, the embryonic brain is comprised of three major parts including PROSENCEPHALON (the forebrain); MESENCEPHALON (the midbrain); and RHOMBENCEPHALON (the hindbrain). The developed brain consists of CEREBRUM; CEREBELLUM; and other structures in the BRAIN STEM. Encephalon
D001999 Bronchoscopy Endoscopic examination, therapy or surgery of the bronchi. Bronchoscopic Surgical Procedures,Surgical Procedures, Bronchoscopic,Bronchoscopic Surgery,Surgery, Bronchoscopic,Bronchoscopic Surgeries,Bronchoscopic Surgical Procedure,Bronchoscopies,Surgeries, Bronchoscopic,Surgical Procedure, Bronchoscopic
D004285 Dogs The domestic dog, Canis familiaris, comprising about 400 breeds, of the carnivore family CANIDAE. They are worldwide in distribution and live in association with people. (Walker's Mammals of the World, 5th ed, p1065) Canis familiaris,Dog
D004562 Electrocardiography Recording of the moment-to-moment electromotive forces of the HEART as projected onto various sites on the body's surface, delineated as a scalar function of time. The recording is monitored by a tracing on slow moving chart paper or by observing it on a cardioscope, which is a CATHODE RAY TUBE DISPLAY. 12-Lead ECG,12-Lead EKG,12-Lead Electrocardiography,Cardiography,ECG,EKG,Electrocardiogram,Electrocardiograph,12 Lead ECG,12 Lead EKG,12 Lead Electrocardiography,12-Lead ECGs,12-Lead EKGs,12-Lead Electrocardiographies,Cardiographies,ECG, 12-Lead,EKG, 12-Lead,Electrocardiograms,Electrocardiographies, 12-Lead,Electrocardiographs,Electrocardiography, 12-Lead
D006358 Hot Temperature Presence of warmth or heat or a temperature notably higher than an accustomed norm. Heat,Hot Temperatures,Temperature, Hot,Temperatures, Hot

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