Figure 2 Left panel: The catheter inside the target lobe with the balloon dilated during the procedure. Right panel: The vapour catheter distally from
the target lobe, and the ablated area
Bronchoscopic
thermal ablation
for emphysema
is easily
applicable in
selected patients;
the procedure
is minimally
invasive and the
main advantage
is fewer adverse
effects compared
with other
endoscopic
modalities
observed was modest and therefore a higher dose
would be possible. 7 Some words regarding the
system. The system comprises a vapour generator
and a vapour catheter (Figures 1 and 2). The
vapour generator is an electronically controlled
pressure vessel that generates and delivers precise
amounts of energy as a heated vapour through
the vapour (balloon) catheter and into a targeted
lung segment (Figure 2). The BTVA procedure is
performed in an operating room or advanced
bronchoscopic suite suite under general
anaesthesia with jet-ventilation respiratory
model. However; the respiratory model can
change from one patient to another. The vapour
catheter is introduced through the bronchoscope
into the targeted lung segment selected for
treatment, where an occlusion balloon is then
inflated and the pre-determined vapour dose (10
cal/g-1 tissue) is delivered. A high resolution CAT
scan is performed at full inspiration and scans are
obtained at pre-treatment, and at three and six
months post-treatment. The total air volume of
the target lobe is calculated at each time-point,
and the change in air volume is related to
pre-treatment (lobar volume reduction (LoVR))
and expressed as a percentage of pre-treatment
volume. In addition to the imaging efficacy
end-points, the BODE (body mass index, airflow
obstruction, dyspnoea and exercise capacity)
index are calculated for each patient. 8 All patients
are monitored in the hospital for a minimum of
24 h following BTVA. After discharge, patients
return to their home and have a close follow-up
12
HHE 2019 | hospitalhealthcare.com
visits at one, two and four weeks, and then at
three and six months. Serious adverse events are
defined as those that are either fatal, life-
threatening, requiring or prolonging
hospitalisation, or resulting in persistent or
significant disability or incapacity. Upon
follow-up, a number of tests are performed
including: laboratory tests that include complete
blood count, biochemistry and non-specific
inflammatory markers such as erythrocyte
sedimentation rate and C-reactive protein (C-RP).
Vital signs are also recorded during every visit.
The mean procedure time is usually 29 min
(range 12–58 min). Procedures are usually
well-tolerated with most of the patients being
discharged from the hospital within 24 hours.
Until now there are no data for patients that
required mechanical ventilation beyond the
procedure time. The average lobe volume loss
from baseline in the treated lobes was
717.6 ± 78.8ml at three months and
715.5 ± 99.4ml at six months (p=0.001). This
volume represents a 48% reduction in lobar
volume in a recent reported study. It has been
observed that the volume differences at six
months are similar to those observed at three
months. Compensatory hyperinflation of the
contralateral lung has not been observed mainly
due to the slow process of remodelling. Current
data indicate that mean ± SE improvement in
FEV1 has been observed at 139.1 ± 27.2ml (17%)
at three months and 140.8 ± 26.3ml (17%) at six
months (p=0.001). The mean ± SE improvement