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Coil Associated Inflammatory Response Syndrome (CAIRS) Following Endoscopic Lung Volume Reduction with Endobronchial Coils in Severe Emphysema
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A1726 - Coil Associated Inflammatory Response Syndrome (CAIRS) Following Endoscopic Lung Volume Reduction with Endobronchial Coils in Severe Emphysema
Author Block: G. C. Michaud1, C. Carbone2, F. C. Sciurba3, C. Marquette4, G. Deslee5; 1Pulmonary, Critical Care and Thoracic Surgery, NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States, 2Yale University School of Medicine, New Haven, CT, United States, 3Univ of Pittsburgh Med Ctr, Pittsburgh, PA, United States, 4Univewrsity Nice, Nice, France, 5Hopital de la Maison Blanche, Reims, France.
Introduction: The efficacy and safety of endobronchial coil placement to achieve lung volume reduction in patients with severe emphysema has been demonstrated in REVOLENS and RENEW trials. Non-infectious lung opacification in the treated area, defined by imaging studies, has been designated as coil-associated opacity (CAO). Post-hoc subgroup analysis demonstrated potential association between CAO and a more robust physiologic and clinical response. Aims and Objectives: We sought to further characterize the clinical profile (CAIRS) heralding the development of CAO.
Methods: Retrospective review of prospectively collected adverse events reported in RENEW was conducted by 2 independent reviewers blinded to effectiveness outcomes. Adverse event profiles including source records were reviewed and sequenced. Adverse events were categorized as definite, probable, unlikely and definitely not CAIRS. Results: 1,509 adverse events were reported in 155 patients in the treatment arm of RENEW. A recurrent pattern of an early tension event (chest pain, hemoptysis and/or pneumothorax) followed by increased respiratory symptoms and then opacification surrounding coils was identified, CAIRS. 16, 53, 72 and 14 patients had adverse event sequences consistent with confirmed, probable, unlikely and not CAIRS respectively. Median increase in 6MWT distance was 21m in subjects with confirmed CAIRS. Improvement in 6MWT in CAIRS subjects was associated with increased lung volume reduction (RV decrease 880ml and VC increase of 370ml). SGRQ improved 17 points (IQR -22, -7) and MMRC 1.5 points (IQR -2, -1). All responses are greater than median responses in the overall trials.
Conclusions: Patients developing CAIRS demonstrate greater improvement in physiologic and quality of life measures associated with marked volume reduction. Recurrent respiratory symptoms and multiple courses of steroids may impact on physiologic response. A prospective study is needed to further elucidate predictors of CAIRS as well as potential precipitating and mitigating factors.
Author Block: G. C. Michaud1, C. Carbone2, F. C. Sciurba3, C. Marquette4, G. Deslee5; 1Pulmonary, Critical Care and Thoracic Surgery, NYU Langone Medical Center, NYU School of Medicine, New York, NY, United States, 2Yale University School of Medicine, New Haven, CT, United States, 3Univ of Pittsburgh Med Ctr, Pittsburgh, PA, United States, 4Univewrsity Nice, Nice, France, 5Hopital de la Maison Blanche, Reims, France.
Introduction: The efficacy and safety of endobronchial coil placement to achieve lung volume reduction in patients with severe emphysema has been demonstrated in REVOLENS and RENEW trials. Non-infectious lung opacification in the treated area, defined by imaging studies, has been designated as coil-associated opacity (CAO). Post-hoc subgroup analysis demonstrated potential association between CAO and a more robust physiologic and clinical response. Aims and Objectives: We sought to further characterize the clinical profile (CAIRS) heralding the development of CAO.
Methods: Retrospective review of prospectively collected adverse events reported in RENEW was conducted by 2 independent reviewers blinded to effectiveness outcomes. Adverse event profiles including source records were reviewed and sequenced. Adverse events were categorized as definite, probable, unlikely and definitely not CAIRS. Results: 1,509 adverse events were reported in 155 patients in the treatment arm of RENEW. A recurrent pattern of an early tension event (chest pain, hemoptysis and/or pneumothorax) followed by increased respiratory symptoms and then opacification surrounding coils was identified, CAIRS. 16, 53, 72 and 14 patients had adverse event sequences consistent with confirmed, probable, unlikely and not CAIRS respectively. Median increase in 6MWT distance was 21m in subjects with confirmed CAIRS. Improvement in 6MWT in CAIRS subjects was associated with increased lung volume reduction (RV decrease 880ml and VC increase of 370ml). SGRQ improved 17 points (IQR -22, -7) and MMRC 1.5 points (IQR -2, -1). All responses are greater than median responses in the overall trials.
Conclusions: Patients developing CAIRS demonstrate greater improvement in physiologic and quality of life measures associated with marked volume reduction. Recurrent respiratory symptoms and multiple courses of steroids may impact on physiologic response. A prospective study is needed to further elucidate predictors of CAIRS as well as potential precipitating and mitigating factors.
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