difficult patient recruitment

Endoscopic valve therapy is an effective therapy for patients with severe emphysema and low interlobar collateral ventilation. Although, valve therapy is a minimal-invasive treatment approach, it is associated with complications the most common of which is pneumothorax with a rate of 18-25%. Modifying post-operative medical care including bed rest for 48 hours after valve implantation may reduce the risk of post-interventional pneumothorax.

Patient enrolment and data acquisition is to be carried out on a prospective basis. It is planned to enrol a total of 130 patients with advanced emphysema and low collateral ventilation. Patients will be randomly assigned in a 1:1 ratio to receive modified medical care including a 48 bed rest or standard medical care following valve implantation. All patients will undergo treatment at one study centre in Heidelberg.

Inclusion Criteria:

• FEV1 < 50%, RV>150%, TLC>100%
• emphysema confirmed by computed tomography
• pO2 >60 mmHg (with supplemental oxygen), pCO2 < 55 mmHg (room condition)
• no significant collateral ventilation (assessed by fissure analysis and/or catheter-based measurement)
• no COPD exacerbation within the past 8 weeks
• daily use of < 20 mg Prednisolon
• non-smoking for a minimum of 4 months prior to consent
• Patient has provided written informed consent

Exclusion Criteria:

• BMI < 18 kg/m²
• clinically relevant bronchiectasis
• failed cardiac clearance: defined as myocardial infarction within last 6 weeks, decompensation of heart failure
• Prior lung resection (e.g. lobectomy)