TABLE 1.
CRITERIA FOR DETERMINATION OF CANDIDACY FOR LUNG VOLUME REDUCTION SURGERY
| Criteria | Good Candidates | Poor Candidates |
|---|---|---|
| History and physical examination | Age < 75 yr | Age ⩾ 75 yr |
| Emphysema by clinical evaluation | History of recurrent bronchial infections with increased sputum production | |
| Ex-smoker > 4 mo* | Cardiovascular comorbidities including significant coronary artery disease, recent MI, CHF, or uncontrolled hypertension or arrhythmias | |
| Clinically stable on no more than 20 mg prednisone daily | Pulmonary hypertension at rest | |
| Significant functional limitation after 6–12 wk of pulmonary rehabilitation on optimal medical therapy | Nonpulmonary comorbidities causing significant functional limitation (morbid obesity†) or that could limit survival (e.g., cancer) | |
| Demonstrated compliance with medical regimen | History of thoracic surgery or chest wall deformity that could interfere with pulmonary resection | |
| Laboratory evaluation | Post-bronchodilator FEV1 ⩽ 45% predicted for all ages and ⩾15% if age ⩾70 yr | FEV1 ⩽ 20% predicted and either DlCO ⩽ 20% predicted or homogeneous distribution of emphysema on HRCT scan |
| Hyperinflation demonstrated by TLC ⩾ 100% predicted and RV ⩾ 150% predicted | Non–upper-lobe distribution of emphysema with high‡ exercise capacity postrehabilitation (demonstrated by maximal achieved cycle ergometry watts) | |
| Postrehabilitation 6MWD > 140 m | Significant pleural or interstitial changes on HRCT | |
| Low‡ postrehabilitation exercise capacity (demonstrated by maximal achieved cycle ergometry watts) | ||
| HRCT demonstrating bilateral severe emphysema, ideally with upper-lobe predominance |
Definition of abbreviations: CHF = congestive heart failure; DlCO = carbon monoxide diffusing capacity; HRCT = high-resolution computerized tomography; MI = myocardial infarction; RV = residual volume; 6MWD = six-minute-walk distance; TLC = total lung capacity.
Plasma cotinine level ⩽ 13.7 ng/ml (or arterial carboxyhemoglobin ⩽ 2.5% if using nicotine products) is considered evidence that the patient is a nonsmoker.
Body mass index > 31.1 kg/m2 (men) or > 32.3 kg/m2 (women) is considered evidence of morbid obesity.
Low exercise capacity is defined as a postrehabilitation maximal workload at or below the sex-specific 40th percentile (25 W for women and 40 W for men); high exercise capacity is defined as a workload above this threshold.