Thursday, March 23, 2006

LVRS

Steve G. asks about lung volume reduction requirements. In a patient with heterogeneous emphysema in the upper lobes, what defines poor exercise tolerance? Is an exercise study necessary or can we use the 6 minute walk to evaluate? If so, how many meters would be considered poor?

5 comments - CLICK HERE to read & add your own!:

Baleeiro said...

I think you could use a 6-minute HW. How heterogeneous is it? Would he also benefit from a quantitative Q scan?

Eugene O said...

A low exercise capacity was defined as a maximal workload at or below the sex-specific 40th percentile (25 W for women and 40 W for men) on cycle ergometry in the NETT study.

Steve G. said...

But how can we extrapolate the NETT data (i.e. 40 W) to the 6 minute hall walk (or can we)? Seems like we should be able to use the 6 min HW instead of a full fledged exercise study to determine whether someone has poor exercise tolerance...

Jeff H said...

Currently, we can't extrapolate to a 6 minute hall walk, if you want to evaluate it based on the NETT criteria. As far as I know, those criteria have not been compared to the 6 MHW in the context of LVRS.

DKeena said...

At our center, a CPET is required, before and after a course of pulmonary rehab in order to assess candidacy (NETT criteria) for the procedure. My understanding is that candidates must meet the NETT criteria to qualify for Medicare reimbursement for the procedure.

I dont think there is a way to substitute 6MHW for the CPET at this point.