Hypercapnia as an absolute exclusion criteria for bronchoscopic lung volume reduction

Bronchoscopic lung volume reduction is a procedure that involves placement of valves into the lung to intentionally cause atelectasis to help with perfusion-ventilation matching. There are strict exclusion criteria, such as hypercapnia, that prevent patients from qualifying for the procedure based on the early trials. We present a case of a patient that became a candidate for the procedure after utilizing AVAPS after BPAP failed to lower his PCO2 to qualify for the procedure. Additionally, newer studies show that patients who are hypercapnic might benefit from the procedure to improve hypercapnia.