Original articleGeneral thoracicMinute Ventilation-to-Carbon Dioxide Output (e/co2) Slope Is the Strongest Predictor of Respiratory Complications and Death After Pulmonary Resection
Section snippets
Patients and Methods
This was a prospective observational study of 225 consecutive candidates for lobectomy (197 patients) or pneumonectomy (28 patients) at our institution from 2008 to 2010. The study was approved by the local Institutional Review Board, and all patients gave their consent to participate in the institutional prospective database and use of their data for research and clinical purposes.
Patients were operated on by board-certified thoracic surgeons through a muscle-sparing, nerve-sparing lateral
Results
The characteristics of the study patients are reported in Table 1. The overall cardiopulmonary morbidity and mortality rates were 23% (51 cases) and 2.2% (5 cases). RCs were present in 25 patients (11%) and had a significantly higher e/co2 slope compared with those without complications (34.8 vs 30.9, p = 0.001). The 5 patients who died had a higher value of e/co2 slope than survivors (36.3 vs 31.2, p = 0.07). Unlike patients with RCs, patients with cardiac complications (mainly atrial
Comment
The CPET is increasingly used for stratifying the risk of lung resection candidates. A peak o2 below 10 mL/kg/min or 35% predicted value has been indicated as a prohibitive threshold for major anatomic resection [1]. Although peako2 is certainly the most widely used variable, CPET provides several other direct or indirect indicators that change in response to incremental workloads. This not only allows assessment of over-all cardiopulmonary reserves, but also, in case of a limitation of
References (16)
- et al.
Cardiopulmonary exercise testing and prognosis in chronic heart failure: a prognosticating algorithm for the individual patient
Chest
(2004) - et al.
Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison
Am Heart J
(2004) Breaking down barriers: helpful breakthrough statistical methods you need to understand better
J Thorac Cardiovasc Surg
(2001)- et al.
Bootstrap resampling method: something for nothing?
Ann Thorac Surg
(2004) - et al.
Internal validation of risk models in lung resection surgery: bootstrap versus training and test sampling
J Thorac Cardiovasc Surg
(2006) - et al.
Ventilatory response to exercise improves risk stratification in patients with chronic heart failure and intermediate functional capacity
Am Heart J
(2002) - et al.
The role of diffusing capacity and exercise tests
Thorac Surg Clin
(2008) - et al.
Clinical correlates and prognostic significance of the ventilatory response to exercise in CHF
J Am Coll Cardiol
(1997)
Cited by (82)
Performance Comparison of Pulmonary Risk Scoring Systems in Lung Resection
2023, Journal of Cardiothoracic and Vascular AnesthesiaHyperoxemia post thoracic surgery – Does it matter?
2023, HeliyonPrediction of Postoperative Complications: Ventilatory Efficiency and Rest End-tidal Carbon Dioxide
2023, Annals of Thoracic SurgeryCitation Excerpt :All tests were performed in accordance with the European Respiratory Society and the American Thoracic Society standards and technical requirements.12 Respiratory complications were prospectively assessed from the first 30 postoperative days or from the hospital stay and defined similar to prior studies:5,7 pneumonia (chest radiograph infiltrates + at least 2 other markers including: fever or leukocytosis/leukopenia or purulent sputum production); atelectasis (chest radiographic signs + bronchoscopy with plug being removed); respiratory failure requiring mechanical ventilation (noninvasive ventilation or tracheal intubation + invasive pulmonary ventilation); adult respiratory distress syndrome (bilateral chest x-ray film infiltrates not fully explained by cardiac failure or fluid overload + arterial partial pressure of oxygen/fraction of inspired oxygen <300); tracheostomy. Prolonged air leak is not consistently included in PPC and is considered a surgical complication by some authors.13
Perioperative cardiovascular pathophysiology in patients undergoing lung resection surgery: a narrative review
2023, British Journal of AnaesthesiaPreoperative cardiopulmonary exercise testing: physiological basis and investigation
2022, Surgery (United Kingdom)Citation Excerpt :The VE/VCO2 has been reported to be predictive of adverse outcomes in some but not all patient groups studied. Recent studies suggest the VE/VCO2 slope might be a better predictor of postoperative mortality and pulmonary complications than VO2peak after thoracic surgery, but this needs further consideration.16 Patients who are unable to complete the CPET due to physical or cognitive limitations are known to have poor outcomes even though the test has not been able to record any objective parameters.