Der Lungenkreislauf als leistungsbegrenzender Faktor bei Patienten

Keller, Rainer; Kopp, C.; Zutter, W; Mlczoch, J; Herzog, H.

doi:10.1007/978-3-662-25411-0_4

Cited by 6 publications

(2 citation statements)

References 13 publications

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“…The elevation of PAPm with increasing exercise levels and CO is dependent on age [20,88]. Older subjects have a significantly steeper PAPm/CO slope than younger subjects, even if they are apparently healthy [87,88,[103][104][105][106][107][108]. This can be explained partly by a steeper PAWP/CO slope, which corresponds to changed diastolic characteristics of the left ventricle during exercise [87] and potentially by decreased resistive vessel distensibility.…”

Section: Exercise Haemodynamics In Healthy Subjects; the Recognition mentioning

confidence: 99%

An official European Respiratory Society statement: pulmonary haemodynamics during exercise

et al. 2017

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There is growing recognition of the clinical importance of pulmonary haemodynamics during exercise, but several questions remain to be elucidated. The goal of this statement is to assess the scientific evidence in this field in order to provide a basis for future recommendations.Right heart catheterisation is the gold standard method to assess pulmonary haemodynamics at rest and during exercise. Exercise echocardiography and cardiopulmonary exercise testing represent non-invasive tools with evolving clinical applications. The term "exercise pulmonary hypertension" may be the most adequate to describe an abnormal pulmonary haemodynamic response characterised by an excessive pulmonary arterial pressure (PAP) increase in relation to flow during exercise. Exercise pulmonary hypertension may be defined as the presence of resting mean PAP <25 mmHg and mean PAP >30 mmHg during exercise with total pulmonary resistance >3 Wood units. Exercise pulmonary hypertension represents the haemodynamic appearance of early pulmonary vascular disease, left heart disease, lung disease or a combination of these conditions. Exercise pulmonary hypertension is associated with the presence of a modest elevation of resting mean PAP and requires clinical follow-up, particularly if risk factors for pulmonary hypertension are present. There is a lack of robust clinical evidence on targeted medical therapy for exercise pulmonary hypertension.

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Section: Exercise Haemodynamics In Healthy Subjects; the Recognition mentioning

confidence: 99%

An official European Respiratory Society statement: pulmonary haemodynamics during exercise

et al. 2017

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“…KELLER et al [55] found that patients with a preoperative Ppa >30 mmHg on 40 W steady-state exercise developed pulmonary artery hypertension (PAH) limiting exercise 1 yr after pneumonectomy. TAUBE and KONIETZKO [72], on the other hand, did not find significant PAH 6 months postoperatively, independent of the extent of resection.…”

Section: Pulmonary Haemodynamicsmentioning

confidence: 99%

Functional evaluation of the lung resection candidate

Bolliger¹,

Perruchoud²

1998

Eur Respir J

163

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Advances in operative technique and perioperative care have considerably reduced surgical morbidity and mortality after pulmonary resections. Various single and combined parameters of functional operability have been proposed to assess the surgical risk. Pulmonary function tests adequately assess the pulmonary risk, and baseline or stress electrocardiography, echocardiography and nuclear cardiac studies assess the cardiac risk.Patients with normal or only slightly impaired pulmonary function (forced expiratory volume in one second (FEV1) and transfer factor of the lung for carbon monoxide (TL,CO) ≥80% of predicted) and no cardiovascular risk factors can undergo pulmonary resections up to a pneumonectomy without further investigation. For others, exercise testing, pulmonary split-function studies, or a combination of these two methods are recommended. Exercise testing, most frequently performed as a symptom-limited test with the measurement of maximal oxygen uptake (V 'O 2 ,max), assesses both the pulmonary and cardiovascular reserves. A V'O 2 ,max of <10 mL·kg -1 ·min -1 is generally considered prohibitive for any resection, a value of >20 mL·kg -1 ·min -1 or >75% of predicted normal, safe for major resections. Split-function studies are radionuclide-based estimations of the predicted postoperative (ppo) values of various parameters. The currently used ppo-parameters are FEV1-ppo, TL,CO-ppo and, most recently, V'O 2 ,max-ppo. Suggested cutoff values for safe resection are: for FEV1-ppo and TL,CO-ppo ≥40% pred; and for V 'O 2 ,max ≥35% pred, combined with an absolute value of ≥10 mL·kg -1 ·min -1 . The lowest acceptable ppo-values will still have to be established by additional prospective studies.In the long-term, resections involving not more than one lobe usually lead to an early functional deficit followed by later recovery. The permanent functional loss in pulmonary function is small (≤10%) and exercise capacity is only slightly reduced or not at all. Pneumonectomy, on the other hand, leads to an early permanent loss of about 33% in pulmonary function and 20% in exercise capacity. Thus, pulmonary function tests alone overestimate the functional loss after lung resection. Eur Respir J 1998; 11: 198-212 The dramatic increase in the incidence of bronchogenic carcinoma has made this disease the most frequent malignancy worldwide. In industrialized nations, the majority of lung resection candidates suffer from bronchogenic carcinoma, whereas only some decades ago benign conditions, such as destroyed lung parenchyma after tuberculosis, had to be removed. The prognosis of bronchogenic carcinoma remains sombre as about 75-85% are inoperable at the time of diagnosis [1], and despite recent advances in chemo-and radiotherapy regimens, surgical resection remains the only curative form of treatment [2].Depending on their extent, pulmonary resections lead to permanent loss of pulmonary function. In healthy people, resections up to a pneumonectomy are tolerated remarkably well. Lung cancer patients, however, are...

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Pulmonale Hypertonie — Cor pulmonale

Bubenheimer¹

2004

Herzkrankheiten

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Der Lungenkreislauf als leistungsbegrenzender Faktor bei Patienten

Cited by 6 publications

References 13 publications

An official European Respiratory Society statement: pulmonary haemodynamics during exercise

An official European Respiratory Society statement: pulmonary haemodynamics during exercise

Functional evaluation of the lung resection candidate

Pulmonale Hypertonie — Cor pulmonale

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