Diffusing capacity predicts morbidity and mortality after pulmonary resection

Ferguson, Mark K.; Little, Louise; Rizzo, Louis; Popovich, K. J.; Glonek, Garique F.; Leff, Alan R.; Manjoney, Deborah L.; Little, Alex G.

doi:10.1016/s0022-5223(19)35157-8

Cited by 262 publications

(73 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In other studies, there was disagreement about the relationship of a low DLCO to postoperative mortality. Four studies showed a relationship between impaired DLCO and postoperative mortality [5][6][7][8], while two did not show such a relationship [9,23]. This difference may be due to the different patient populations studied, the differences in extent of resection, and possibly the differences in surgical, anesthetic, and critical care techniques used in the different centers.…”

Section: Discussionmentioning

confidence: 99%

“…Newer tests such as pulmonary hemodynamic measurements are not widely used because they are expensive and labor intensive, and few data are available to assess their accuracy. The recent literature clearly demonstrates that DLCO is an important predictor of morbidity and mortality [5][6][7][8]. DLCO reflects pulmonary alveolar-capillary surface area and pulmonary capillary blood volume, provided that it is corrected for any decrease in hemoglobin content.…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative pulmonary function testing usually includes spirometry, lung volumes, diffusing capacity, oximetry, and arterial blood gases, and may include, in selected cases, radionuclide lung scanning, exercise testing, invasive pulmonary hemodynamic measurements, and risk stratification analysis. The single breath diffusing capacity of the lung for carbon monoxide (DLCO) has recently been shown to be an independent predictor of postoperative outcome, including mortality and postoperative complications [5][6][7][8]. Patients with low DLCO (= 60% predicted for pneumonectomy or bilobectomy, = 50% predicted for lobectomy) underwent major pulmonary resection with an increased respiratory complication rate [9].…”

mentioning

confidence: 99%

See 2 more Smart Citations

Relationship of Carbon Monoxide Pulmonary Diffusing Capacity to Postoperative Cardiopulmonary Complications in Patients Undergoing Pneumonectomy

Wang

2003

The Kaohsiung J of Med Scie

View full text Add to dashboard Cite

This retrospective analytic study evaluated whether abnormal diffusing capacity for carbon monoxide (DLCO) is a predictor of postoperative morbidity and mortality in patients undergoing pneumonectomy for lung cancer. The medical records of patients undergoing pneumonectomy at Vancouver General Hospital between January 1992 and December 1997 were reviewed. Postoperative complications occurring within 30 days of resection were classified into mortality, and cardiovascular, pulmonary, and technical complications. A total of 151 pneumonectomy cases were reviewed. There were 100 men (66%) and 51 women (34%) with a mean age of 61 years. Complications occurred in 73 patients (48%), including mortality in eight (5%), cardiovascular morbidity in 50 (33%), pulmonary morbidity in 30 (20%), and technical morbidity in 22 (15%). Arrhythmia (21%) and pulmonary edema (13%) were the two major cardiovascular complications. Patients with complications had a greater smoking history, a longer hospital stay, a lower forced expiratory volume in 1 second (FEV1), a lower FEV1/forced vital capacity (FVC) ratio, a lower DLCO, and a lower DLCO/alveolar volume (VA) ratio than patients without complications. A DLCO of 70% predicted was the best functional predictor of postoperative complications, with a complication rate of 94% in patients with a DLCO of less than 70% predicted compared with 27% in patients with a DLCO of at least 70% predicted (sensitivity, 62%; specificity, 96%). However, technical morbidity was not related to preoperative lung function variables, including DLCO. Patients with a DLCO of at least 70% predicted had a low postpneumonectomy complication rate. Although cardiac arrhythmia was the major cause of morbidity, pulmonary edema was the major cause of mortality.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Relationship of Carbon Monoxide Pulmonary Diffusing Capacity to Postoperative Cardiopulmonary Complications in Patients Undergoing Pneumonectomy

Wang

2003

The Kaohsiung J of Med Scie

View full text Add to dashboard Cite

show abstract

“…The questionnaire was designed to measure the strength of preferences that patients assign to potential outcomes of lung cancer surgery. Standard gamble scenarios were used to describe traditional outcomes after lung surgery such as atelectasis, pneumonia, and prolonged mechanical ventilation, [12][13][14][15][16][17][18][19] as well as specific limitations of physical function. The functional states of interest included mobility limited to bed-to-chair, restrictions of activities of daily living, and mandatory nursing home placement.…”

Section: Methodsmentioning

confidence: 99%

Racial differences in patients’ perceptions of debilitated health states

et al. 1999

View full text Add to dashboard Cite

OBJECTIVE:To determine health utility scores for specific debilitated health states and to identify whether race or other demographic differences predict significant variation in these utility scores. DESIGN: Utility analysis.SETTING: A community hospital general internal medicine clinic, a private internal medicine practice, and a private pulmonary medicine practice. PARTICIPANTS:Sixty-four consecutive patients aged 50 to 75 years awaiting appointments. In order to participate, patients at the pulmonary clinic had to meet prespecified criteria of breathing impairment. MEASUREMENTS:

show abstract

“…Although it is not possible to recalculate percent predicted values from published data on absolute values, an FEV 1 of Ͼ 80% predicted has been accepted as indicating that the patient should be considered suitable to undergo pneumonectomy without further evaluation. 58 Interest in the diffusing capacity of the lung for carbon monoxide (Dlco) as a useful marker of operative risk was stimulated by Ferguson et al 59 who related preoperative Dlco to postresection morbidity and mortality in 237 patients. Patients were selected for surgery on the basis of clinical evaluation and spirometry, but not the Dlco, which was also measured.…”

Section: Smentioning

confidence: 99%