Lung Scanning and Exercise Testing for the Prediction of Postoperative Performance in Lung Resection Candidates at Increased Risk for Complications

Bolliger, Chris T.; Wyser, C; Roser, H.W.; Solèr, Markus; Perruchoud, André P.

doi:10.1378/chest.108.2.341

Cited by 183 publications

(104 citation statements)

References 18 publications

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“…Forty-three patients (16.3%) suffered severe cardio-respiratory complications: 29/186 patients (15.6%) after lobectomy/bilobectomy and 14/77 (18.2%) after pneumonectomy. These data were similar to previously reported by other authors [2,3,6].…”

Section: Resultssupporting

confidence: 93%

“…The assessment of the lower limit of surgical tolerance for lung resection in patients with non-small-cell lung cancer (NSCLC) remains difficult [1][2][3][4][5][6]. Although peak oxygen consumption (V' O2peak ) is the most used variable in the preoperative evaluation before lung resection, recently the ventilatory inefficiency (measured as the minute ventilation to CO 2 production ratio (V' E /V' CO2 slope) was considered as useful [7], or even the best [8] survival predictor after lung resection.…”

Section: Introductionmentioning

confidence: 99%

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Minute ventilation to carbon dioxide output (V’E/V’CO2 slope) is the strongest death predictor before larger lung resections

Torchio¹,

Mazzucco²,

Guglielmo³

et al. 2017

Monaldi Arch Chest Dis

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The minute ventilation to carbon dioxide (CO 2 ) production ratio (V' E /V' CO2 slope) was recently identified as a mortality predictor after lung surgery, but the effect of the resection extent was not taken into account. The aim of this study was to investigate the role of V' E /V' CO2 slope as preoperative mortality predictor depending on the type of surgery performed. Retrospective analysis was performed on 263 consecutive patients evaluated before surgery for lung cancer. Death within 30 days and serious respiratory complications were considered. Univariate and multivariate regression analyses were used to identify independent predictors of death. Lobectomy or bilobectomy were performed in 186 patients with 29/186 (15.6%) serious pulmonary complications and 6/186 (3.2%) deaths. Pneumonectomy was performed in 77 patients with 14/77 (18.2%) serious complications and 5/77 (6.5%) deaths. Considering the whole group, the peak oxygen consumption (V' O2peak, L/min; z=-2.66, p<0.008, OR 0.007) and V' E /V' CO2 slope (z=2.80, p<0.005, OR 1.14) were independent predictors of mortality whereas in pneumonectomies V' E /V' CO2 slope (z=2.34, p<0.02, OR 1.22) was the only independent predictor of mortality. High V' E /V' CO2 slope, age and low V' O2peak are predictors of death and severe complications after lung surgery. Before larger resections as pneumonectomies an increased V' E /V' CO2 slope represents the best mortality predictor.

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Section: Resultssupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Minute ventilation to carbon dioxide output (V’E/V’CO2 slope) is the strongest death predictor before larger lung resections

Torchio¹,

Mazzucco²,

Guglielmo³

et al. 2017

Monaldi Arch Chest Dis

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“…These authors were the first to use percentage of predicted values instead of absolute values. Subsequently, others have confirmed that perioperative risk increase substantially when the ppoFEV 1 is <40% of predicted normal (17)(18)(19)(20)(21)(22)(23).…”

Section: Pulmonary Function Evaluationmentioning

confidence: 95%

Preoperative functional workup for patients with advanced lung cancer

Brunelli

2016

J. Thorac. Dis.

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Locally advanced lung cancer remains a surgical indication in selected patients. This condition often demands larger resections. As a consequence preoperative functional workup is of paramount importance to stratify the risk and choose the most appropriate treatment. We reviewed the current evidence on functional evaluation with a special focus on specific aspects related to locally advanced lung cancer stages (i.e., risk after neoadjuvant treatment, pneumonectomy). Evidence is discussed to provide information that could assist clinicians in their preoperative workup of these challenging patients.

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“…Nevertheless, pneumonia and acute respiretory failure are the main causes of postoperative death in about 46% of patients [2]. Especially in patients with reduced forced expiratory volume at one second (FEV 1 ) and diffusing lung capacity for carbon monoxide (DL-CO), postoperative mortality and morbidity increases inversely proportional to lung function [3][4][5][6][7]. Non-invasive pressure support ventilation (NIPSV) is a mode of mechanical ventilation without endotracheal intubation [8].…”

Section: Introductionmentioning

confidence: 99%

“…Patients with indication for major lung resection and severe COPD are challenging in perioperative management [3]. Postoperative pneumonia and acute respiratory failure are main causes of death in patients with severe COPD [16].…”

Section: Introductionmentioning

confidence: 99%

Non-Invasive Pressure Support Ventilation in Major Lung Resection for High Risk Patients: Does It Matter?

Danner

Koerber²,

Emmert³

et al. 2012

OJTS

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Background and purpose: Patients with severely impaired pulmonary function have an increased operative risk for major lung resection. The clinical benefits of pre-and perioperative, non-invasive pressure support ventilation (NIPSV) have up to now not been extensively evaluated. Patients with severely reduced pulmonary function were investigated in this prospective and randomised single centre clinical trial. Methods: Standard pulmonary evaluation was performed in all patients before major lung resection. To predict postoperative pulmonary function, a lung perfusion-ventilation scan was carried out. All patients enrolled in the study were instructed preoperatively on how to use a NIPSV respirator. After lung resection patients were randomised either for continuation of NIPSV or for standard treatment. Results: Of the 52 patients assessed, 21 patients met the inclusion criteria for the study protocol. Predicted mean postoperative FEV 1 was 1.10 L (range 0.92 -1.27 L). Lobectomy was performed in 14 patients, pneumonectomy in 6 patients and a segmentectomy in 1 patient. No inhospital deaths occurred. Pulmonary complications (reintubation, pneumonia) were more frequent in the NIPSV group than in the control group (3 patients versus 1 patient), without statistical significance (p = 0.31). Conclusions: We observed no mortality and a low morbidity in this high risk group. Postoperative continuation of NIPSV had no beneficial effect on the clinical outcome. Preoperative conditioning with NIPSV, however, seems to be a suitable tool for patients with severely impaired pulmonary function. This study may serve therefore as basis for further investigations for the potential clinical benefits of prophylactic NIPSV in major lung surgery.

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Lung Scanning and Exercise Testing for the Prediction of Postoperative Performance in Lung Resection Candidates at Increased Risk for Complications

Cited by 183 publications

References 18 publications

Minute ventilation to carbon dioxide output (V’E/V’CO2 slope) is the strongest death predictor before larger lung resections

Minute ventilation to carbon dioxide output (V’E/V’CO2 slope) is the strongest death predictor before larger lung resections

Preoperative functional workup for patients with advanced lung cancer

Non-Invasive Pressure Support Ventilation in Major Lung Resection for High Risk Patients: Does It Matter?

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