Prediction of Postoperative Complications: Ventilatory Efficiency and Rest End-tidal Carbon Dioxide

Brat, Kristián; Homolka, Pavel; Merta, Zdeněk; Chobola, Miloš; Heroutová, Michaela; Bratová, Monika; Mitáš, Ladislav; Chovanec, Zdeněk; Horváth, Theodor; Benej, Michal; Ivičič, Jaroslav; Svoboda, Michal; Šrámek, Vladimír; Olson, Lyle J.; Čundrle, Ivan

doi:10.1016/j.athoracsur.2021.11.073

Cited by 9 publications

(27 citation statements)

References 22 publications

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“…Data from 353 lung resection surgery candidates from our previous study [10] were analyzed. Thirty patients (9%) developed pulmonary complications only and were excluded; 78 patients (22%) developed cardiovascular complications and 245 patients (69%) had no complications.…”

Section: Resultsmentioning

confidence: 99%

“…This is a post-hoc analysis of a previously published prospective multicenter study which evaluated pre-operative rest ventilatory parameters as predictors of post-operative pulmonary complications in lung resection candidates [10]. All of the included patients underwent preoperative CPET and pulmonary function tests.…”

Section: Methodsmentioning

confidence: 99%

“…V E /VCO 2 slope is determined by ventilatory control impairment [6] suggesting it may be a parameter which is predictive of post-operative pulmonary complications. Indeed, several studies have previously shown its superiority to peak VO 2 [4,5,10,14,24,25]. However,…”

Section: Plos Onementioning

confidence: 99%

“…Exercise capacity was assessed by CPET as described previously [10]. Subjects underwent preoperative CPET (symptom-limited) using a bicycle ergometer (Ergoline, Ergometrics 800 1 , Bitz, Germany).…”

Section: Cardiopulmonary Exercise Testingmentioning

confidence: 99%

“…Pulmonary complications were assessed as previously described by our group [10] and others [4,14] and included pneumonia; atelectasis; respiratory failure requiring mechanical ventilation; adult respiratory distress syndrome and tracheostomy. ICU length of stay (LOS), hospital LOS and 30-day mortality were also monitored.…”

Section: Pulmonary Complicationsmentioning

confidence: 99%

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Ventilatory efficiency is superior to peak oxygen uptake for prediction of lung resection cardiovascular complications

et al. 2022

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Introduction Ventilatory efficiency (VE/VCO2 slope) has been shown superior to peak oxygen consumption (VO2) for prediction of post-operative pulmonary complications in patients undergoing thoracotomy. VE/VCO2 slope is determined by ventilatory drive and ventilation/perfusion mismatch whereas VO2 is related to cardiac output and arteriovenous oxygen difference. We hypothesized pre-operative VO2 predicts post-operative cardiovascular complications in patients undergoing lung resection. Methods Lung resection candidates from a published study were evaluated by post-hoc analysis. All of the patients underwent preoperative cardiopulmonary exercise testing. Post-operative cardiovascular complications were assessed during the first 30 post-operative days or hospital stay. One-way analysis of variance or the Kruskal–Wallis test, and multivariate logistic regression were used for statistical analysis and data summarized as median (IQR). Results Of 353 subjects, 30 (9%) developed pulmonary complications only (excluded from further analysis), while 78 subjects (22%) developed cardiovascular complications and were divided into two groups for analysis: cardiovascular only (n = 49) and cardiovascular with pulmonary complications (n = 29). Compared to patients without complications (n = 245), peak VO2 was significantly lower in the cardiovascular with pulmonary complications group [19.9 ml/kg/min (16.5–25) vs. 16.3 ml/kg/min (15–20.3); P<0.01] but not in the cardiovascular only complications group [19.9 ml/kg/min (16.5–25) vs 19.0 ml/kg/min (16–23.1); P = 0.18]. In contrast, VE/VCO2 slope was significantly higher in both cardiovascular only [29 (25–33) vs. 31 (27–37); P = 0.05] and cardiovascular with pulmonary complication groups [29 (25–33) vs. 37 (34–42); P<0.01)]. Logistic regression analysis showed VE/VCO2 slope [OR = 1.06; 95%CI (1.01–1.11); P = 0.01; AUC = 0.74], but not peak VO2 to be independently associated with post-operative cardiovascular complications. Conclusion VE/VCO2 slope is superior to peak VO2 for prediction of post-operative cardiovascular complications in lung resection candidates.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%