Poor ventilatory efficiency during exercise may predict prolonged air leak after pulmonary lobectomy
| Autor: | Ladislav Mitáš, Michaela Heroutová, Lyle J. Olson, Miloš Chobola, Michal Benej, Kristián Brat, Ivan Čundrle, Pavel Homolka |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Lung Diseases
Male Pulmonary and Respiratory Medicine medicine.medical_treatment Pulmonary function testing 03 medical and health sciences Oxygen Consumption 0302 clinical medicine Predictive Value of Tests 030202 anesthesiology medicine Humans Prospective Studies Thoracotomy Pneumonectomy Dynamic hyperinflation Exercise Aged Thoracic Surgery Video-Assisted business.industry Odds ratio Middle Aged Prognosis Confidence interval Respiratory Function Tests Chest tube Clinical trial Logistic Models Chest Tubes 030220 oncology & carcinogenesis Anesthesia Exercise Test Female Surgery Pulmonary Ventilation Cardiology and Cardiovascular Medicine business Respiratory minute volume |
| Zdroj: | Interactive CardioVascular and Thoracic Surgery. |
| ISSN: | 1569-9285 0349-8352 |
| DOI: | 10.1093/icvts/ivz255 |
| Popis: | Poor ventilatory efficiency, defined as the increase in minute ventilation relative to carbon dioxide production during exercise (VE/VCO2 slope), may be associated with dynamic hyperinflation and thereby promote the development of prolonged air leak (PAL) after lung resection. Consecutive lung lobectomy candidates (n = 96) were recruited for this prospective two-centre study. All subjects underwent pulmonary function tests and cardiopulmonary exercise testing prior to surgery. PAL was defined as the presence of air leaks from the chest tube on the 5th postoperative day and developed in 28 (29%) subjects. Subjects with PAL were not different in terms of age, sex, American Society of Anesthesiologists class, type of surgery (thoracotomy/video-assisted thoracoscopic surgery) and site of surgery (right/left lung; upper/lower lobes). Subjects with PAL had more frequent pleural adhesions (50% vs 21%; P = 0.006) and steeper VE/VCO2 slope (35 ± 7 vs 30 ± 5; P = 0.001). Stepwise logistic regression showed that only the presence of pleural adhesions [odds ratio (OR) 3.9, 95% confidence interval (CI) 1.4–10.9; P = 0.008] and VE/VCO2 slope (OR 1.1, 95% CI 1.0–1.2; P = 0.003) were independently associated with PAL (AUC 0.74, 95% CI 0.62–0.86). We conclude that a high VE/VCO2 slope during exercise may be helpful in identifying patients at greater risk for the development of PAL after lung lobectomy. Clinical trial registration number: ClinicalTrials.gov identifier: NCT03498352. |
| Databáze: | OpenAIRE |
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