Assessment of Exercise Oxygen Consumption as Preoperative Criterion for Lung Resection

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Abstract

Determination of preoperative pulmonary function is crucial in avoiding complications from pulmonary resection. Many have employed static pulmonary function testing in an attempt to decrease morbidity and mortality from lung resections. The purpose of the present study was to correlate preoperative static pulmonary function, one-second forced expiratory volume (FEV1), and exercise O2 consumption (MVo2) with postoperative morbidity and mortality. Fifty consecutive patients underwent preoperative FEV1 and MVo2 determinations. A criterion for surgical resection included an FEV1 greater than 1.7 liters for pneumonectomy, greater than 1.2 liters for lobectomy, and greater than 0.9 liters for wedge resection. The surgeon was blinded as to the results of MVo2 studies. Mean age was 63.8 years (range, 47 to 76 years). There were 10 pneumonectomies, 28 lobectomies, and 12 wedge resections. Among the 50 surgical candidates selected solely on the standard FEV1 values, mortality was 4% (2/50) and morbidity, 12% (6/50). Stratification on the basis of exercise performance showed a 29% mortality (2/7) and a 43% morbidity (3/7) in patients with an MVo2 less than 10 ml/kg/min. Patients with an MVo2 less than 20 but greater than 10 ml/kg/min had a 10.7% morbidity (3/28), and there were no deaths. No patients with an MVo2 greater than 20 ml/kg/min sustained any morbidity or died (p < 0.001). We conclude that exercise is an important criterion in the preoperative evaluation of patients for pulmonary surgery. An MVo2 less than 10 ml/kg/min is associated with significant morbidity and mortality.

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      Citation Excerpt :

      Oxygen pulse at peak exercise was found to be associated with postoperative cardiac and pulmonary complications (Fang et al., 2013; Campione et al., 2010; Epstein et al., 1993), as well as with postoperative mortality (Fang et al., 2013). Oxygen uptake at the ventilatory anaerobic threshold normalized for body mass was associated with cardiac and pulmonary complications (Bechard and Wetstein, 1987; Nagamatsu et al., 2015) and postoperative mortality (Fang et al., 2013). The slope describing the relation between minute ventilation and carbon dioxide production (VE/VCO2-slope) was also associated with cardiac and pulmonary complications (Miyazaki et al., 2018; Shafiek et al., 2016) and postoperative mortality (Miyazaki et al., 2018).

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    Presented at the Thirty-third Annual Meeting of the Southern Thoracic Surgical Association, White Sulphur Springs, WV, Oct 30-Nov 1, 1986.

    Supported in part by Grant No. R23HL34515-01Al from the National Heart, Lung, and Blood Institute, Bethesda, MD, and the Veterans Administration Research Merit Review Award.

    We thank Debra Sweeney, Robin Parsons, Linda Faircloth, and Joyce Byrd for their excellent technical skills in preparing the patients, running the exercise protocol, collating the reams of data, and coordinating the collection of blood samples; Mrs. Donna Johnson, Mrs. Deborah H. White, and Mrs. Fay Akers for the superb secretarial support; and Ms. Deborah A. Ravin, Mr. Donald 8. Spragg, and the Department of Medical Media of the Hunter Holmes McGuire VA Medical Center for the excellent artistic and photographic assistance.

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