The Role of Diffusing Capacity and Exercise Tests

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Beside pulmonary function tests, other measures of cardiopulmonary fitness have been shown to be useful for preoperative risk stratification. Reduced values of carbon monoxide lung diffusion capacity and its predicted postoperative value have been reported to be associated with postoperative complications and mortality. The most widely used low-technology exercise tests, which include 6 minutes of walking and stair climbing, have been reported to be valid predictors of complications. Patients with an impaired performance at these tests need to undergo a formal cardiopulmonary test with measurement of maximum oxygen consumption at cycle-ergometry or treadmill. Functional algorithms have been proposed that incorporate all these tests, with the aim to assist in defining the surgical risk.

Section snippets

Diffusion capacity

DLCO is a proxy measurement for alveolar oxygen exchange of atmospheric oxygen that capitalizes on carbon monoxide's (CO) strong affinity for hemoglobin. Patients inhale gas containing a known concentration of CO to total lung capacity, hold the breath for 10 seconds, and then completely exhale (forced vital capacity, or FVC). The calculated difference in CO concentration yields the diffusing capacity. DLCO is influenced by the following variables: alveolar membrane area, the pressure of the

Exercise tests

Exercise testing is increasingly used to assess the aerobic reserve of lung resection candidates. These tests have the capability to assess the oxygen transport system in its wholeness and to detect possible deficits that may predispose to postoperative complications. Patients with marginal aerobic reserve have greater difficulty handling the multiple pathophysiologic changes that accompany major surgical procedures [25]. In fact, in the normal postoperative period, a rise in oxygen consumption

Algorithm for the assessment of cardio-pulmonary reserves

Although VO2max is the single most potent parameter to assess cardiopulmonary reserves, it is not recommended as the sole parameter overruling all others. On the one hand, the vast majority of lung resection candidates qualify for safe resections up to a pneumonectomy, measuring simple spirometry and the diffusing capacity, taking their respective ppo-values into consideration, combined with low-technology exercise tests as discussed above. On the other hand, CPET, with its high technology

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