The Role of Diffusing Capacity and Exercise Tests
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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Cited by (28)
Can we predict morbidity and mortality before an operation?
2013, Thoracic Surgery ClinicsVariations in the vascular endothelial growth factor pathway predict pulmonary complications
2012, Annals of Thoracic SurgeryCitation Excerpt :This significant dose-response relationship was also evident in the replication population (p-trend < 0.01), and in the pooled population (Table 3). A number of clinical factors may be used to assess risk and select patients for pulmonary resection [2–5, 17]. Despite the use of these factors, it is often difficult to predict which patients will have postoperative pulmonary complications.
Functional Evaluation before Lung Resection
2011, Clinics in Chest MedicineCitation Excerpt :Technical aspects regarding ppo calculations are discussed later in this article. The DLCO is a proxy measurement of alveolar oxygen exchange.34 As early as 1963, Cander35 suggested that a value of less than 50% of predicted precluded pulmonary resections.