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Bar-On O, Goldberg O, Stafler P, Levine H, Jacobi E, Shmueli E, Rothschild B, Prais D, Mei-Zahav M. Wearing face masks while climbing stairs influences respiratory physiology. J Breath Res 2024; 18:036002. [PMID: 38631331 DOI: 10.1088/1752-7163/ad3fde] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 04/17/2024] [Indexed: 04/19/2024]
Abstract
During the COVID-19 pandemic wearing face masks was mandatory. Nowadays, face masks are still encouraged indoors, especially in hospitals. People climbing stairs with masks describe unpredictable dyspnea. In this study, healthy adults climbed 5 floors with and without a mask. Various cardio-respiratory parameters were measured, including O2-saturation (O2-Sat) and end-tidal CO2(EtCO2), at baseline and on the top floor. Subjective indexes, such as Borg's scale, were evaluated. Thirty-two volunteers (16 males), median age 39 years (IQR 32.5-43), median BMI = 23.6 (IQR 21.5-25.1), with good fitness levels, participated. Comparing baseline to end-activity, median (IQR): O2-Sat change was -1.0% (-2-0) without mask, versus -3.0% (-4-0) with mask,p= 0.003; EtCO2+ 7.0 (+3.3-+9) without mask, versus +8.0 (+6-+12) with mask,p= 0.0001. Hypercarbia was seen in 5 (15.6%) participants without mask, median = 48 mmHg (IQR 47.5-51), and in 11 (34%) participants with mask, median = 50 mmHg (IQR 47-54),p< 0.001. Desaturation (O2-Sat < 95%) was seen in 5 (15.6%) participants without mask, median = 94% (IQR 93%-94%), and in 10 (31%) participants with mask, median = 91.5% (IQR 90%-93%),p= 0.06. Regression analysis demonstrated that only male sex was significantly associated with abnormal EtCO2(OR = 26.4, 95% CI = 1.9-366.4,p= 0.005). Ascent duration increased from median (IQR) of 94 s (86-100) without mask to 98 s (89-107) with mask,p< 0.001. Borg's scale of perceived exertion (range 0-10) increased from median (IQR) of 3.0 (2.5-3.87) without mask to 4.0 (3.0-4.37) with mask,p< 0.001. To conclude, during routine daily activities, such as stair-climbing, face masks cause dyspnea, and have measurable influences on ventilation, including true desaturation and hypercapnia, especially in males.
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Affiliation(s)
- Ophir Bar-On
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ori Goldberg
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
- Pediatric Pulmonary Service, Kaplan Medical Center (affiliated with the Faculty of Medicine, Hebrew University, Jerusalem, Israel), Rehovot, Israel
| | - Patrick Stafler
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Hagit Levine
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Eyal Jacobi
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Einat Shmueli
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ben Rothschild
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Dario Prais
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Meir Mei-Zahav
- Pulmonology Institute, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
- School of Medicine, Faculty of Medical and Health Sciences, Tel-Aviv University, Tel-Aviv, Israel
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2
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Arbee-Kalidas N, Moutlana HJ, Moodley Y, Kebalepile MM, Motshabi Chakane P. The association between cardiopulmonary exercise testing and postoperative outcomes in patients with lung cancer undergoing lung resection surgery: A systematic review and meta-analysis. PLoS One 2023; 18:e0295430. [PMID: 38060569 PMCID: PMC10703215 DOI: 10.1371/journal.pone.0295430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Exercise capacity should be determined in all patients undergoing lung resection for lung cancer surgery and cardiopulmonary exercise testing (CPET) remains the gold standard. The purpose of this study was to investigate associations between preoperative CPET and postoperative outcomes in patients undergoing lung resection surgery for lung cancer through a review of the existing literature. METHODS A search was conducted on PubMed, Scopus, Cochrane Library and CINAHL from inception until December 2022. Studies investigating associations between preoperative CPET and postoperative outcomes were included. Risk of bias was assessed using the QUIPS tool. A random effect model meta-analysis was performed. I2 > 40% indicated a high level of heterogeneity. RESULTS Thirty-seven studies were included with 6450 patients. Twenty-eight studies had low risk of bias. [Formula: see text] peak is the oxygen consumption at peak exercise and serves as a marker of cardiopulmonary fitness. Higher estimates of [Formula: see text] peak, measured and as a percentagege of predicted, showed significant associations with a lower risk of mortality [MD: 3.66, 95% CI: 0.88; 6.43 and MD: 16.49, 95% CI: 6.92; 26.07] and fewer complications [MD: 2.06, 95% CI: 1.12; 3.00 and MD: 9.82, 95% CI: 5.88; 13.76]. Using a previously defined cutoff value of > 15mL/kg/min for [Formula: see text] peak, showed evidence of decreased odds of mortality [OR: 0.55, 95% CI: 0.28-0.81] and but not decreased odds of postoperative morbidity [OR: 0.82, 95% CI: 0.64-1.00]. There was no relationship between [Formula: see text] slope, which depicts ventilatory efficiency, with mortality [MD: -9.60, 95% CI: -27.74; 8.54] however, patients without postoperative complications had a lower preoperative [Formula: see text] [MD: -2.36, 95% CI: -3.01; -1.71]. Exercise load and anaerobic threshold did not correlate with morbidity or mortality. There was significant heterogeneity between studies. CONCLUSIONS Estimates of cardiopulmonary fitness as evidenced by higher [Formula: see text] peak, measured and as a percentage of predicted, were associated with decreased morbidity and mortality. A cutoff value of [Formula: see text] peak > 15mL/kg/min was consistent with improved survival but not with fewer complications. Ventilatory efficiency was associated with decreased postoperative morbidity but not with improved survival. The heterogeneity in literature could be remedied with large scale, prospective, blinded, standardised research to improve preoperative risk stratification in patients with lung cancer scheduled for lung resection surgery.
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Affiliation(s)
- Nabeela Arbee-Kalidas
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hlamatsi Jacob Moutlana
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Yoshan Moodley
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Moses Mogakolodi Kebalepile
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Palesa Motshabi Chakane
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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3
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Wang Z, Zhang H, Huang C, Li K, Luo W, Zhang G, Li X. Predictive value of modified systemic inflammation score for postoperative unplanned ICU admission in patients with NSCLC. Front Surg 2022; 9:893555. [PMID: 35990092 PMCID: PMC9381959 DOI: 10.3389/fsurg.2022.893555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 07/18/2022] [Indexed: 01/17/2023] Open
Abstract
BackgroundThe purpose of this study was to investigate the predictive value of the modified systemic inflammation score (mSIS) in postoperative unplanned admission to the intensive care unit (ICU) in patients with non-small-cell lung cancer (NSCLC).MethodsThe clinical data of 1,321 patients with NSCLC treated with thoracic surgery in our hospital from August 2019 to June 2021 were analyzed retrospectively. The preoperative mSIS, which takes into account the serum albumin (ALB) level and lymphocyte-to-monocyte ratio (LMR), was recorded as 0, 1 or 2 and then was used to identify high-risk patients with unplanned admission to the ICU. The independent risk factors for unplanned admission to the ICU in patients with NSCLC after surgery were identified by multivariate logistic regression analysis.ResultsA total of 1,321 patients, including 549 (41.6%) males and 772 (58.4%) females, were included. The median age was 57 years (range 16–95 years). The incidence of unplanned admission to the ICU in patients with mSIS = 2 was significantly higher than that in those with mSIS = 0 and mSIS = 1. The multivariate analysis showed that an mSIS of 2 (OR = 3.728; P = 0.004; 95% CI, 1.520–9.143), an alcohol consumption history (OR = 2.791, P = 0.011; 95% CI, 1.262–6.171), intraoperative infusion volume (OR = 1.001, P = 0.021; 95% CI, 1.000–1.001) and preoperative underlying diseases (OR = 3. 57, P = 0.004; 95% CI, 1.497–8.552) were independent risk factors for unplanned admission to the ICU after lung cancer surgery. In addition, the multivariate logistic regression model showed that the C-statistic value was 0.799 (95% CI: 0.726∼0.872, P < 0.001).ConclusionsThe mSIS scoring system can be used as a simplified and effective predictive tool for unplanned ICU admission in patients with NSCLC.
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Affiliation(s)
- Zhulin Wang
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, ZhengzhouChina
| | - Hua Zhang
- Department of Cardiovascular surgery, Henan Provincial Chest Hospital, ZhengzhouChina
| | - Chunyao Huang
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, ZhengzhouChina
| | - Kaiyuan Li
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, ZhengzhouChina
| | - Wenqing Luo
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, ZhengzhouChina
| | - Guoqing Zhang
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, ZhengzhouChina
- Correspondence: Xiangnan Li Guoqing Zhang
| | - Xiangnan Li
- Department of Thoracic Surgery, First Affiliated Hospital of Zhengzhou University, ZhengzhouChina
- Correspondence: Xiangnan Li Guoqing Zhang
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4
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Steffens D, Ismail H, Denehy L, Beckenkamp PR, Solomon M, Koh C, Bartyn J, Pillinger N. Preoperative Cardiopulmonary Exercise Test Associated with Postoperative Outcomes in Patients Undergoing Cancer Surgery: A Systematic Review and Meta-Analyses. Ann Surg Oncol 2021; 28:7120-7146. [PMID: 34101066 PMCID: PMC8186024 DOI: 10.1245/s10434-021-10251-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/17/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUNDS There is mixed evidence on the value of preoperative cardiorespiratory exercise test (CPET) to predict postoperative outcomes in patients undergoing a cancer surgical procedure. The purpose of this review was to investigate the association between preoperative CPET variables and postoperative complications, length of hospital stay, and quality of life in patients undergoing cancer surgery. METHODS A search was conducted on MEDLINE, Embase, AMED, and Web of science from inception to April 2020. Cohort studies investigating the association between preoperative CPET variables, including peak oxygen uptake (peak VO2), anaerobic threshold (AT), or ventilatory equivalent for carbon dioxide (VE/VCO2), and postoperative outcomes (complications, length of stay, and quality of life) were included. Risk of bias was assessed using the QUIPS tool. A random-effect model meta-analysis was performed whenever possible. RESULTS Fifty-two unique studies, including 10,030 patients were included. Overall, most studies were rated as having low risk of bias. Higher preoperative peak VO2 was associated with absence of postoperative complications (mean difference [MD]: 2.28; 95% confidence interval [CI]: 1.26-3.29) and no pulmonary complication (MD: 1.47; 95% CI: 0.49-2.45). Preoperative AT and VE/VCO2 also demonstrated some positive trends. None of the included studies reported a negative trend. CONCLUSIONS This systematic review and meta-analysis demonstrated a significant association between superior preoperative CPET values, especially peak VO2, and better postoperative outcomes. The assessment of preoperative functional capacity in patients undergoing cancer surgery has the potential to facilitate treatment decision making.
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Affiliation(s)
- Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia. .,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia.
| | - Hilmy Ismail
- School of Health Sciences, The University of Melbourne, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Linda Denehy
- School of Health Sciences, The University of Melbourne, Melbourne, Australia.,Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Paula R Beckenkamp
- Faculty of Health Sciences, Discipline of Physiotherapy, Musculoskeletal Health, The University of Sydney, Sydney, Australia
| | - Michael Solomon
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
| | - Cherry Koh
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
| | - Jenna Bartyn
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia
| | - Neil Pillinger
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital (RPAH), Sydney, NSW, Australia.,Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, Australia
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5
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Associations between pretreatment physical performance tests and treatment complications in patients with non-small cell lung cancer: A systematic review. Crit Rev Oncol Hematol 2021; 158:103207. [PMID: 33383208 DOI: 10.1016/j.critrevonc.2020.103207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/16/2020] [Accepted: 12/20/2020] [Indexed: 12/25/2022] Open
Abstract
This systematic review evaluated which outcome variables and cut-off values of pretreatment exercise tests are associated with treatment complications in patients with stage I-III non-small cell lung cancer (NSCLC). PRISMA and Cochrane guidelines were followed. A total of 38 studies with adult patients undergoing treatment for stage I-III NSCLC who completed pretreatment exercise tests, and of whom treatment-related complications were recorded were included. A lower oxygen uptake at peak exercise amongst several other variables on the cardiopulmonary exercise test and a lower performance on field tests, such as the incremental shuttle walk test, stair-climb test, and 6-minute walk test, were associated with a higher risk for postoperative complications and/or postoperative mortality. Cut-off values were reported in a limited number of studies and were inconsistent. Due to the variety in outcomes, further research is needed to evaluate which outcomes and cut-off values of physical exercise tests are most clinically relevant.
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6
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Esmonde N, Rodan W, Haisley KR, Joslyn N, Carboy J, Hunter JG, Schipper PH, Tieu BH, Hansen J, Dolan JP. Treatment protocol for secondary esophageal reconstruction using 'supercharged' colon interposition flaps. Dis Esophagus 2020; 33:5810256. [PMID: 32193534 DOI: 10.1093/dote/doaa008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 01/06/2020] [Accepted: 01/28/2020] [Indexed: 12/11/2022]
Abstract
Locoregional esophageal cancer is currently treated with induction chemoradiotherapy, followed by esophagectomy with reconstruction, using a gastric conduit. In cases of conduit failure, patients are temporized with a cervical esophagostomy and enteral nutrition until gastrointestinal continuity can be established. At our institution, we favor reconstruction, using a colon interposition with a 'supercharged' accessory vascular pedicle. Consequently, we sought to examine our technique and outcomes for esophageal reconstruction, using this approach. We performed a retrospective review of all patients who underwent esophagectomy at our center between 2008 and 2018. We identified those patients who had a failed gastric conduit and underwent secondary reconstruction. Patient demographics, perioperative details, and clinical outcomes were analyzed after our clinical care pathway was used to manage and prepare patients for a second major reconstructive surgery. Three hundred and eighty eight patients underwent esophagectomy and reconstruction with a gastric conduit. Seven patients (1.8%) suffered gastric conduit loss and underwent a secondary reconstruction using a colon interposition with a 'supercharged' vascular pedicle. Mean age was 70.1 (±7.3) years, and six patients were male. The transverse colon was used in four cases (57.1%), left colon in two cases (28.6%), and right colon in one case (14.3%). There were no deaths or loss of the colon interposition at follow-up. Three patients (42.9%) developed an anastomotic leak, which resolved with conservative management. All patients had resumption of oral intake within 30 days. Utilizing a 'supercharging' technique for colon interposition may improve the perfusion to the organ and may decrease morbidity. Secondary reconstruction should occur when the patient's oncologic, physiologic, and psychosocial condition is optimized. Our outcomes and preoperative strategies may provide guidance for those centers treating this complicated patient population.
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Affiliation(s)
- N Esmonde
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - W Rodan
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - K R Haisley
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - N Joslyn
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - J Carboy
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - J G Hunter
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - P H Schipper
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - B H Tieu
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - J Hansen
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - J P Dolan
- Division of Gastrointestinal and General Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
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7
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Elgebaly AS, Anwar AG, Fathy SM, Sallam A, Elbarbary Y. The accuracy of electrical cardiometry for the noninvasive determination of cardiac output before and after lung surgeries compared to transthoracic echocardiography. Ann Card Anaesth 2020; 23:288-292. [PMID: 32687084 PMCID: PMC7559959 DOI: 10.4103/aca.aca_196_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The anatomical changes associated with lung surgeries may decrease cardiac output and heart function. Therefore, monitoring of cardiac output (CO) is of significant value in these patients for clinical decision-making. Objective: This study is to evaluate the reliability of electrical cardiometry (EC) for the noninvasive continuous determination of CO after lobectomy or pneumonectomy compared to transthoracic echocardiography (TTE). Patients and Methods: This study was carried out on 60 patients, age ≥18 years scheduled for elective lung surgery (lobectomy or pneumonectomy). All patients underwent simultaneous measurement by EC using the ICON_ device and by TTE by measuring left ventricle outflow tract diameter (LVOT) and velocity time integral (VTI). Heart rate (HR), systolic and diastolic blood pressure (SBP and DBP), stroke volume (SV), stroke volume index (SVI), CO, and cardiac index (CI) were measured 1 day before the surgery and 7 days after the surgery. Results: There was no significant difference between TTE and EC regarding preoperative and postoperative HR, SV, SVI, CO, and CI. There was a strong positive correlation between TTE and EC as regard preoperative and postoperative HR, SV, SVI, CO, and CI. Bland and Altman analysis showed low bias with accepted limits of agreement of HR, SV, SVI, CO, and CI. Postoperative readings showed a significant increase in HR and a significant decrease in SV and CO (either by TTE or EC), SBP, and DBP as compared to preoperative reading. Conclusion: Compared to the TTE, EC provides accurate and reliable CO, SV, and HR measurements before and even after lung surgeries.
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Affiliation(s)
- Ahmed S Elgebaly
- Department of Anesthesiology, Surgical Intensive Care and Pain Medicine, Tanta University, Egypt
| | - Atteia G Anwar
- Department of Anesthesiology, Surgical Intensive Care and Pain Medicine, Tanta University, Egypt
| | - Sameh M Fathy
- Department of Anesthesiology, Surgical Intensive Care and Pain Medicine, Tanta University, Egypt
| | - Ayman Sallam
- Department of Cardio-thoracic Surgery, Surgical Intensive Care and Pain Medicine, Tanta University, Egypt
| | - Yaser Elbarbary
- Department of Cardiology, Faculty of Medicine, Surgical Intensive Care and Pain Medicine, Tanta University, Egypt
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8
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Boujibar F, Gillibert A, Gravier FE, Gillot T, Bonnevie T, Cuvelier A, Baste JM. Performance at stair-climbing test is associated with postoperative complications after lung resection: a systematic review and meta-analysis. Thorax 2020; 75:791-797. [PMID: 32651199 PMCID: PMC7476257 DOI: 10.1136/thoraxjnl-2019-214019] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 05/15/2020] [Accepted: 06/05/2020] [Indexed: 12/25/2022]
Abstract
Background Thoracic surgery is the optimal treatment for early-stage lung cancer, but there is a high risk of postoperative morbidity. Therefore, it is necessary to evaluate patients’ preoperative general condition and cardiorespiratory capacity to determine the risk of postoperative complications. The objective of this study was to assess whether the stair-climbing test could be used in the preoperative evaluation of lung resection patients to predict postoperative morbidity following thoracic surgery. Methods We performed a systematic review and a meta-analysis on the association between stair-climbing test result and morbidity/mortality after thoracic surgery. We analysed all articles published until May 2020 in the following databases: Pubmed/Medline, Pedro, The Cochrane library, Embase and CINAHL. The risk of bias was assessed using the Quality in Prognosis Studies tool. This meta-analysis is registered as PROSPERO CRD42019121348. Results 13 articles were included in the systematic review for a total of 2038 patients and 6 in the meta-analysis. There were multiple test evaluation criteria: rise time, height, desaturation and heart rate change. For the meta-analysis, we were able to pool data on the height of rise at a variable threshold: risk ratio 2.34 (95% CI 1.59 to 3.43) with I²=53% (p=0.06). The threshold for occurrence of complications was estimated at a 10 m climb. Conclusions Our results indicate that the stair-climbing test could be used as a first-line functional screening test to predict postoperative morbidity following thoracic surgery and that patients with a poor test result (<10 m) should be referred to formal cardiopulmonary exercise testing.
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Affiliation(s)
- Fairuz Boujibar
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France .,Normandie University UNIROUEN, INSERM U1096, Rouen, France
| | | | - Francis Edouard Gravier
- ADIR Association, Bois Guillaume, France.,Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Timothée Gillot
- CETAPS EA 3832, Mont Saint Aignan, France.,ERFPS, CHU Rouen, Rouen, France
| | - Tristan Bonnevie
- ADIR Association, Bois Guillaume, France.,Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France
| | - Antoine Cuvelier
- Normandie University, UNIROUEN, UPRES EA 3830, Rouen University Hospital, Haute Normandie Research and Biomedical Innovation, Rouen, France.,Pulmonary & Respiratory Intensive Care Department, CHU Rouen, Rouen, Normandie, France
| | - Jean-Marc Baste
- Department of General and Thoracic Surgery, CHU Rouen, Rouen, France.,Normandie University UNIROUEN, INSERM U1096, Rouen, France
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9
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Villani F, Busia A. Preoperative Evaluation of Patients Submitted to Pneumonectomy for Lung Carcinoma: Role of Exercise Testing. TUMORI JOURNAL 2018; 90:405-9. [PMID: 15510984 DOI: 10.1177/030089160409000408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of the present investigation was to evaluate which parameters of preoperative spirometry, arterial blood gas, radionuclide lung scanning and cardiopulmonary exercise test are the best predictor of postoperative morbidity and mortality in patients submitted to pneumonectomy. The study was conducted in 150 patients (mean age, 57.1). Forty-four patients (29.3%) had postoperative complications. Four patients (2.7%) died within one month of the pneumonectomy. Patients with complications had significantly lower ppoFEV1 as percentage of predicted and lower VO2 max, and those who died also had a significant decrease in PaO2 during exercise. Moreover, among patients with obstructive pulmonary disease (FEV1<70% of predicted), we found a significantly higher percentage predicted residual volume and a significantly lower VO2 max in complicated patients. The present data support the suggestion that exercise testing could be a useful adjunt in the evaluation of postoperative risk for pneumonectomy, especially in patients with obstructive pulmonary disease. In particular, patients with VO2 max <50% of predicted should be considered at high risk of morbidity from cardiopulmonary causes.
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Affiliation(s)
- Fabrizio Villani
- UO di Pneumologia e Fisiopatologia Respiratoria, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy.
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10
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Yakal S, Sofyalı S, Özkan B, Yıldız S, Toker A, Kasikcioglu E. Oxygen Uptake Efficiency Slope and Prediction of Post-operative Morbidity and Mortality in Patients with Lung Cancer. Lung 2018; 196:255-262. [PMID: 29349536 DOI: 10.1007/s00408-018-0085-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 01/04/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Peak oxygen consumption is a very valuable cardiopulmonary functional parameter in pre-operative evaluation of patients with lung cancer. However, it has several critical limitations for operability decision due to failure in achieving maximal level of exercise test for cases. The aim of this study was to reveal the importance of more accurate cardiopulmonary parameters that can be calculated from data of submaximal level test, such as oxygen uptake efficiency slope (OUES) and to determine whether it could be used in the operability decision phase for borderline cases by means of morbidity and mortality. MATERIALS AND METHODS One hundred and twenty-five patients who were scheduled to undergo lung surgery due to lung cancer were included in the study. Peak oxygen uptake (pVO2), heart rate at the anaerobic threshold, and oxygen consumption volume at anaerobic threshold values were obtained after performing the cardiopulmonary exercise test. The OUES value was calculated from the ratio of the peak VO2 value and logarithmic equivalent of the ventilatory volume (VE). The following equation was used for determining OUES: VO2/log10 VE. RESULTS The peak VO2 mean value was 21.37 ± 4.20 mL/min/kg in patients. However, OUES mean value was 12.44 ± 2.11. When the metabolic parameters of the patients were compared, a significant correlation was determined between the peak VO2 value and peak VE, OUES, and survival (p < 0.01). CONCLUSION This study demonstrated that OUES is significantly correlated with peak VO2 and it does not require the performance of maximal exercise and can be used together with peak VO2 in this patient population when there is difficulty in making decision for surgery in patients with lung cancer.
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Affiliation(s)
- Sertaç Yakal
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sevtün Sofyalı
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Berker Özkan
- Department of Chest Surgery, Istanbul University, Istanbul, Turkey
| | - Safinaz Yıldız
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Alper Toker
- Department of Chest Surgery, Istanbul University, Istanbul, Turkey
| | - Erdem Kasikcioglu
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
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Novoa NM, Rodríguez M, Gómez MT, Jiménez MF, Varela G. Fixed-altitude stair-climbing test replacing the conventional symptom-limited test. A pilot study. Arch Bronconeumol 2014; 51:268-72. [PMID: 25453531 DOI: 10.1016/j.arbres.2014.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 09/13/2014] [Accepted: 09/15/2014] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The objective of this study was to investigate whether a patient's maximum capacity is comparable in 2 different stair-climbing tests, allowing the simplest to be used in clinical practice. METHOD Prospective, observational study of repeated measures on 33 consecutive patients scheduled for lung resection. Stair-climbing tests were: the standard test (climb to 27 m) and the alternative fixed-altitude test (climb to 12 m). In both cases, heart rate and oxygen saturation were monitored before and after the test. The power output of stair-climbing for each test (Watt1 for the standard and Watt2 for the fixed-altitude test) was calculated using the following equation: Power (watt)=weight (kg)*9.8*height (m)/time (sec). Concordance between tests was evaluated using a regression model and the residuals were plotted against Watt1. Finally, power output values were analyzed using a Bland-Altman plot. RESULTS Twenty-one male and 12 female patients (mean age 63.2±11.2) completed both tests. Only 12 patients finished the standard test, while all finished the fixed-altitude test. Mean power output values were Watt1: 184.1±65 and Watt2: 214.5±75.1. The coefficient of determination (R(2)) in the linear regression was 0.67. No fixed bias was detected after plotting the residuals. The Bland-Altman plot showed that 32 out of 33 values were within 2 standard deviations of the differences between methods. CONCLUSIONS The results of this study show a reasonable level of concordance between both stair-climbing tests. The standard test can be replaced by the fixed-altitude test up to 12 m.
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Affiliation(s)
- Nuria M Novoa
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, Salamanca, España.
| | - María Rodríguez
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - M Teresa Gómez
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - Marcelo F Jiménez
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, Salamanca, España
| | - Gonzalo Varela
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, Salamanca, España
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Bravo-Iñiguez C, Perez Martinez M, Armstrong KW, Jaklitsch MT. Surgical Resection of Lung Cancer in the Elderly. Thorac Surg Clin 2014; 24:371-81. [DOI: 10.1016/j.thorsurg.2014.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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13
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Mazzone PJ. Preoperative evaluation of the lung cancer resection candidate. Expert Rev Respir Med 2014; 4:97-113. [DOI: 10.1586/ers.09.68] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Donington J, Ferguson M, Mazzone P, Handy J, Schuchert M, Fernando H, Loo B, Lanuti M, de Hoyos A, Detterbeck F, Pennathur A, Howington J, Landreneau R, Silvestri G. American College of Chest Physicians and Society of Thoracic Surgeons consensus statement for evaluation and management for high-risk patients with stage I non-small cell lung cancer. Chest 2013. [PMID: 23208335 DOI: 10.1378/chest.12-0790] [Citation(s) in RCA: 175] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The standard treatment of stage I non-small cell lung cancer (NSCLC) is lobectomy with systematic mediastinal lymph node evaluation. Unfortunately, up to 25% of patients with stage I NSCLC are not candidates for lobectomy because of severe medical comorbidity. METHODS A panel of experts was convened through the Thoracic Oncology Network of the American College of Chest Physicians and the Workforce on Evidence-Based Surgery of the Society of Thoracic Surgeons. Following a literature review, the panel developed 13 suggestions for evaluation and treatment through iterative discussion and debate until unanimous agreement was achieved. RESULTS Pretreatment evaluation should focus primarily on measures of cardiopulmonary physiology, as respiratory failure represents the greatest interventional risk. Alternative treatment options to lobectomy for high-risk patients include sublobar resection with or without brachytherapy, stereotactic body radiation therapy, and radiofrequency ablation. Each is associated with decreased procedural morbidity and mortality but increased risk for involved lobe and regional recurrence compared with lobectomy, but direct comparisons between modalities are lacking. CONCLUSIONS Therapeutic options for the treatment of high-risk patients are evolving quickly. Improved radiographic staging and the diagnosis of smaller and more indolent tumors push the risk-benefit decision toward parenchymal-sparing or nonoperative therapies in high-risk patients. Unbiased assessment of treatment options requires uniform reporting of treatment populations and outcomes in clinical series, which has been lacking to date.
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Affiliation(s)
- Jessica Donington
- Department of Cardiothoracic Surgery, NYU School of Medicine, New York, NY.
| | - Mark Ferguson
- Department of Surgery, University of Chicago, Chicago, IL
| | - Peter Mazzone
- Department of Pulmonary, Allergy, and Critical Care Medicine, Cleveland Clinic Foundation, Cleveland, OH
| | | | - Matthew Schuchert
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Hiran Fernando
- Department of Cardiothoracic Surgery, Boston Medical Center, Boston, MA
| | - Billy Loo
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, CA
| | - Michael Lanuti
- Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA
| | - Alberto de Hoyos
- Department of Cardiothoracic Surgery, Northwestern Memorial Hospital, Chicago, IL
| | - Frank Detterbeck
- Department of Thoracic Surgery, Yale University School of Medicine, New Haven, CT
| | - Arjun Pennathur
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - John Howington
- Department of Surgery, Northshore University Health System, Evanston, IL
| | - Rodney Landreneau
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Gerard Silvestri
- Division of Pulmonary Medicine and Critical Care, Medical University of South Carolina, Charleston, SC
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Cartwright N, Coonar AS. Surgery for Lung Cancer. Lung Cancer 2013. [DOI: 10.1002/9781118702857.ch5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Functional capacity, physical activity and muscle strength assessment of individuals with non-small cell lung cancer: a systematic review of instruments and their measurement properties. BMC Cancer 2013; 13:135. [PMID: 23514337 PMCID: PMC3623892 DOI: 10.1186/1471-2407-13-135] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 03/07/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The measurement properties of instruments used to assess functional capacity, physical activity and muscle strength in participants with non-small cell lung cancer (NSCLC) have not been systematically reviewed. METHOD OBJECTIVES To identify outcome measures used to assess these outcomes in participants with NSCLC; and to evaluate, synthesise and compare the measurement properties of the outcome measures identified. DATA SOURCES A systematic review of articles using electronic databases MEDLINE (1950-2012), CINAHL (1982-2012), EMBASE (1980-2012), Cochrane Library (2012), Expanded Academic ASAP (1994-2012), Health Collection Informit (1995-2012) and PEDRO (1999-2012). Additional studies were identified by searching personal files and cross referencing. Eligibility Criteria for Study Selection: Search one: studies which assessed functional capacity, physical activity or muscle strength in participants with NSCLC using non-laboratory objective tests were included. Search two: studies which evaluated a measurement property (inter- or intra-rater reliability; measurement error; criterion or construct validity; or responsiveness) in NSCLC for one of the outcome measures identified in search one. Studies published in English from 1980 were eligible. Data Extraction and Methodological Quality Assessment: data collection form was developed and data extracted. Methodological quality of studies was assessed by two independent reviewers using the 4-point COSMIN checklist. RESULTS Thirteen outcome measures were identified. Thirty-one studies evaluating measurement properties of the outcome measures in participants with NSCLC were included. Functional capacity was assessed using the six- and twelve-minute walk tests; incremental- and endurance-shuttle walk tests; and the stair-climbing test. Criterion validity for three of these measures was established in NSCLC but not the reliability or responsiveness. Physical activity was measured using accelerometers and pedometers. Only the construct validity for accelerometers and pedometers was reported. Muscle strength was measured using hand-held dynamometry, hand-grip dynamometry, manual muscle test, one-repetition maximum and the chair-stand test, however only two studies reported reliability and measurement error and one study reported construct validity. CONCLUSION Currently there is a gap in the literature regarding the measurement properties of commonly used outcome measures in NSCLC participants, particularly reliability, measurement error and responsiveness. Further research needs to be conducted to determine the most suitable outcome measures for use in trials involving NSCLC participants.
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Cukic V. Preoperative prediction of lung function in pneumonectomy by spirometry and lung perfusion scintigraphy. Acta Inform Med 2013; 20:221-5. [PMID: 23378687 PMCID: PMC3558306 DOI: 10.5455/aim.2012.20.221-225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 09/30/2012] [Indexed: 11/26/2022] Open
Abstract
Introduction: Nowadays an increasing number of lung resections are being done because of the rising prevalence of lung cancer that occurs mainly in patients with limited lung function, what is caused by common etiologic factor - smoking cigarettes. Loss of lung tissue in such patients can worsen much the postoperative pulmonary function. So it is necessary to asses the postoperative pulmonary function especially after maximal resection, i.e. pneumonectomy. Objective: To check over the accuracy of preoperative prognosis of postoperative lung function after pneumonectomy using spirometry and lung perfusion scinigraphy. Material and methods: The study was done on 17 patients operated at the Clinic for thoracic surgery, who were treated previously at the Clinic for Pulmonary Diseases “Podhrastovi” in the period from 01. 12. 2008. to 01. 06. 2011. Postoperative pulmonary function expressed as ppoFEV1 (predicted postoperative forced expiratory volume in one second) was prognosticated preoperatively using spirometry, i.e.. simple calculation according to the number of the pulmonary segments to be removed and perfusion lung scintigraphy. Results: There is no significant deviation of postoperative achieved values of FEV1 from predicted ones obtained by both methods, and there is no significant differences between predicted values (ppoFEV1) obtained by spirometry and perfusion scintigraphy. Conclusion: It is necessary to asses the postoperative pulmonary function before lung resection to avoid postoperative respiratory failure and other cardiopulmonary complications. It is absolutely necessary for pneumonectomy, i.e.. maximal pulmonary resection. It can be done with great possibility using spirometry or perfusion lung scintigraphy.
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Affiliation(s)
- Vesna Cukic
- Clinic for pulmonary diseases and TB "Podhrastovi", Clinical center of Sarajevo University, Bosnia and Herzegovina
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Vidal Melo MF, Musch G, Kaczka DW. Pulmonary pathophysiology and lung mechanics in anesthesiology: a case-based overview. Anesthesiol Clin 2012; 30:759-784. [PMID: 23089508 PMCID: PMC3479443 DOI: 10.1016/j.anclin.2012.08.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Anesthesia, surgical requirements, and patients' unique pathophysiology all combine to make the accumulated knowledge of respiratory physiology and lung mechanics vital in patient management. This article take a case-based approach to discuss how the complex interactions between anesthesia, surgery, and patient disease affect patient care with respect to pulmonary pathophysiology and clinical decision making. Two disparate scenarios are examined: a patient with chronic obstructive pulmonary disease undergoing a lung resection, and a patient with coronary artery disease undergoing cardiopulmonary bypass. The impacts of important concepts in pulmonary physiology and respiratory mechanics on clinical management decisions are discussed.
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Affiliation(s)
| | - Guido Musch
- Harvard Medical School, Boston, MA
- Massachusetts General Hospital, Boston, MA
| | - David W. Kaczka
- Harvard Medical School, Boston, MA
- Beth Israel Deaconess Medical Center, Boston, MA
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Prediction of the postoperative pulmonary function in lung cancer patients with borderline function using ventilation–perfusion scintigraphy. Nucl Med Commun 2012; 33:283-7. [PMID: 22157729 DOI: 10.1097/mnm.0b013e32834eaca1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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von Groote-Bidlingmaier F, Koegelenberg CFN, Bolliger CT. Functional evaluation before lung resection. Clin Chest Med 2011; 32:773-82. [PMID: 22054885 DOI: 10.1016/j.ccm.2011.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Lung cancer is the leading cause of cancer-related death worldwide, and lung resection remains the only curative approach. In the Western world, lung cancer is one of the main indications for lung resection, despite only 15% to 25% of all lung cancers being operable at the time of presentation. In most cases of operable lung cancer, a substantial part of functional lung tissue has to be resected, leading to a permanent loss of pulmonary function. Resection in patients with insufficient pulmonary reserves can result in permanent respiratory disability. This article reviews the current standards of preoperative assessment.
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Affiliation(s)
- Florian von Groote-Bidlingmaier
- Division of Pulmonology, Department of Medicine, University of Stellenbosch, PO Box 19063, Tygerberg 7505, Cape Town, South Africa
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Mehta HJ, Ross C, Silvestri GA, Decker RH. Evaluation and treatment of high-risk patients with early-stage lung cancer. Clin Chest Med 2011; 32:783-97. [PMID: 22054886 DOI: 10.1016/j.ccm.2011.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Standard therapy for early-stage non-small cell lung cancer is lobectomy for patients who are able to tolerate such surgery. However, the risk of postoperative morbidity is not trivial, with a 30% to 40% incidence of postoperative complications and a 1% to 5% incidence of operative mortality. Some patients, though technically resectable, refuse surgery or are considered medically inoperable because of insufficient respiratory reserve, cardiovascular disease, or general frailty. This group is considered either "high risk" or "medically inoperable."
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Affiliation(s)
- Hiren J Mehta
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, 171 Ashley Avenue, Charleston, SC 29425, USA
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Pancieri MVC, Cataneo DC, Montovani JC, Cataneo AJM. Comparison between actual and predicted postoperative stair-climbing test, walk test and spirometric values in patients undergoing lung resection. Acta Cir Bras 2011; 25:535-40. [PMID: 21120287 DOI: 10.1590/s0102-86502010000600014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Accepted: 06/24/2010] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To assess whether the tests - Forced Expiratory Volume at one second (FEV₁), 6-minute walk test (6MWT) and stair-climbing test (SCT) showed proportional changes after the resection of functioning lung. METHODS Candidates for pulmonary resection were included. Spirometry, 6MWT and SCT were performed preoperatively (pre) and at least 3 months after surgery (pos). SCT was performed on a staircase with a total ascent height of 12.16m. The time taken to climb the total height the fastest possible was defined as stair-climbing time (SCt). Number of functioning segments lost, was used to calculated predicted postoperative (ppo) tests values. Pre, ppo and pos values for each test were compared. Data were analyzed by repeated-measure ANOVA with significance level set at 5%. RESULTS A total of 40 patients were enrolled. Pulmonary resection results ranged from gain of 2 functioning segments to loss of 9. Pre, ppo and pos values were the following: preFEV₁ = 2.6±0.8L, ppo FEV₁ =2.3±0.8L, and pos FEV₁=2.3±0.8L, (pre FEV₁ > ppo FEV₁ = pos FEV₁); pre6MWT = 604±63m, ppo6MWT= 529±103m, pos6MWT= 599±74m (pre6MWT = pos6MWT > ppo6MWT); preSCt = 32.9±7.6s, ppoSCt = 37.8±12.1s, posSCt = 33.7±8.5s (preSCt = posSCt < ppoSCt). CONCLUSION In our group of patients, pulmonary resection led to loss of lung function measured by spirometry, but not to exercise capacity measured by stair-climbing and walk tests.
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Yamashita CM, Langridge J, Hergott CA, Inculet RI, Malthaner RA, Lefcoe MS, Mehta S, Mahon JL, Lee TY, McCormack DG. Predicting postoperative FEV1 using spiral computed tomography. Acad Radiol 2010; 17:607-13. [PMID: 20188601 DOI: 10.1016/j.acra.2010.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2009] [Revised: 01/05/2010] [Accepted: 01/06/2010] [Indexed: 01/12/2023]
Abstract
RATIONALE AND OBJECTIVES Lung resection for primary bronchogenic carcinoma in the setting of chronic obstructive pulmonary disease often requires a detailed assessment of lung function to avoid perioperative complications and long-term disability. The aim of this study was to test the hypothesis that a novel technique of spiral computed tomographic (CT) subtraction imaging provides accuracy equal to the current standard of radioisotope perfusion scintigraphy in predicting postoperative lung function. METHODS AND MATERIALS Preoperative lung function, radioisotope perfusion scintigraphy, spiral CT subtraction imaging, and assessment of postoperative lung function were performed in 25 patients with surgically resectable primary bronchogenic carcinoma. Comparisons of predicted postoperative lung function between the two modalities and to true postoperative lung function were performed using Pearson's correlation and linear regression analysis. RESULTS Among the 25 patients enrolled in the study, there was a high degree of agreement between the predicted value of postoperative forced expiratory lung volume in 1 second (FEV(1)) generated on novel contrast CT subtraction imaging and that on radioisotope perfusion scintigraphy (r = 0.96, P < .001). Furthermore, there was a strong correlation between the predicted and actual postoperative FEV(1) values for both imaging modalities (r = 0.87, P < .001, and r = 0.88, P < .001, respectively), among the 14 patients completing the study protocol. CONCLUSION A novel technique of CT subtraction imaging is equally accurate at predicting postoperative lung function as radioisotope perfusion scintigraphy, which may obviate the need for additional nuclear imaging in the context of the preoperative assessment of resectable lung cancer in high-risk patients.
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Affiliation(s)
- Cory M Yamashita
- Division of Respirology, London Health Sciences Centre, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, ON, Canada.
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Kashiwabara K, Sasaki JI, Mori T, Nomori H, Fujii K, Kohrogi H. Relationship Between Functional Preservation after Segmentectomy and Volume-Reduction Effects after Lobectomy in Stage I Non-small Cell Lung Cancer Patients with Emphysema. J Thorac Oncol 2009; 4:1111-6. [DOI: 10.1097/jto.0b013e3181ae59e2] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Jaklitsch M, Billmeier S. Preoperative Evaluation and Risk Assessment for Elderly Thoracic Surgery Patients. Thorac Surg Clin 2009; 19:301-12. [DOI: 10.1016/j.thorsurg.2009.07.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The 15-Step Oximetry Test: a Reliable Tool to Identify Candidates for Lung Transplantation Among Patients With Idiopathic Pulmonary Fibrosis. J Heart Lung Transplant 2009; 28:328-33. [DOI: 10.1016/j.healun.2008.12.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 11/04/2008] [Accepted: 12/29/2008] [Indexed: 11/19/2022] Open
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Kasikcioglu E, Toker A, Tanju S, Arzuman P, Kayserilioglu A, Dilege S, Kalayci G. Oxygen uptake kinetics during cardiopulmonary exercise testing and postoperative complications in patients with lung cancer. Lung Cancer 2009; 66:85-8. [PMID: 19185383 DOI: 10.1016/j.lungcan.2008.12.024] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Revised: 11/07/2008] [Accepted: 12/24/2008] [Indexed: 11/18/2022]
Abstract
It is accepted that cardiopulmonary exercise testing is one of the most valuable parameters, especially peak oxygen uptake (VO(2)), for the evaluation of risk assessment in lung cancer surgery. It therefore represents an attractive way of identifying a patient at high risk for postoperative complications. However, many patients do not achieve the maximal or predictive level during an incremental exercise testing. The purpose of the current investigation was to study the value of the oxygen uptake efficiency slope (OUES), which shows exercise capacity during submaximal testing, in predicting postoperative mortality in patients with bronchogenic carcinoma scheduled for lung resection. Forty-nine patients with bronchogenic carcinoma participated in studies with exercise tests as a preoperative evaluation. The peak VO(2) was calculated for each subject by averaging values obtained during the final 10s of exercise. The following equation was used to determine OUES: VO(2)/log(10)VE. Peak VO(2) without postoperative complication was 22.8+/-3.3 ml/(kg min), however, peak VO(2) in patients with present complications was 19.1+/-4.2 ml/(kg min) (p=0.001). In addition, although the mean OUES in patients with present complications was 11.1+/-1.2, the mean OUES in the absent group was 13.3+/-2.1 (p<0.001). Although peak VO(2) is useful in evaluating selected patients with bronchogenic carcinoma, OUES is also a beneficial parameter and should be calculated and recorded with peak VO(2), a better predictor of poor surgical outcome than absolute values, and should be integrated into preoperative decision making.
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Affiliation(s)
- Erdem Kasikcioglu
- Istanbul University, Istanbul Faculty of Medicine, Department of Sports Medicine, Istanbul, Turkey.
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Bernstein WK, Deshpande S. Preoperative evaluation for thoracic surgery. Semin Cardiothorac Vasc Anesth 2009; 12:109-21. [PMID: 18635562 DOI: 10.1177/1089253208319868] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The goal of the preoperative evaluation for thoracic surgery is to assess and implement measures to decrease perioperative complications and prepare high-risk patients for surgery. Major respiratory complications, such as atelectasis, pneumonia, and respiratory failure, occur in 15% to 20% of patients and account for most of the 3% to 4% mortality rate. Development of pulmonary complications has been associated with higher postoperative mortality rates. Strategies aimed at preventing postoperative difficulties have the potential to reduce morbidity and mortality, decrease hospital stay, and improve resource use. One lung ventilation leads to a significant derangement of gas exchange, and hypoxemia can develop due to increased intrapulmonary shunting. Recent advances in anesthetic management, monitoring devices, improved lung isolation techniques, and improved critical care management have increased the number of patients who were previously considered inoperable. In addition, there is a growing tendency to offer surgery to patients with significant lung function impairment; hence a higher incidence of intraoperative gas-exchange abnormalities can be expected. The anesthesiologist must also consider the risks of denying or postponing a potentially curative operation in patients with lung cancer. Detailed consideration of the information provided by preoperative testing is essential to successful outcomes following thoracic surgery.
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Affiliation(s)
- Wendy K Bernstein
- Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Brunelli A, Refai M, Xiumé F, Salati M, Sciarra V, Socci L, Sabbatini A. Performance at symptom-limited stair-climbing test is associated with increased cardiopulmonary complications, mortality, and costs after major lung resection. Ann Thorac Surg 2008; 86:240-7; discussion 247-8. [PMID: 18573431 DOI: 10.1016/j.athoracsur.2008.03.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 03/09/2008] [Accepted: 03/14/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Exercise tests are increasingly used during preoperative evaluation before lung resection. This study assessed the association between performance at the symptom-limited stair-climbing test and postoperative cardiopulmonary morbidity, mortality, and costs after major lung resections. METHODS As part of their routine preoperative evaluation, 640 patients who had lobectomy (n = 533) or pneumonectomy (n = 107) for lung cancer from January 2000 through April 2007 performed a preoperative symptom-limited stair-climbing test. Sensitivity/specificity analysis was used to identify the best cutoff values of altitude climbed (number of steps x height of the step in m) associated with outcome. Univariate and multivariate regression analyses (validated by bootstrap) were used to test associations between preoperative and operative factors and postoperative cardiopulmonary complications, mortality, and postoperative costs. RESULTS The altitude reached at the stair-climbing test was reliably associated with increased cardiopulmonary complications (p = 0.04), mortality (p = 0.02), and costs (p < 0.0001). In patients who climbed less than 12 m, cardiopulmonary complications, mortality, and costs were 2-fold (p < 0.0001), 13-fold (p < 0.0001), and 2.5-fold higher, respectively, than in patients who climbed more than 22 m. CONCLUSIONS Performance at a maximal stair-climbing test was reliably associated with postoperative morbidity and mortality. We recommend the use of this simple and economic test in all lung resection candidates. Patients who perform poorly at the stair-climbing test should undergo a formal cardiopulmonary exercise test with measurement of oxygen consumption to optimize their perioperative management.
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Rusanov V, Shitrit D, Fox B, Amital A, Peled N, Kramer MR. Use of the 15-steps climbing exercise oximetry test in patients with idiopathic pulmonary fibrosis. Respir Med 2008; 102:1080-8. [PMID: 18457939 DOI: 10.1016/j.rmed.2007.12.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 11/27/2007] [Accepted: 12/16/2007] [Indexed: 11/30/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is often associated with exercise-induced hypoxemia. Although maximal oxygen consumption (VO2(max)) is considered the gold-standard index of functional capacity in IPF, its measurement requires sophisticated equipment and trained personnel. The aim of the present study was to investigate the value of the simple 15-steps climbing exercise oximetry test in patients with IPF. The 15-steps climbing test was administered to 51 patients with IPF. Pulmonary function tests (PFTs), cardiopulmonary exercise test (CPET), and the 6-min walk distance (6MWD) test were performed in the same session. Oxygen saturation in the 15-steps climbing test was measured by continuous oximetry, and quantified oxygen desaturation was determined by calculating the area under the curve of oxygen saturation from the beginning of exercise through the lowest desaturation point until recovery to baseline ("desaturation area"). There was a statistically significant correlation between all parameters of the 15-steps climbing test and both VO2(max)) on the CPET (lowest saturation, p=0.002, r=0.43; saturation difference, p=0.02, r=-0.33; recovery time, p=0.02, r=-0.32; and desaturation area, p=0.005, r=-0.39), and carbon dioxide diffusion in the lungs (DLCO) on the PFTs (lowest saturation, p=0.0001, r=0.52; saturation difference, p=0.0002, r=-0.50; recovery time, p=0.0001, r=-0.53; and desaturation area, p=0.0001, r=-0.53). On stepwise linear regression analysis, independent significant predictors of VO2(max) were lowest saturation on the 15-steps test and the 6MWD. We concluded that the 15-steps oximetry test is a simple and accurate bedside tool for the evaluation of functional capacity in patients with IPF.
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Affiliation(s)
- Victorya Rusanov
- Department of Internal Medicine B, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Ferguson MK, Lehman AG, Bolliger CT, Brunelli A. The Role of Diffusing Capacity and Exercise Tests. Thorac Surg Clin 2008; 18:9-17, v. [DOI: 10.1016/j.thorsurg.2007.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ilonen IK, Räsänen JV, Sihvo EI, Knuuttila A, Sovijärvi ARA, Sintonen H, Salo JA. Pneumonectomy: Post-operative quality of life and lung function. Lung Cancer 2007; 58:397-402. [PMID: 17716778 DOI: 10.1016/j.lungcan.2007.07.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 05/11/2007] [Accepted: 07/04/2007] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pneumonectomy is associated with high morbidity and mortality. After pneumonectomy, data on health-related quality of life (HRQoL) or its correlation with dyspnea and lung function are scarce. Our main aim was to evaluate long-term HRQoL after pneumonectomy. METHODS In a retrospective one-center cross-sectional study, we investigated 31 of 98 patients who underwent pneumonectomy between January 1997 and October 2003 due to primary lung cancer. Pre- or postoperative chemotherapy or radiotherapy was applied according to hospital protocol. In June 2004, all patients alive received the generic HRQoL instrument (15D), as well as the Baseline Dyspnea Index (BDI). Results of the 15D were compared with those for an age- and gender-standardized general population. In April 2005, 20 patients participated in follow-up spirometric pulmonary function tests. RESULTS The 15D total score and its various dimensions were significantly lower after pneumonectomy than in the general population. Females both in 15D score and in the BDI had more dyspnea (p<0.05). No difference appeared between right and left pneumonectomy patients, except for more prominent dyspnea in women with right-sided pneumonectomy. CONCLUSIONS Pneumonectomy had a negative impact on patients' HRQoL. The use of a broad HRQoL instrument like the 15D, which covers multiple dimensions of HRQoL, yields a more accurate evaluation than did a single-dimension HRQoL instrument. Possibilities for sleeve-resection should be considered thoroughly before any pneumonectomy. SUMMARY Quality of life (QoL) after pneumonectomy, as measured with a generic QoL instrument, the 15D, was compared in an age- and gender-standardized population. QoL after pneumonectomy was significantly lower, especially in women after right-sided pneumonectomy.
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Affiliation(s)
- Ilkka K Ilonen
- Division of General Thoracic and Esophageal Surgery, Department of Cardiothoracic Surgery, Helsinki University Central Hospital, Haartmaninkatu 4, 00290 Helsinki, Finland
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Colice GL, Shafazand S, Griffin JP, Keenan R, Bolliger CT. Physiologic evaluation of the patient with lung cancer being considered for resectional surgery: ACCP evidenced-based clinical practice guidelines (2nd edition). Chest 2007; 132:161S-77S. [PMID: 17873167 DOI: 10.1378/chest.07-1359] [Citation(s) in RCA: 282] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND This section of the guidelines is intended to provide an evidence-based approach to the preoperative physiologic assessment of a patient being considered for surgical resection of lung cancer. METHODS Current guidelines and medical literature applicable to this issue were identified by computerized search and evaluated using standardized methods. Recommendations were framed using the approach described by the Health and Science Policy Committee. RESULTS The preoperative physiologic assessment should begin with a cardiovascular evaluation and spirometry to measure the FEV(1). If diffuse parenchymal lung disease is evident on radiographic studies or if there is dyspnea on exertion that is clinically out of proportion to the FEV(1), the diffusing capacity of the lung for carbon monoxide (Dlco) should also be measured. In patients with either an FEV(1) or Dlco < 80% predicted, the likely postoperative pulmonary reserve should be estimated by either the perfusion scan method for pneumonectomy or the anatomic method, based on counting the number of segments to be removed, for lobectomy. An estimated postoperative FEV(1) or Dlco < 40% predicted indicates an increased risk for perioperative complications, including death, from a standard lung cancer resection (lobectomy or greater removal of lung tissue). Cardiopulmonary exercise testing (CPET) to measure maximal oxygen consumption (Vo(2)max) should be performed to further define the perioperative risk of surgery; a Vo(2)max of < 15 mL/kg/min indicates an increased risk of perioperative complications. Alternative types of exercise testing, such as stair climbing, the shuttle walk, and the 6-min walk, should be considered if CPET is not available. Although often not performed in a standardized manner, patients who cannot climb one flight of stairs are expected to have a Vo(2)max of < 10 mL/kg/min. Data on the shuttle walk and 6-min walk are limited, but patients who cannot complete 25 shuttles on two occasions will likely have a Vo(2)max of < 10 mL/kg/min. Desaturation during an exercise test has not clearly been associated with an increased risk for perioperative complications. Lung volume reduction surgery (LVRS) improves survival in selected patients with severe emphysema. Accumulating experience suggests that patients with extremely poor lung function who are deemed inoperable by conventional criteria might tolerate combined LVRS and curative-intent resection of lung cancer with an acceptable mortality rate and good postoperative outcomes. Combining LVRS and lung cancer resection should be considered in patients with a cancer in an area of upper lobe emphysema, an FEV(1) of > 20% predicted, and a Dlco of > 20% predicted. CONCLUSIONS A careful preoperative physiologic assessment will be useful to identify those patients who are at increased risk with standard lung cancer resection and to enable an informed decision by the patient about the appropriate therapeutic approach to treating their lung cancer. This preoperative risk assessment must be placed in the context that surgery for early-stage lung cancer is the most effective currently available treatment for this disease.
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Affiliation(s)
- Gene L Colice
- Director, Pulmonary, Critical Care, and Respiratory Services, Washington Hospital Center, 110 Irving St NW, Washington, DC 20010, USA.
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Loewen GM, Watson D, Kohman L, Herndon JE, Shennib H, Kernstine K, Olak J, Mador MJ, Harpole D, Sugarbaker D, Green M. Preoperative exercise Vo2 measurement for lung resection candidates: results of Cancer and Leukemia Group B Protocol 9238. J Thorac Oncol 2007; 2:619-25. [PMID: 17607117 DOI: 10.1097/jto.0b013e318074bba7] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION A stepwise approach to the functional assessment of lung resection candidates is widely accepted, and this approach incorporates the measurement of exercise peak Vo2 when spirometry and radionuclear studies suggest medical inoperability. A new functional operability (FO) algorithm incorporates peak exercise Vo2 earlier in the preoperative assessment to determine which patients require preoperative radionuclear studies. This algorithm has not been studied in a multicenter study. METHODS The CALGB (Cancer and Leukemia Group B) performed a prospective multi-institutional study to investigate the use of primary exercise Vo2 measurement for the prediction of surgical risk. Patients with known or suspected resectable non-small cell lung cancer (NSCLC) were eligible. Exercise testing including measurement of peak oxygen uptake (Vo2), spirometry, and single breath diffusion capacity (DLCO) was performed on each patient. Nuclear perfusion scans were obtained on selected high-risk patients. After surgery, morbidity and mortality data were collected and correlated with preoperative data. Mortality and morbidity were retrospectively compared by algorithm-based risk groups. RESULTS Three hundred forty-six patients with suspected lung cancer from nine institutions underwent thoracotomy with or without resection; 57 study patients did not undergo thoracotomy. Patients who underwent surgery had a median survival time of 30.9 months, whereas patients who did not undergo surgery had a median survival time of 15.6 months. Among the 346 patients who underwent thoracotomy, 15 patients died postoperatively (4%), and 138 patients (39%) exhibited at least one cardiorespiratory complication postoperatively. We found that patients who had a peak exercise Vo2 of <65% of predicted (or a peak Vo2/kg <16 ml/min/kg) were more likely to suffer complications (p = 0.0001) and were also more likely to have a poor outcome (respiratory failure or death) if the peak Vo2 was <15 ml/min/kg (p = 0.0356). We also found a subset of 58 patients who did not meet FO algorithm criteria for operability, but who still tolerated lung resection with a 2% mortality rate. CONCLUSIONS Our data provide multicenter validation for the use of exercise Vo2 for preoperative assessment of lung cancer patients, and we encourage an aggressive approach when evaluating these patients for surgery.
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Bayram AS, Candan T, Gebitekin C. Preoperative maximal exercise oxygen consumption test predicts postoperative pulmonary morbidity following major lung resection. Respirology 2007; 12:505-10. [PMID: 17587416 DOI: 10.1111/j.1440-1843.2007.01097.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE Pulmonary resection carries a significant morbidity and mortality. The utility of maximal oxygen uptake test (VO(2)max) to predict cardiopulmonary complications following major pulmonary resection was evaluated. METHODS Following standard preoperative work-up and VO(2)max testing, 55 patients (49 male; mean age 59 years, range 20-74) underwent major pulmonary surgery: lobectomy (n = 31), bilobectomy (n = 6) and pneumonectomy (n = 18). An investigator blinded to the preoperative assessment prospectively collected data on postoperative cardiopulmonary complications. Patients were divided into two groups according to preoperative VO(2)max and also according to FEV(1). The frequency of postoperative complications in the groups was compared. RESULTS Complications were observed in 19 (34.5%) patients, 11 of which were pulmonary (20%). There were two deaths (3.6%), both due to respiratory failure. Preoperative FEV(1) failed to predict postoperative respiratory complications. Five of 36 patients with a preoperative FEV(1) > 2 L suffered pulmonary complications, compared with six of 19 patients with FEV(1) < 2 L. Cardiopulmonary complications were not observed in patients with VO(2)max > 15 mL/kg/min (n = 27); however, 11 patients with VO(2)max < 15 mL/kg/min (n = 28) suffered cardiopulmonary complications (P < 0.05). CONCLUSION VO(2)max predicts postoperative pulmonary complications following major lung resection, and the risk of complications increases significantly when the preoperative VO(2)max is less than 15 mL/kg/min.
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Affiliation(s)
- Ahmet Sami Bayram
- Medical Faculty, Department of Thoracic Surgery, Uludag University, Bursa, Turkey.
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Cataneo DC, Cataneo AJM. Acurácia do teste de escada utilizando o consumo máximo de oxigênio como padrão-ouro. J Bras Pneumol 2007; 33:128-33. [PMID: 17724530 DOI: 10.1590/s1806-37132007000200005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2006] [Accepted: 08/03/2006] [Indexed: 11/21/2022] Open
Abstract
OBJETIVO: Determinar a acurácia dos atributos do teste de escada (TE) de altura definida utilizando como padrão-ouro o consumo máximo de oxigênio (VO2 máx). MÉTODOS: O TE foi realizado com incentivo, em escada (6 lances; 72 degraus; 12,16 m de altura total), em 51 pacientes. O 'tempo' de subida foi cronometrado e o 'trabalho' e a 'potência' calculados. O VO2 máx foi obtido por ergoespirometria, utilizando-se o protocolo de Balke. Foram calculados a correlação linear de Pearson (r) e os valores de p entre as variáveis do TE e o VO2 máx. Para o cálculo da acurácia, o ponto de corte do VO2 máx foi estabelecido em 25 mL/kg/min, estratificando os indivíduos em normais ou alterados. Os pontos de corte para os atributos do TE foram obtidos através da curva receiver operating characteristic. A estatística Kappa (k) foi utilizada para estudo da concordância. RESULTADOS: Obtiveram-se os seguintes valores para a variável 'tempo': ponto de corte = 40 s; x= 41 ± 15,5 s; r = -0,707; p < 0,005; especificidade = 89%; sensibilidade = 83%; acurácia = 86% e k = 0,724. Para a variável 'potência', obteve-se ponto de corte = 200 w; x= 222,3 ± 95,2 w; r = 0,515; p < 0,005; especificidade = 67%; sensibilidade = 75%; acurácia = 71% e k = 0,414. A correlação de 'trabalho' com o VO2 máx não foi significativa, sendo esse atributo descartado. CONCLUSÃO: Dos atributos testados do TE, tendo como padrão-ouro o VO2 máx, a variável 'tempo' foi a que apresentou a melhor acurácia.
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Affiliation(s)
- Daniele Cristina Cataneo
- Department of Thoracic Surgery, Júlio de Mesquita Filho Universidade Estadual Paulista-UNESP, Paulista State University at Botucatu School of Medicine, Botucatu, SP, Brazil.
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Michelet P, Jaber S, Eledjam JJ, Auffray JP. Prise en charge anesthésique de l'œsophagectomie: avancées et perspectives. ACTA ACUST UNITED AC 2007; 26:229-41. [PMID: 17270381 DOI: 10.1016/j.annfar.2006.11.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Accepted: 11/21/2006] [Indexed: 01/06/2023]
Abstract
Oesophagectomy is still characterized by a high postoperative mortality and respiratory morbidity. Nevertheless, epidemiological, medical and surgical advances have improved the management of this surgical procedure. The anaesthesiologist influence is present at each level, from the preoperative evaluation to the management of postoperative complications. The preoperative period is improved by the use of assessment scores, the better knowing of respiratory risk factors and of the neoadjuvant therapy adverse effects. The main objective of the operative period is to ensure a rapid weaning procedure and stability of the respiratory and haemodynamic functions, warranting the anastomotic healing. The interest of the association between respiratory rehabilitation and thoracic epidural analgesia is highlighted in the postoperative period. The management of postoperative complications, mainly represented by respiratory failure and anastomotic leakages, requires a multidisciplinary analysis. The potential interest of non-invasive ventilation and of the modulation of postoperative inflammatory response needs further investigation.
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Affiliation(s)
- P Michelet
- Département d'anesthésie-réanimation, hôpital Sainte-Marguerite, 270, boulevard Sainte-Marguerite, 13009 Marseille, France.
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Win T, Tasker AD, Groves AM, White C, Ritchie AJ, Wells FC, Laroche CM. Ventilation-perfusion scintigraphy to predict postoperative pulmonary function in lung cancer patients undergoing pneumonectomy. AJR Am J Roentgenol 2006; 187:1260-5. [PMID: 17056914 DOI: 10.2214/ajr.04.1973] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The American College of Chest Physicians (ACCP) recommends using quantitative perfusion scintigraphy to predict postoperative lung function in lung cancer patients with borderline pulmonary function tests who will undergo pneumonectomy. However, previous scintigraphic data were gathered on small cohorts more than a decade ago, when surgical populations were significantly different with respect to age and sex compared with typical lung cancer patients undergoing pneumonectomy in 2005. We therefore revisited the use of V/Q scintigraphy in pneumonectomy patients in predicting postoperative pulmonary function and the appropriateness of current clinical guidelines. CONCLUSION Contrary to ACCP guidelines, we found that ventilation scintigraphy alone provided the best correlation between the predicted and actual postoperative values and recommend its use to predict postoperative lung function. However, scintigraphic techniques may underestimate postoperative lung function, so caution is required before unnecessarily preventing a patient from undergoing surgery that offers a potential cure.
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Affiliation(s)
- Thida Win
- Department of Thoracic Oncology, Papworth Hospital, Papworth Everard, Cambridge, CB3 8RE, United Kingdom.
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Wedge Resection for Non-small Cell Lung Cancer in Patients with Pulmonary Insufficiency: Prospective Ten-Year Survival. J Thorac Oncol 2006. [DOI: 10.1097/01243894-200611000-00007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Griffin JP, Eastridge CE, Tolley EA, Pate JW. Wedge Resection for Non-small Cell Lung Cancer in Patients with Pulmonary Insufficiency: Prospective Ten-Year Survival. J Thorac Oncol 2006. [DOI: 10.1016/s1556-0864(15)31628-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Takeda SI, Funakoshi Y, Kadota Y, Koma M, Maeda H, Kawamura S, Matsubara Y. Fall in Diffusing Capacity Associated With Induction Therapy for Lung Cancer: A Predictor of Postoperative Complication? Ann Thorac Surg 2006; 82:232-6. [PMID: 16798220 DOI: 10.1016/j.athoracsur.2006.01.045] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Revised: 01/08/2006] [Accepted: 01/10/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pulmonary resection after induction therapy is associated with high rates of pulmonary morbidity and mortality. However, the impact of induction therapy on the pulmonary toxicity and associated pulmonary complications has not been fully investigated in the setting of lung cancer surgery. METHODS We assessed the 66 consecutive patients who underwent a pulmonary resection after induction therapy, 48 of whom received chemoradiotherapy and 18, chemotherapy alone. Results of pulmonary function before and after induction therapy were compared, and logistic regression analyses utilized to explore the risk factors of pulmonary morbidity. RESULTS After induction therapy, forced expiratory volume in 1 second (FEV1) was increased significantly (from 2.28 +/- 0.61 L to 2.40 +/- 0.62 L; p < 0.05); however, percent vital capacity (%VC) and FEV1/FVC did not change significantly. The diffusing capacity of lung for carbon monoxide (D(LCO)) was decreased significantly by 21% (from 90.3% +/- 18.3% to 71.1% +/- 12.5%; p < 0.0005). Patients with respiratory complication showed lower predicted postoperative %FEV1 (49.5% +/- 11.1% versus 57.2% +/- 14.2%; p = 0.031) and predicted postoperative %Dlco (41.9% +/- 8.0% versus 55.4% +/- 10.1%; p < 0.0001) results than those without complications. Univariate and multivariate analyses revealed that predicted postoperative %D(LCO) alone was an independent factor to predict postoperative pulmonary morbidity. CONCLUSIONS For patients who undergo a pulmonary resection after induction therapy, predicted postoperative %D(LCO) is more important to predict pulmonary morbidity rather than static pulmonary function (predicted postoperative %VC or %FEV1). The decrease in D(LCO) is thought to reflect a limited gas exchange reserve, caused by the potential toxicity of chemotherapy or chemoradiotherapy. We believe that the impact of diffusion limitation after induction therapy should to be emphasized to decrease the pulmonary morbidity.
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MESH Headings
- Adenocarcinoma/drug therapy
- Adenocarcinoma/physiopathology
- Adenocarcinoma/radiotherapy
- Adenocarcinoma/surgery
- Aged
- Antineoplastic Combined Chemotherapy Protocols/adverse effects
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carbon Monoxide/analysis
- Carcinoma, Large Cell/drug therapy
- Carcinoma, Large Cell/physiopathology
- Carcinoma, Large Cell/radiotherapy
- Carcinoma, Large Cell/surgery
- Carcinoma, Non-Small-Cell Lung/drug therapy
- Carcinoma, Non-Small-Cell Lung/physiopathology
- Carcinoma, Non-Small-Cell Lung/radiotherapy
- Carcinoma, Non-Small-Cell Lung/surgery
- Carcinoma, Squamous Cell/drug therapy
- Carcinoma, Squamous Cell/physiopathology
- Carcinoma, Squamous Cell/radiotherapy
- Carcinoma, Squamous Cell/surgery
- Cisplatin/administration & dosage
- Combined Modality Therapy
- Empyema, Pleural/etiology
- Female
- Forced Expiratory Volume
- Forecasting
- Humans
- Hypoxia/etiology
- Lung Neoplasms/drug therapy
- Lung Neoplasms/physiopathology
- Lung Neoplasms/radiotherapy
- Lung Neoplasms/surgery
- Male
- Middle Aged
- Mitomycin/administration & dosage
- Pneumonectomy
- Pneumonia/etiology
- Postoperative Complications/epidemiology
- Postoperative Complications/etiology
- Postoperative Complications/mortality
- Predictive Value of Tests
- Pulmonary Atelectasis/etiology
- Pulmonary Diffusing Capacity
- Pulmonary Embolism/etiology
- Pulmonary Embolism/mortality
- Pulmonary Gas Exchange
- Radiotherapy/adverse effects
- Remission Induction
- Respiratory Distress Syndrome/etiology
- Respiratory Distress Syndrome/mortality
- Respiratory Insufficiency/etiology
- Retrospective Studies
- Risk Factors
- Vinblastine/administration & dosage
- Vinblastine/analogs & derivatives
- Vindesine/administration & dosage
- Vinorelbine
- Vital Capacity
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Affiliation(s)
- Shin-ichi Takeda
- Department of General Thoracic Surgery, Toneyama National Hospital, Toyonaka City, Osaka, Japan.
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Varela-Simó G, Barberà-Mir JA, Cordovilla-Pérez R, Duque-Medina JL, López-Encuentra A, Puente-Maestu L. [Guidelines for the evaluation of surgical risk in bronchogenic carcinoma]. Arch Bronconeumol 2006; 41:686-97. [PMID: 16373045 DOI: 10.1016/s1579-2129(06)60336-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- G Varela-Simó
- Servicio de Cirugía Torácica, Hospital Universitario, Salamanca, Spain.
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Varela-Simó G, Barberà-Mir J, Cordovilla-Pérez R, Duque-Medina J, López-Encuentra A, Puente-Maestu L. Normativa sobre valoración del riesgo quirúrgico en el carcinoma broncogénico. Arch Bronconeumol 2005. [DOI: 10.1016/s0300-2896(05)70724-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
INTRODUCTION The overall prognosis of non-small cell carcinoma of the bronchus (NSCLC) remains poor on account of frequently late diagnosis and associated co-morbidity preventing the optimal treatment of the tumour. Surgical resection remains the best curative treatment for limited stage disease. STATE OF THE ART The pre-operative assessment should determine whether the extent of the tumour permits complete resection and whether the physiological state of the patient would tolerate the curative resection required. The ultimate goal is to improve 5-year survival. In the case of initial inoperability the assessment should determine whether pre-operative oncological treatment might make an advanced tumour operable (e.g. stage IIIA), or whether targeted medical treatment might improve the patient sufficiently to tolerate an intervention initially judged too risky. The rapid development of the technical modalities available for the assessment requires a continuous review of the current practice guidelines. Positron emission tomography has considerably augmented the accuracy of classical radiological assessment. Nevertheless staging by imaging alone remains imprecise to the extent that invasive examinations are still necessary to provide histological proof of the clinical stage of NSCLC. The techniques for assessing mediastinal invasion are developing rapidly and becoming more accurate and less invasive. Mediastinoscopy enhanced by modern video technology, ultrasound guided endoscopic biopsies and thoracoscopy are complimentary rather than competing techniques. The functional assessment should estimate the operative risk of the proposed pulmonary resection, identify the targeted actions aimed at reducing this risk or, in the absence of such actions, suggest less invasive but less well validated surgical techniques or even palliative treatments. When the operative risk cannot be reduced its precise estimation at least allows the patient to decide whether the risk seems acceptable in relation to the chances of a cure. VIEWPOINT AND CONCLUSIONS In the future the pre-operative assessment of NSCLC should improve the detection of micro-metastases in order to optimise the choice of induction and adjuvant therapies. The increasing use of induction chemotherapy before surgical resection can only increase the importance of a detailed assessment for the selection of patients and the evaluation of results.
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Affiliation(s)
- G Decker
- Département de Chirurgie Thoracique, Groupe Thorax, Centre Hospitalier Luxembourg.
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Abstract
Fig. 2 is an algorithm for the preoperative pulmonary evaluation of the lung resection candidate. Patients should undergo routine spirometry and diffusion capacity testing. If the FEV1 and DLCO are greater than 80% predicted, no further study is needed. When these parameters are less than 80%, some estimation of postoperative function is likely needed, taking into account the proposed resection. Patients with ppoFEV1 or ppoDLCO less than 40% are at increased risk of perioperative complications or death and should undergo formal exercise testing. A VO2max or ppoVO2max less than 10 mL/kg/min is associated with prohibitive risk for anatomic lung resection, and alternative treatment modalities should be considered.
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Affiliation(s)
- Aditya K Kaza
- Section of General Thoracic Surgery, Division of Cardiothoracic Surgery, University of Colorado Health Sciences Center, 4200 East 9th Avenue, C-310, Denver, CO 80262, USA
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Biccard BM. Relationship between the inability to climb two flights of stairs and outcome after major non-cardiac surgery: implications for the pre-operative assessment of functional capacity. Anaesthesia 2005; 60:588-93. [PMID: 15918830 DOI: 10.1111/j.1365-2044.2005.04181.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Functional capacity is an integral component of the pre-operative evaluation of the cardiac patient for non-cardiac surgery. Stair climbing capacity has peri-operative prognostic importance. It may predict survival after lung resection and complications after major non-cardiac surgery. However, stair climbing cannot determine the aerobic metabolic capacity necessary to survive the peri-operative stress response. The potential benefits and current limitations of cardiopulmonary exercise testing to determine peri-operative aerobic capacity are discussed. Principles for the selection of an appropriate screening test of aerobic function are put forward.
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Affiliation(s)
- B M Biccard
- Department of Anaesthetics, Nelson R. Mandela School of Medicine, Private Bag 7, Congella 4013, South Africa.
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