Poor ventilatory efficiency during exercise may predict prolonged air leak after pulmonary lobectomy

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BRAT Kristián CHOBOLA Miloš HOMOLKA Pavel HEROUTOVÁ Michaela BENEJ Michal MITÁŠ Ladislav OLSON Lyle J. ČUNDRLE Ivan

Rok publikování 2020
Druh Článek v odborném periodiku
Časopis / Zdroj Interactive CardioVascular and Thoracic Surgery
Fakulta / Pracoviště MU

Lékařská fakulta

Citace
www http://dx.doi.org/10.1093/icvts/ivz255
Doi http://dx.doi.org/10.1093/icvts/ivz255
Klíčová slova V-E/VCO2 slope; Prolonged air leak; Postoperative complications; Anatomical lung resection
Popis Poor ventilatory efficiency, defined as the increase in minute ventilation relative to carbon dioxide production during exercise (V-E/VCO2 slope), may be associated with dynamic hyperinflation and thereby promote the development of prolonged air leak (PAL) after lung resection. Consecutive lung lobectomy candidates (n = 96) were recruited for this prospective two-centre study. All subjects underwent pulmonary function tests and cardiopulmonary exercise testing prior to surgery. PAL was defined as the presence of air leaks from the chest tube on the 5th postoperative day and developed in 28 (29%) subjects. Subjects with PAL were not different in terms of age, sex, American Society of Anesthesiologists class, type of surgery (thoracotomy/video-assisted thoracoscopic surgery) and site of surgery (right/left lung; upper/lower lobes). Subjects with PAL had more frequent pleural adhesions (50% vs 21%; P = 0.006) and steeper V-E/VCO2 slope (35 +/- 7 vs 30 +/- 5; P = 0.001). Stepwise logistic regression showed that only the presence of pleural adhesions [odds ratio (OR) 3.9, 95% confidence interval (CI) 1.4-10.9; P = 0.008] and V-E/VCO2 slope (OR 1.1, 95% CI 1.0-1.2; P = 0.003) were independently associated with PAL (AUC 0.74, 95% CI 0.62-0.86). We conclude that a high V-E/VCO2 slope during exercise may be helpful in identifying patients at greater risk for the development of PAL after lung lobectomy.

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