BACKGROUND: Cardiopulmonary exercise testing parameters including ventilatory efficiency (VE/VCO2 slope) are used for risk assessment of lung resection candidates. However, many patients are unable or unwilling to undergo exercise. VE/VCO2 slope is closely related to the partial pressure of end-tidal carbon dioxide (PETCO2). We hypothesized PETCO2 at rest predicts postoperative pulmonary complications. METHODS: Consecutive lung resection candidates were included in this prospective multicenter study. Postoperative respiratory complications were assessed from the first 30 postoperative days or from the hospital stay. Student t test or Mann-Whitney U test was used for comparison. Multivariate stepwise logistic regression analysis was used to analyze association with the development of postoperative pulmonary complications. The De Long test was used to compare area under the curve (AUC). Data are summarized as median (interquartile range). RESULTS: Three hundred fifty-three patients were analyzed, of which 59 (17%) developed postoperative pulmonary complications. PETCO2 at rest was significantly lower (27 [24-30] vs 29 [26-32] mm Hg; P < .01) and VE/VCO2 slope during exercise significantly higher (35 [30-40] vs 29 [25-33]; P < .01) in patients who developed postoperative pulmonary complications. Both rest PETCO2 with odds ratio 0.90 (95% confidence interval [CI] 0.83-0.97); P = .01 and VE/VCO2 slope with odds ratio 1.10 (95% CI 1.05-1.16); P < .01 were independently associated with postoperative pulmonary complications by multivariate stepwise logistic regression analysis. There was no significant difference between AUC of both models (rest PETCO2: AUC = 0.79 (95% CI 0.74-0.85); VE/VCO2 slope: AUC = 0.81 (95% CI 0.75-0.86); P = .48). CONCLUSIONS: PETCO2 at rest has similar prognostic utility as VE/VCO2 slope, suggesting rest PETCO2 may be used for postoperative pulmonary complications prediction in lung resection candidates.

• MeSH
• lidé MeSH
• oxid uhličitý * MeSH
• plíce MeSH
• prospektivní studie MeSH
• spotřeba kyslíku MeSH
• srdeční selhání * MeSH
• zátěžový test MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• Názvy látek
• oxid uhličitý * MeSH

UNLABELLED: Poor ventilatory efficiency, defined as the increase in minute ventilation relative to carbon dioxide production during exercise (VE/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 VE/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 VE/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 VE/VCO2 slope during exercise may be helpful in identifying patients at greater risk for the development of PAL after lung lobectomy. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov identifier: NCT03498352.

• Klíčová slova
• Anatomical lung resection, Postoperative complications, Prolonged air leak, VE/VCO2 slope,
• MeSH
• cvičení fyziologie   MeSH
• hrudní chirurgie video-asistovaná MeSH
• hrudní trubice MeSH
• lidé středního věku MeSH
• lidé MeSH
• logistické modely MeSH
• plicní nemoci mortalita   patofyziologie   chirurgie   MeSH
• plicní ventilace fyziologie   MeSH
• pneumektomie škodlivé účinky   MeSH
• prediktivní hodnota testů MeSH
• prognóza MeSH
• prospektivní studie MeSH
• respirační funkční testy MeSH
• senioři MeSH
• spotřeba kyslíku fyziologie   MeSH
• zátěžový test MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

OBJECTIVES: One-lung ventilation (OLV) may be complicated by hypoxemia. Ventilatory efficiency, defined as the ratio of minute ventilation to carbon dioxide output (VE/VCO2), is increased with ventilation/perfusion mismatch and pulmonary artery hypertension, both of which may be associated with hypoxemia. Hence, the authors hypothesized increased VE/VCO2 will predict hypoxemia during OLV. DESIGN: Prospective observational study. SETTING: Single-center, university, tertiary care hospital. PARTICIPANTS: The study comprised 50 consecutive lung resection candidates. INTERVENTIONS: All patients underwent cardiopulmonary exercise testing before surgery. Patients who required inspired oxygen fraction (FiO2) ≥0.7 to maintain arterial oxygen (O2) saturation >90% after 30 minutes of OLV were considered to be hypoxemic. The Student t or Mann-Whitney U test were used for comparison of patients who became hypoxemic and those who did not. Multiple regression analysis adjusted for age, sex, and body mass index was used to evaluate which parameters were associated with the VE/VCO2 slope. Data are summarized as mean ± standard deviation. MEASUREMENTS AND MAIN RESULTS: Twenty-four patients (48%) developed hypoxemia. There was no significant difference in age, sex, and body mass index between hypoxemic and nonhypoxemic patients. However, patients with hypoxemia had a significantly higher VE/VCO2 slope (30 ± 5 v 27 ± 4; p = 0.04) with exercise and lower partial pressure of oxygen/FiO2 (129 ± 92 v 168 ± 88; p = 0.01), higher mean positive end-expiratory pressure (6.6 ± 1.5 v 5.6 ± 0.9 cmH2O; p = 0.02), and lower mean pulse oximetry O2 saturation/FiO2 index (127 ± 20 v 174 ± 17; p < 0.01) during OLV. Multiple regression showed VE/VCO2 to be independently associated with the mean pulse oximetry O2 saturation/FiO2 index (b = -0.28; F = 3.1; p = 0.05). CONCLUSIONS: An increased VE/VCO2 slope may predict hypoxemia development in patients who undergo OLV.

• Klíčová slova
• cardiopulmonary exercise testing, hypoxemia, one-lung ventilation,
• MeSH
• dospělí MeSH
• hypoxie etiologie   MeSH
• kyslík krev   MeSH
• lidé středního věku MeSH
• lidé MeSH
• plicní ventilace fyziologie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• spotřeba kyslíku MeSH
• ventilace jedné plíce škodlivé účinky   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• Názvy látek
• kyslík MeSH