BACKGROUND: Ventilatory efficiency (V˙e/V˙co2 slope [minute ventilation to carbon dioxide output slope]) has been shown to predict morbidity and mortality in lung resection candidates. Patients with increased V˙e/V˙co2 during exercise also exhibit an increased V˙e/V˙co2 ratio and a decreased end-tidal CO2 at rest. This study hypothesized that ventilatory values at rest predict respiratory complications and death in patients undergoing thoracic surgical procedures. METHODS: Inclusion criteria for this retrospective, multicenter study were thoracotomy and cardiopulmonary exercise testing as part of routine preoperative assessment. Respiratory complications were assessed from the medical records (from the hospital stay or from the first 30 postoperative days). For comparisons, Student's t test or the Mann-Whitney U test was used. Logistic regression and receiver operating characteristic analyses were performed for evaluation of measurements associated with respiratory complications. Data are summarized as mean ± SD; p <0.05 is considered significant. RESULTS: Seventy-six subjects were studied. Postoperatively, respiratory complications developed in 56 (74%) patients. Patients with postoperative respiratory complications had significantly lower resting tidal volume (0.8 ± 0.3 vs 0.9 ± 0.3L; p = 0.03), lower rest end-tidal CO2 (28.1 ± 4.3vs 31.5 ± 4.2 mm Hg; p < 0.01), higher resting V˙e/V˙co2 ratio (45.1 ± 7.1 vs 41.0 ± 6.4; p = 0.02), and higher V˙e/V˙co2 slope (34.9 ± 6.4 vs 31.2 ± 4.3; p = 0.01). Logistic regression (age and sex adjusted) showed resting end-tidal CO2 to be the best predictor of respiratory complications (odds ratio: 1.21; 95% confidence interval: 1.06 to 1.39; area under the curve: 0.77; p = 0.01). CONCLUSIONS: Resting end-tidal CO2 may identify patients at increased risk for postoperative respiratory complications of thoracic surgical procedures.

Department of Anesthesiology and Intensive Care St Anne's University Hospital Brno Czech Republic

Department of Respiratory Diseases University Hospital Brno Brno Czech Republic; Faculty of Medicine Masaryk University Brno Czech Republic

Department of Respiratory Medicine Thomayer Hospital Prague Czech Republic

Department of Thoracic Surgery Thomayer Hospital Prague Czech Republic

Division of Cardiovascular Diseases Mayo Clinic Rochester Minnesota

Faculty of Medicine Masaryk University Brno Czech Republic; Department of Sports Medicine and Rehabilitation St Anne's University Hospital Brno Czech Republic; International Clinical Research Center St Anne's University Hospital Brno Czech Republic

International Clinical Research Center St Anne's University Hospital Brno Czech Republic; Department of Anesthesiology and Intensive Care St Anne's University Hospital Brno Czech Republic

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