BACKGROUND: Respiratory muscle training may improve ventilatory efficiency (VE/VCO2 slope), a strong predictor of postoperative pulmonary complications. We hypothesised that multimodal prehabilitation, incorporating high-intensity respiratory muscle training, before lung resection would reduce postoperative complications and length of hospital stay. METHODS: We conducted a prospective multicentre, randomised controlled trial (NCT04826575) to examine the effect of prehabilitation in individuals undergoing lung resection. Participants were defined as high-risk for postoperative pulmonary complications if they achieved VE/VCO2 slope ≥33, as determined by cardiopulmonary exercise testing. Participants were then randomised to either usual care or multimodal prehabilitation, which consisted of a 14-day programme of high-intensity respiratory muscle training, smoking cessation, nutritional support, and psychological support. The primary outcome were postoperative pulmonary and cardiovascular complications (pneumonia, atelectasis, respiratory failure necessitating mechanical ventilation, adult respiratory distress syndrome, prolonged air leak). RESULTS: A total of 122 patients (46% female; age range: 64-75 yr) completed the study. Postoperative pulmonary complications occurred in 20/58 (34%) of patients randomised to multimodal prehabilitation, compared with 35/64 (55%) patients receiving usual care (odds ratio 2.29 [95% confidence interval 1.10-4.77]; P=0.029). Hospital length of stay was shorter after multimodal rehabilitation compared with patients randomised to receive usual care (from 9 [7-11] days to 7 [6-9] days; P=0.038). After prehabilitation, mean (sd) VE/VCO2 slope decreased from 39 (8) to 36 (9); P=0.01. Prehabilitation also improved patient-reported quality of life measures. CONCLUSIONS: In high-risk patients undergoing elective lung resection surgery, multimodal prehabilitation, including high-intensity respiratory muscle training to target VE/VCO2, reduced postoperative pulmonary complications and hospital length of stay.
- MeSH
- dechová cvičení * metody MeSH
- délka pobytu statistika a číselné údaje MeSH
- fyzioterapie v předoperační přípravě * MeSH
- kombinovaná terapie MeSH
- lidé středního věku MeSH
- lidé MeSH
- odvykání kouření MeSH
- plicní nemoci * prevence a kontrola MeSH
- pneumektomie * MeSH
- pooperační komplikace * prevence a kontrola MeSH
- předoperační péče * metody MeSH
- prospektivní studie MeSH
- senioři MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- randomizované kontrolované studie MeSH
INTRODUCTION: Ventilatory efficiency (V'E/V'CO2 ) has been shown to predict postoperative pulmonary complications (PPCs) in lung resection candidates. V'E/V'CO2 is determined by arterial partial pressure of carbon dioxide (PaCO2 ) and by dead space to tidal volume ratio (VD/VT). We hypothesised PaCO2 and VD/VT contribute equally to the increase in V'E/V'CO2 in lung resection patients. METHODS: Consecutive lung resection candidates from two prior prospective studies were included in this post hoc analysis. All subjects underwent preoperative spirometry, cardiopulmonary exercise testing and arterial blood gas analysis at rest and peak exercise. PPCs were prospectively assessed during the first 30 postoperative days, or hospital stay. A t-test, Mann-Whitney U-test and two-tailed Fisher's exact test were used to compare patients with and without PPCs. p-values <0.05 were considered statistically significant. RESULTS: Of 398 patients, PPC developed in 64 (16%). Patients with PPCs more frequently underwent lobectomy by open thoracotomy, had longer hospital and ICU length of stay and higher 30- and 90-day mortality. Moreover, patients with PPCs exhibited a higher V'E/V'CO2 ratio both at rest and peak exercise. Both ratios were independently associated with PPCs. At rest, the contribution of PaCO2 and VD/VT to the increase in V'E/V'CO2 ratio in patients with PPCs was 45% and 55%, respectively. At peak exercise, the contribution of PaCO2 and VD/VT to the increase in V'E/V'CO2 ratio was 16% and 84%, respectively. CONCLUSIONS: VD/VT (V'/Q' mismatch and/or rapid shallow breathing pattern) is the dominant contributor to the increase in V'E/V'CO2 in lung resection candidates who develop PPCs.
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: In recent years, ventilatory efficiency (minute ventilation (V'E)/carbon dioxide production (V'CO2 ) slope) and partial pressure of end-tidal carbon dioxide (PETCO2 ) have emerged as independent predictors of postoperative pulmonary complications (PPC). Single parameters may give only partial information regarding periprocedural hazards. Accordingly, our aim was to create prediction models with improved ability to stratify PPC risk in patients scheduled for elective lung resection surgery. METHODS: This post hoc analysis was comprised of consecutive lung resection candidates from two prior prospective trials. All individuals completed pulmonary function tests and cardiopulmonary exercise testing (CPET). Logistic regression analyses were used for identification of risk factors for PPC that were entered into the final risk prediction models. Two risk models were developed; the first used rest PETCO2 (for patients with no available CPET data), the second used V'E/ V'CO2 slope (for patients with available CPET data). Receiver operating characteristic analysis with the De-Long test and area under the curve (AUC) were used for comparison of models. RESULTS: The dataset from 423 patients was randomly split into the derivation (n=310) and validation (n=113) cohorts. Two final models were developed, both including sex, thoracotomy, "atypical" resection and forced expiratory volume in 1 s/forced vital capacity ratio as risk factors. In addition, the first model also included rest PETCO2 , while the second model used V'E/V'CO2 slope from CPET. AUCs of risk scores were 0.795 (95% CI: 0.739-0.851) and 0.793 (95% CI: 0.737-0.849); both p<0.001. No differences in AUCs were found between the derivation and validation cohorts. CONCLUSIONS: We created two multicomponental models for PPC risk prediction, both having excellent predictive properties.
- Publikační typ
- časopisecké články MeSH
BACKGROUND: Physical activity is a crucial demand on cystic fibrosis treatment management. The highest value of oxygen uptake (VO2peak) is an appropriate tool to evaluate the physical activity in these patients. However, there are several other valuable CPET parameters describing exercise tolerance (Wpeak, VO2VT1, VO2VT2, VO2/HRpeak, etc.), and helping to better understand the effect of specific treatment (VE, VT, VD/VT etc.). Limited data showed ambiguous results of this improvement after CFTR modulator treatment. Elexacaftor/tezacaftor/ivacaftor medication improves pulmonary function and quality of life, whereas its effect on CPET has yet to be sufficiently demonstrated. METHODS: We performed a single group prospective observational study of 10 adolescent patients with cystic fibrosis who completed two CPET measurements between January 2019 and February 2023. During this period, elexacaftor/tezacaftor/ivacaftor treatment was initiated in all of them. The first CPET at the baseline was followed by controlled CPET at least one year after medication commencement. We focused on interpreting the data on their influence by the novel therapy. We hypothesized improvements in cardiorespiratory fitness following treatment. We applied the Wilcoxon signed-rank test. The data were adjusted for age at the time of CPET to eliminate bias of aging in adolescent patients. RESULTS: We observed significant improvement in peak workload, VO2 peak, VO2VT1, VO2VT2, VE/VCO2 slope, VE, VT, RQ, VO2/HR peak and RR peak. The mean change in VO2 peak was 5.7 mL/kg/min, or 15.9% of the reference value (SD ± 16.6; p= 0.014). VO2VT1 improved by 15% of the reference value (SD ± 0.1; p= 0.014), VO2VT2 improved by 0.5 (SD ± 0.4; p= 0.01). There were no differences in other parameters. CONCLUSION: Exercise tolerance improved after elexacaftor/tezacaftor/ivacaftor treatment initiation. We suggest that the CFTR modulator alone is not enough for recovering physical decondition, but should be supplemented with physical activity and respiratory physiotherapy. Further studies are needed to examine the effect of CFTR modulators and physical therapy on cardiopulmonary exercise tolerance.
- MeSH
- aminofenoly * terapeutické užití MeSH
- benzodioxoly * terapeutické užití MeSH
- chinolony * terapeutické užití MeSH
- cystická fibróza * farmakoterapie patofyziologie MeSH
- dítě MeSH
- fixní kombinace léků * MeSH
- indoly * terapeutické užití MeSH
- kardiorespirační zdatnost MeSH
- lidé MeSH
- mladiství MeSH
- pilotní projekty MeSH
- prospektivní studie MeSH
- pyrazoly * terapeutické užití MeSH
- pyridiny * terapeutické užití MeSH
- pyrrolidiny MeSH
- pyrroly terapeutické užití MeSH
- spotřeba kyslíku MeSH
- tolerance zátěže účinky léků MeSH
- zátěžový test MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
BACKGROUND: Hypertension is one of the most prevalent chronic non-communicable diseases and affects more than 60% of individuals over 60 years of age. Additionally, hypertension is a prominent risk factor for the development of cardiovascular diseases (CVDs). Human body composition is both the result and predictor of an individual's health status, and hypertension has consistently been shown to be more prevalent among obese individuals. In the current study, we focussed on the association between body composition parameters and hypertension occurrence. METHODS: Data from KardioVize 2030, a population-based study (n = 1988), was used to determine the association between the body composition parameters related to both fat and water content with hypertension. Body composition was assessed using the direct segmental multi-frequency bioelectrical impedance analysis method (DSM-BIA). RESULTS: Using logistic regression modelling we found that the majority of hypertension incidence could be determined by body fat and water content, as hypertension occurrence was positively correlated with increased fat-related body composition parameters and water content. Specifically, results from this study demonstrate that increased intracellular fluid was positively associated with higher hypertension incidence in men (14%) and women (16%). CONCLUSION: Body composition reflects the occurrence of hypertension and may serve as a novel therapeutic goal that can be easily implemented in the clinical setting using DSM-BIA.
- MeSH
- antropometrie metody MeSH
- elektrická impedance MeSH
- hypertenze * diagnóza epidemiologie MeSH
- index tělesné hmotnosti MeSH
- lidé středního věku MeSH
- lidé MeSH
- obezita epidemiologie MeSH
- senioři MeSH
- složení těla * MeSH
- voda MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: According to the guidelines for preoperative assessment of lung resection candidates, patients with normal forced expiratory volume in 1 s (FEV1) and diffusing capacity of the lung for carbon monoxide (DLCO) are at low risk for post-operative pulmonary complications (PPC). However, PPC affect hospital length of stay and related healthcare costs. We aimed to assess risk of PPC for lung resection candidates with normal FEV1 and DLCO (>80% predicted) and identify factors associated with PPC. METHODS: 398 patients were prospectively studied at two centres between 2017 and 2021. PPC were recorded from the first 30 post-operative days. Subgroups of patients with and without PPC were compared and factors with significant difference were analysed by uni- and multivariate logistic regression. RESULTS: 188 subjects had normal FEV1 and DLCO. Of these, 17 patients (9%) developed PPC. Patients with PPC had significantly lower pressure of end-tidal carbon dioxide (PETCO2 ) at rest (27.7 versus 29.9; p=0.033) and higher ventilatory efficiency (V'E/V'CO2 ) slope (31.1 versus 28; p=0.016) compared to those without PPC. Multivariate models showed association between resting PETCO2 (OR 0.872; p=0.035) and V'E/V'CO2 slope (OR 1.116; p=0.03) and PPC. In both models, thoracotomy was strongly associated with PPC (OR 6.419; p=0.005 and OR 5.884; p=0.007, respectively). Peak oxygen consumption failed to predict PPC (p=0.917). CONCLUSIONS: Resting PETCO2 adds incremental information for risk prediction of PPC in patients with normal FEV1 and DLCO. We propose resting PETCO2 be an additional parameter to FEV1 and DLCO for preoperative risk stratification.
- Publikační typ
- časopisecké články MeSH
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
INTRODUCTION: Ventilatory efficiency (VE/VCO2 slope) has been shown superior to peak oxygen consumption (VO2) for prediction of post-operative pulmonary complications in patients undergoing thoracotomy. VE/VCO2 slope is determined by ventilatory drive and ventilation/perfusion mismatch whereas VO2 is related to cardiac output and arteriovenous oxygen difference. We hypothesized pre-operative VO2 predicts post-operative cardiovascular complications in patients undergoing lung resection. METHODS: Lung resection candidates from a published study were evaluated by post-hoc analysis. All of the patients underwent preoperative cardiopulmonary exercise testing. Post-operative cardiovascular complications were assessed during the first 30 post-operative days or hospital stay. One-way analysis of variance or the Kruskal-Wallis test, and multivariate logistic regression were used for statistical analysis and data summarized as median (IQR). RESULTS: Of 353 subjects, 30 (9%) developed pulmonary complications only (excluded from further analysis), while 78 subjects (22%) developed cardiovascular complications and were divided into two groups for analysis: cardiovascular only (n = 49) and cardiovascular with pulmonary complications (n = 29). Compared to patients without complications (n = 245), peak VO2 was significantly lower in the cardiovascular with pulmonary complications group [19.9 ml/kg/min (16.5-25) vs. 16.3 ml/kg/min (15-20.3); P<0.01] but not in the cardiovascular only complications group [19.9 ml/kg/min (16.5-25) vs 19.0 ml/kg/min (16-23.1); P = 0.18]. In contrast, VE/VCO2 slope was significantly higher in both cardiovascular only [29 (25-33) vs. 31 (27-37); P = 0.05] and cardiovascular with pulmonary complication groups [29 (25-33) vs. 37 (34-42); P<0.01)]. Logistic regression analysis showed VE/VCO2 slope [OR = 1.06; 95%CI (1.01-1.11); P = 0.01; AUC = 0.74], but not peak VO2 to be independently associated with post-operative cardiovascular complications. CONCLUSION: VE/VCO2 slope is superior to peak VO2 for prediction of post-operative cardiovascular complications in lung resection candidates.
- MeSH
- kyslík MeSH
- lidé MeSH
- plíce chirurgie MeSH
- prognóza MeSH
- spotřeba kyslíku * MeSH
- srdeční selhání * MeSH
- zátěžový test MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
