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Role of CO diffusing capacity during exercise in the preoperative evaluation for lung resection
J S Wang1, R T Abboud, K G Evans
1Respiratory and Thoracic Surgery Divisions and Lung Function Laboratory, University of British Columbia, Vancouver.
American Journal of Respiratory and Critical Care Medicine
|October 13, 2000
Summary
Patients undergoing lung resection with an inadequate increase in diffusing capacity for carbon monoxide (DL(CO)) during exercise face higher postoperative complication risks. A DL(CO) increase below 10% is a strong predictor of complications after surgery.
Area of Science:
- Pulmonary Medicine
- Cardiopulmonary Physiology
- Surgical Risk Assessment
Background:
- Lung resection surgery carries significant postoperative risks.
- Assessing preoperative pulmonary function is crucial for predicting patient outcomes.
- Diffusing capacity for carbon monoxide (DL(CO)) is a key measure of gas exchange efficiency.
Purpose of the Study:
- To investigate the association between inadequate increase in DL(CO) during exercise and postoperative complications after lung resection.
- To identify DL(CO) response during exercise as a potential predictor of surgical risk.
Main Methods:
- Prospective study involving 57 patients undergoing lung resection.
- Utilized the three-equation method (3EQ-DL(CO)) to measure DL(CO) during exercise at 35% and 70% of maximal workload.
- Compared resting DL(CO), exercise-induced DL(CO) increase, and maximal oxygen uptake (VO(2)max) with postoperative complication rates.
Main Results:
- Patients with postoperative complications exhibited lower resting DL(CO) (R-DL(CO)), a smaller DL(CO) increase from rest to 70% maximal workload ([70% - R]-DL(CO)%), and lower VO(2)max.
- The [70% - R]-DL(CO)% was the strongest preoperative predictor of complications.
- A threshold of 10% for [70% - R]-DL(CO)% demonstrated high sensitivity (78%) and specificity (100%), identifying patients with a 100% complication rate if below this threshold.
Conclusions:
- An insufficient increase in DL(CO) during exercise ([70% - R]-DL(CO)% < 10%) is significantly associated with increased postoperative complications following lung resection.
- Preoperative assessment of exercise-induced DL(CO) response can aid in identifying high-risk patients for lung resection.