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Titolo:
EVALUATION OF HIGH-RISK LUNG RESECTION CANDIDATES - PULMONARY HEMODYNAMICS VERSUS EXERCISE TESTING - A SERIES OF 5 PATIENTS
Autore:
BOLLIGER CT; SOLER M; STULZ P; GRADEL E; MULLERBRAND J; ELSASSER S; GONON M; WYSER C; PERRUCHOUD AP;
Indirizzi:
UNIV BASEL HOSP,DEPT INTERNAL MED,DIV PNEUMOL,PETERSGRABEN 4 CH-4031 BASEL SWITZERLAND UNIV BASEL HOSP,DEPT SURG,CARDIOTHORAC UNIT CH-4031 BASEL SWITZERLAND UNIV BASEL HOSP,DEPT RADIOL CH-4031 BASEL SWITZERLAND
Titolo Testata:
Respiration
fascicolo: 4, volume: 61, anno: 1994,
pagine: 181 - 186
SICI:
0025-7931(1994)61:4<181:EOHLRC>2.0.ZU;2-E
Fonte:
ISI
Lingua:
ENG
Soggetto:
PREOPERATIVE ASSESSMENT; BRONCHOGENIC-CARCINOMA; OXYGEN-CONSUMPTION; MORBIDITY; MORTALITY; CANCER; PREDICTOR; CAPACITY;
Keywords:
PREOPERATIVE EVALUATION; LUNG RESECTION; PULMONARY FUNCTION TESTS; PULMONARY HEMODYNAMICS; EXERCISE TESTING; MAXIMAL OXYGEN UPTAKE;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
25
Recensione:
Indirizzi per estratti:
Citazione:
C.T. Bolliger et al., "EVALUATION OF HIGH-RISK LUNG RESECTION CANDIDATES - PULMONARY HEMODYNAMICS VERSUS EXERCISE TESTING - A SERIES OF 5 PATIENTS", Respiration, 61(4), 1994, pp. 181-186

Abstract

We compared the value of exercise testing and measurement of pulmonary haemodynamics (PH) in the pre-operative assessment of 5 patients (mean age: 64 years, 3 men) with clinical stage I or II bronchogenic carcinoma and severe chronic obstructive pulmonary disease. They were considered at high risk due to poor pulmonary function tests (PFT); (one or more of the following): (1) radionuclide calculated postlobectomy FEV(1) <30% predicted, (2) diffusion capacity or transfer factor <60% predicted, combined with a fall in PaO2 on maximal exercise of >5 mm Hg,(3) a PaCO2 at rest of >45 mm HE. Maximal oxygen uptake (VO2max) during symptom-limited cycle ergometry and PH were measured in these 5 patients. They were considered eligible for lobectomy if they fulfilled at least one of the two criteria: (1) mean pulmonary artery pressure (PAP) of <35 mm Hg and pulmonary vascular resistance of <190 dyn.s.cm(-5) at moderate exercise (40 W), (2) a VO2max of greater than or equal to 15 ml/kg/min. Six months postoperatively PFT and VO2max were measured again. PAP(40W) was 21, 38, 38, 46 and 52 mm Hg, respectively, whichwould have excluded 4/5 patients from surgery, VO2max was 21.7, 14.9,13.4, 19.2 and 18.6 ml/kg/min, respectively, which would have excluded 2/5 patients. Expressed in percent predicted, however, VO2max was greater than or equal to 69% in all 5 patients, indicating only mild impairment of exercise capacity in the 2 patients with <15 ml/kg/min VO2max. Therefore all 5 patients were offered surgery and underwent lobectomy. Apart from 1 prolonged air leak no complications occurred, the mean hospital stay was 16 days (13-21). At 6 months their PFT and VO2maxwere unchanged. In conclusion, in our series of patients with marginal pulmonary function, exercise testing with the determination of VO2max was superior to PH measurements for the prediction of operability. It seems that VO2max should be expressed as a percent of predicted; however, our findings will need confirmation by future studies with bigger sample sizes.

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Documento generato il 04/12/20 alle ore 15:22:31