Publication details

Poor ventilatory efficiency during exercise may predict prolonged air leak after pulmonary lobectomy

Authors

BRAT Kristián CHOBOLA Miloš HOMOLKA Pavel HEROUTOVÁ Michaela BENEJ Michal MITÁŠ Ladislav OLSON Lyle J. ČUNDRLE Ivan

Year of publication 2020
Type Article in Periodical
Magazine / Source Interactive CardioVascular and Thoracic Surgery
MU Faculty or unit

Faculty of Medicine

Citation
Web http://dx.doi.org/10.1093/icvts/ivz255
Doi http://dx.doi.org/10.1093/icvts/ivz255
Keywords V-E/VCO2 slope; Prolonged air leak; Postoperative complications; Anatomical lung resection
Description Poor ventilatory efficiency, defined as the increase in minute ventilation relative to carbon dioxide production during exercise (V-E/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 V-E/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 V-E/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 V-E/VCO2 slope during exercise may be helpful in identifying patients at greater risk for the development of PAL after lung lobectomy.