Publication details

The risk of post-operative pulmonary complications in lung resection candidates with normal forced expiratory volume in 1 s and diffusing capacity of the lung for carbon monoxide: a prospective multicentre study

Authors

ČUNDRLE Ivan MERTA Zdeněk BRATOVÁ Monika HOMOLKA Pavel MITÁŠ Ladislav ŠRÁMEK Vladimír SVOBODA Michal CHOVANEC Zdeněk CHOBOLA Miloš OLSON Lyle J. BRAT Kristián

Year of publication 2023
Type Article in Periodical
Magazine / Source ERJ open research
MU Faculty or unit

Faculty of Medicine

Citation
Web https://openres.ersjournals.com/content/9/2/00421-2022
Doi http://dx.doi.org/10.1183/23120541.00421-2022
Keywords lung resection; post-operative pulmonary complications; carbon monoxide
Description 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 D-LCO (>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 D-LCO. Of these, 17 patients (9%) developed PPC. Patients with PPC had significantly lower pressure of end-tidal carbon dioxide (P-ETCO2) 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 P-ETCO2 (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 P-ETCO2 adds incremental information for risk prediction of PPC in patients with normal FEV1 and D-LCO. We propose resting P-ETCO2 be an additional parameter to FEV1 and D-LCO for preoperative risk stratification.

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