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Predicted Postoperative Product and Diffusion Heterogeneity Index in the Evaluation of Candidates for Lung Resection

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Abstract:

OBJECTIVES: The primary objective of this retrospective study was to evaluate whether abnormal predicted postoperative variables and predicted postoperative product are useful in predicting postoperative complications. The secondary objective was to assess whether an abnormal diffusion heterogeneity index is associated with increased postoperative complications. METHODS: In this retrospective study we evaluated the medical records of 57 patients who underwent lung resection for lung cancer. Calculations of the predicted postoperative variables were done using preoperative testing data, including the extent of the resected lung segments. Predicted postoperative product was obtained by multiplying the predicted postoperative percent-of-predicted FEV1 by the predicted postoperative percent-of-predicted single-breath diffusing capacity of the lung for carbon monoxide (DLCO). The measured product was obtained by multiplying FEV1 by DLCO. We derived diffusion heterogeneity index from measurements of the single-breath DLCO with the 3-equation method, as a measure of the heterogeneity of the distribution of gas exchange in the lung. RESULTS: Patients with complications had lower predicted postoperative FEV1 (P < .001), lower predicted postoperative DLCO (P < .001), lower predicted postoperative maximal oxygen uptake (P < .001), lower predicted postoperative increase in percent-of-predicted DLCO at 70% work load from at-rest percent-of-predicted DLCO (ΔDLCO%) (P < .001), lower predicted postoperative product (P < .001), and lower measured product (P = .004). Interestingly, diffusion heterogeneity index increased with exercise in all patients with complications but decreased with exercise in all patients without complications. CONCLUSIONS: The predicted postoperative variables, predicted postoperative product, measured product, and diffusion heterogeneity index are potentially useful predictors of complications in candidates for lung resection.

Keywords: diffusing capacity; exercise testing; lung resection; predicted postoperative product; preoperative evaluation; spirometry

Document Type: Research Article

DOI: http://dx.doi.org/10.4187/respcare.00850

Affiliations: Division of Respirology, Antai Medical Care Cooperation, Antai Tian-Sheng Memorial Hospital, No. 166 Min-Shiang Street, Kaohsiung 800, Taiwan. wangjs6@hotmail.com.

Publication date: April 1, 2011

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