Comparison between actual and predicted postoperative stair-climbing test, walk test and spirometric values in patients undergoing lung resection

Abstract

Purpose:To assess whether the tests -Forced Expiratory Volume at one second (FEV 1 ), 6-minute walk test (6MWT) and stair-climbing test (SCT) showed proportional changes after the resection of functioning lung. Methods: Candidates for pulmonary resection were included. Spirometry, 6MWT and SCT were performed preoperatively (pre) and at least 3 months after surgery (pos). SCT was performed on a staircase with a total ascent height of 12.16m. The time taken to climb the total height the fastest possible was defined as stair-climbing time (SCt). Number of functioning segments lost, was used to calculated predicted postoperative (ppo) tests values. Pre, ppo and pos values for each test were compared. Data were analyzed by repeated-measure ANOVA with significance level set at 5%. Results: A total of 40 patients were enrolled. Pulmonary resection results ranged from gain of 2 functioning segments to loss of 9. Pre, ppo and pos values were the following: preFEV 1 = 2.6±0.8L, ppo FEV 1 =2.3±0.8L, and pos FEV 1 =2.3±0.8L, (pre FEV 1 > ppo FEV 1 = pos FEV 1 ); pre6MWT = 604±63m, ppo6MWT= 529±103m, pos6MWT= 599±74m (pre6MWT = pos6MWT > ppo6MWT); preSCt = 32.9±7.6s, ppoSCt = 37.8±12.1s, posSCt = 33.7±8.5s (preSCt = posSCt < ppoSCt). Conclusion: In our group of patients, pulmonary resection led to loss of lung function measured by spirometry, but not to exercise capacity measured by stair-climbing and walk tests. Key words: Respiratory Function Tests. Heart Function Tests. Spirometry. RESUMOObjetivo: Verificar se os testes: Volume Expiratório Forçado no 1° segundo (VEF 1 ), Teste de Caminhada de 6 minutos (TC6) e Teste de Escada (TE) se alteram proporcionalmente ao pulmão funcionante ressecado. Métodos: Foram incluídos pacientes candidatos a toracotomia para ressecção pulmonar. No pré-operatório (pré) e no mínimo três meses após a cirurgia (pós), realizaram espirometria, TC6 e TE. O TE foi realizado em escada com 12,16m de altura. O tempo para subir todos os degraus o mais rápido possível foi chamado tempo de escada (tTE). Os cálculos dos valores dos testes preditos para o pós-operatório (ppo) foram realizados conforme o número de segmentos funcionantes perdidos. Os valores pré, ppo e pós foram comparados entre si para cada teste. Estatística: foi utilizada a análise de variância para medidas repetidas (ANOVA), com significância de 5%. Resultados: Foram estudados 40 pacientes. A ressecção pulmonar variou desde o ganho de dois segmentos funcionantes até a perda de 9. Os valores pré, ppo e pós foram respectivamente: VEF 1 -pré = 2,6±0,8L, ppo = 2,3±0,8L, pós = 2,3±0,8L (VEF 1 pré > VEF 1 ppo = VEF 1 pós), TC6-pré = 604±63m, ppo = 529±103m, pós = 599±74m (TC6pré = TC6pós > TC6ppo), tTE-pré = 32,9±7,6s, ppo = 37,8±12,1s, pós = 33,7±8,5s (tTEpré = tTEpós < tTEppo). Conclusão: Nas ressecções pulmonares, este grupo de pacientes perdeu função pulmonar medida através da espirometria, mas não perdeu a capacidade de exercício, medida através dos testes de escada e caminhada.

Performance in the 6-minute walk test and postoperative pulmonary complications in pulmonary surgery: an observational study

“…Some researchers have shown that reduced exercise capacity is associated with a longer hospital stay and costs in patients undergoing lung resection 20 - 22 . Other authors have shown that when the distance was 300 meters or less, the risk of hospitalization or mortality in patients with heart failure increased 23 . It is noteworthy that the average distance traveled by the group with PPC in our study was 340.89 meters.…”

The effects of inspiratory muscle training on exercise capacity, dyspnea and respiratory functions in lung transplantation candidates: a randomized controlled trial

“…Significance level was accepted as P < 0.05 in all tests. We estimated that a sample size of 17 patients for each group to have 80% power with 5% type 1 error level to detect a minimum clinically significant differences of 54 m 28 of the 6-minute walk test 29 with the highest standard deviation of the study parameters.…”

Effects of an early postoperative walking exercise programme on health status in lung cancer patients recovering from lung lobectomy

“…The study by Dwyer et al (2011) demonstrates that ventilation and respiratory flow were significantly higher during walking exercise compared with control, and exercise-induced reductions in mechanical impedance from sputum may have been due to trunk oscillations associated with walking in patients with lung cystic fibrosis. A previous study found preoperative (pre) and ≥3 months postoperative (pos) values to be preFEV₁= 2Á6 AE 0Á8 l and posFEV₁= 2Á3 AE 0Á8 l (Pancieri et al 2010), suggesting that, in the absence of any intervention, pulmonary function will remain below the preoperative level at three months after lung resection. An observational study by Cesario et al (2007) found that patients participating in a four-week inpatient exercise programme experienced breathlessness immediately after surgery at levels significantly lower than the norm as measured by FEV₁, FVC and 6MWD (Cesario et al 2007).…”

“…A previous study found preoperative (pre) and ≥3 months postoperative (pos) values to be preFEV₁= 2·6 ± 0·8 l and posFEV₁= 2·3 ± 0·8 l (Pancieri et al . ), suggesting that, in the absence of any intervention, pulmonary function will remain below the preoperative level at three months after lung resection. An observational study by Cesario et al .…”