Minute ventilation to carbon dioxide output (V’E/V’CO2 slope) is the strongest death predictor before larger lung resections

Abstract

The minute ventilation to carbon dioxide (CO 2 ) production ratio (V' E /V' CO2 slope) was recently identified as a mortality predictor after lung surgery, but the effect of the resection extent was not taken into account. The aim of this study was to investigate the role of V' E /V' CO2 slope as preoperative mortality predictor depending on the type of surgery performed. Retrospective analysis was performed on 263 consecutive patients evaluated before surgery for lung cancer. Death within 30 days and serious respiratory complications were considered. Univariate and multivariate regression analyses were used to identify independent predictors of death. Lobectomy or bilobectomy were performed in 186 patients with 29/186 (15.6%) serious pulmonary complications and 6/186 (3.2%) deaths. Pneumonectomy was performed in 77 patients with 14/77 (18.2%) serious complications and 5/77 (6.5%) deaths. Considering the whole group, the peak oxygen consumption (V' O2peak, L/min; z=-2.66, p<0.008, OR 0.007) and V' E /V' CO2 slope (z=2.80, p<0.005, OR 1.14) were independent predictors of mortality whereas in pneumonectomies V' E /V' CO2 slope (z=2.34, p<0.02, OR 1.22) was the only independent predictor of mortality. High V' E /V' CO2 slope, age and low V' O2peak are predictors of death and severe complications after lung surgery. Before larger resections as pneumonectomies an increased V' E /V' CO2 slope represents the best mortality predictor.

Influence of circadian blood pressure patterns and cardiopulmonary functional capacity in hypertensive patients

“…This might be explained by changes in pulmonary vasculature and cardiac dysfunction induced by arterial hypertension. 5 Studies showed that ventilation/carbon dioxide slope was the strongest predictor of mortality and severe complications after lung resection, 21 and superior predictor to the oxygen uptake efficiency slope in patients with heart failure. 22 TA B L E 4 The association between demographic and clinical with parameters of cardiopulmonary exercise testing (correlation and multivariate regression analyses)…”

“…This might be explained by changes in pulmonary vasculature and cardiac dysfunction induced by arterial hypertension . Studies showed that ventilation/carbon dioxide slope was the strongest predictor of mortality and severe complications after lung resection, and superior predictor to the oxygen uptake efficiency slope in patients with heart failure …”

Exertional ventilation/carbon dioxide output relationship in COPD: from physiological mechanisms to clinical applications

“…For instance, TORCHIO et al [69] reported that a high V′ E -V′ CO 2 slope was the strongest predictor of mortality after pneumonectomies, a finding extended by MIYAZAKI et al [70] to less extensive anatomical lung resections. ELLENBERGER et al [71] found that a particularly high V′ E /V′ CO 2 (>40) predicted poor survival after radical surgery for lung cancer.…”

Effect of prehabilitation on ventilatory efficiency in non–small cell lung cancer patients: A cohort study

“…18,19 A high VE/VCO 2 slope is known to be associated with a risk of pulmonary arterial hypertension in patients with COPD, 20 and has been suggested as a possible indicator of subclinical heart failure in patients referred for pneumonectomy. 21 The VE/VCO 2 slope is more commonly evaluated in patients with chronic heart failure. Two recent meta-analyses on the effects of exercise training in patients with heart failure also notably failed to show any benefits of exercise training on the VE/VCO 2 slope, even with high-intensity interval training.…”