Cardiopulmonary exercise testing in thoracic surgery

Pele, Irina; Mihălţan, F

doi:10.2478/pneum-2020-0001

Cited by 3 publications

(11 citation statements)

References 53 publications

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“…CPET is feasible, safe, and recommended for patients with cancer prior to a physical exercise program ( 35 ). For patients with lung cancer, though only few available studies, the physician can prescribe tailored PRCR and can also asses the effectiveness of the rehabilitation based on CPET parameters ( 36 – 38 ). Our team has performed CPET-guided PRCR since 2017, based on the results of this current study and the low risk of major adverse events associated with performing CPET ( 33 ), routine pre-operative CPET should be highlighted for all lung cancer patients pending lung resection if it is performed in a controlled environment with continuous monitoring, appropriate equipment and well-trained personnel, without contraindications proposed by ACSM ( 39 ).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery

Chao

Tuan²,

Tang³

et al. 2022

Front. Med.

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ObjectivesPatients with lung cancer pose a high risk of morbidity and mortality after lung resection. Those who receive perioperative cardiopulmonary rehabilitation (PRCR) have better prognosis. Peak oxygen consumption (peak VO2), VO2 at the ventilatory threshold (VO2 at VT), and slope of minute ventilation to carbon dioxide production (VE/VCO2 slope) measured during pre-surgical cardiopulmonary exercise testing (CPET) have prognostic values after lung resection. We aimed to investigate the influence of individualized PRCR on postoperative complications in patients undergoing video-assisted thoracic surgery (VATS) for lung cancer with different pre-surgical risks.MethodsThis was a retrospective study. We recruited 125 patients who underwent VATS for lung cancer between 2017 and 2021. CPET was administered before surgery to evaluate the risk level and PRCR was performed based on the individual risk level defined by peak VO2, VO2 at VT, and VE/VCO2 slope, respectively. The primary outcomes were intensive care unit (ICU) and hospital lengths of stay, endotracheal intubation time (ETT), and chest tube insertion time (CTT). The secondary outcomes were postoperative complications (PPCs), including subcutaneous emphysema, pneumothorax, pleural effusion, atelectasis, infection, and empyema.ResultsThree intergroup comparisons based on the risk level by peak VO2 (3 groups), VO2 at VT (2 groups), and VE/VCO2 slope (3 groups) were done. All of the comparisons showed no significant differences in both the primary and secondary outcomes (p = 0.061–0.910).ConclusionPatients with different risk levels showed comparable prognosis and PPCs after undergoing CPET-guided PRCR. PRCR should be encouraged in patients undergoing VATS for lung cancer.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery

Chao

Tuan²,

Tang³

et al. 2022

Front. Med.

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“…It is based on the principle that system failure occurs when under stress. Monitoring of cardiopulmonary variables such as peak oxygen consumption (VO2), anaerobic threshold (AT), ventilatory equivalent for carbon dioxide (VE/VCO2 slope) can aid assessment [13,14]. VO2 peak and AT are measures of a patient's exercise capacity whereas VCO2 demonstrates the gas exchange efficiency [14].…”

Section: Cardiopulmonary Exercise Testing (Cpet)mentioning

confidence: 99%

“…It is the most used parameter when describing the capacity of surgery candidates. It is associated with postoperative mortality and morbidity, with separate predictive values for major surgical procedures [13].…”

Section: Cardiopulmonary Exercise Testing (Cpet)mentioning

confidence: 99%

“…One of the known disadvantages of this parameter is that it can be influenced by the subject's motivation, therefore causing an incorrect exclusion from a potentially curative procedure [13]. In addition, CPET is difficult to offer to patients unfit for the test, for example, patients with severe arthritis.…”

Section: Cardiopulmonary Exercise Testing (Cpet)mentioning

confidence: 99%

“…Over the years controversies exist over the best cut-off which separates the lower risk from the intermediate/high risk for postoperative complications. Nonetheless in clinical practice, patients with VO2 max values > 20ml/kg/min (or 75% predicted) undergo major surgeries such as pneumonectomy whereas patients with values < 10ml/kg/min (or 35% predicted) seem to have better prognosis with oncological or palliative treatments [13].…”

Section: Cardiopulmonary Exercise Testing (Cpet)mentioning

confidence: 99%

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Risk Stratification for Lung Cancer Patients

Jain¹,

Philip²,

Begum³

et al. 2022

Cureus

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A comprehensive review of relevant clinical literature on evidence-based recommendations and existing prediction models specific to lung cancer surgery was undertaken. Preoperative risk assessment parameters such as pulmonary function tests (PFT), cardiopulmonary exercise testing (CPET), Brunelli models, Thoracoscore and frailty were analyzed for predicting postoperative risk of complications.When assessing fitness for surgery, the primarily used PFT parameters such as predictive postoperative forced expiratory volume in one second (FEV1) and diffusion capacity for carbon monoxide (DLCO ) showed conflicting evidence in determining a positive correlation with postoperative mortality. CPET variables predicted higher complication risk when VO2peak < 10ml/kg/min, AT < 11ml/kg/min and ventilation/carbon dioxide production (VE/VCO2) was in range of 34-40. While a cardiac risk index like the Thoracic Revised Cardiac Risk Index (ThRCRI) predicted major cardiovascular compromise, a thoracic risk index like Thoracoscore proved imprecise. Lastly, frailty is used to risk stratify patients in clinical practice but a recognized validated model specific to thoracic surgery is non-existent.When considering patients for lung cancer surgery, some dilemma exists regarding the accuracy of clinical prediction models and their external validation. There is a pressing need for the development of a consolidated clinically robust risk stratification model to predict complications after thoracic resections.

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Early outcomes of “low-risk” patients undergoing lung resection assessed by cardiopulmonary exercise testing: Single-institution experience

et al. 2023

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ObjectiveCardiopulmonary exercise testing (CPET) is currently recommended for all patients undergoing lung resection with either respiratory comorbidities or functional limitations. The main parameter evaluated is oxygen consumption at peak (VO2peak). Patients with VO2peak above 20 ml/kg/min are classified as low risk surgical candidates. The aims of this study were to evaluate postoperative outcomes of low-risk patients, and to compare their outcomes with those of patients without pulmonary impairment at respiratory function testing.MethodsRetrospective monocentric observational study was designed, evaluating outcomes of patients undergoing lung resection at San Paolo University Hospital, Milan, Italy, between January 2016 and November 2021, preoperatively assessed by CPET, according to 2009 ERS/ESTS guidelines. All low-risk patients undergoing any extent surgical lung resection for pulmonary nodules were enrolled. Postoperative major cardiopulmonary complications or death, occurring within 30 days from surgery, were assessed. A case-control study was nested, matching 1:1 for type of surgery the cohort population with control patients without functional respiratory impairment consecutively undergoing surgery at the same centre in the study period.ResultsA total of 80 patients were enrolled: 40 subjects were preoperatively assessed by CPET and deemed at low risk, whereas 40 subjects represented the control group. Among the first, 4 patients (10%) developed major cardiopulmonary complications, and 1 patient (2.5%) died within 30 days from surgery. In the control group, 2 patients (5%) developed complications and none of the patients (0%) died. The differences in morbidity and mortality rates did not reach statistically significance. Instead, age, weight, BMI, smoking history, COPD incidence, surgical approach, FEV1, Tiffenau, DLCO and length of hospital stay resulted significantly different between the two groups. At a case-by-case analysis, CPET revealed a pathological pattern in each complicated patient, in spite of VO2peak above target for safe surgery.ConclusionsPostoperative outcomes of low-risk patients undergoing lung resections are comparable to those of patients without any pulmonary functional impairment; nonetheless the formers represent a dramatically different category of individuals from the latter and may harbour few patients with worse outcomes. CPET variables overall interpretation may add to the VO2peak in identifying higher risk patients, even in this subgroup.

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Cardiopulmonary exercise testing in thoracic surgery

Cited by 3 publications

References 53 publications

Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery

Effectiveness of Perioperative Cardiopulmonary Rehabilitation in Patients With Lung Cancer Undergoing Video-Assisted Thoracic Surgery

Risk Stratification for Lung Cancer Patients

Early outcomes of “low-risk” patients undergoing lung resection assessed by cardiopulmonary exercise testing: Single-institution experience

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