Minute ventilation-to-carbon dioxide slope is associated with postoperative survival after anatomical lung resection

Miyazaki, Takuro; Callister, Matthew; Franks, K.; Dinesh, Padma; Nagayasu, Takeshi; Brunelli, Alessandro

doi:10.1016/j.lungcan.2018.10.003

Cited by 23 publications

(25 citation statements)

References 18 publications

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“…First, in contrast to V E /VCO previous studies found V E /VCO 2 slope to be a strong predictor of PPC [5][6][7][8] and its inclusion in risk stratification algorithms of lung resection candidates has been suggested, 20 though not yet adopted. Results of our large, prospective, multicenter study support inclusion of V E /VCO 2 slope within functional evaluation algorithms of lung resection candidates.…”

Section: Resultsmentioning

confidence: 96%

“…1,2 However, several studies have shown ventilatory efficiency, defined as the slope of ratio of minute ventilation to carbon dioxide production (V E /VCO 2 ), to be a better predictor of postoperative pulmonary complications (PPC) 5,6 and mortality. 7,8 By the alveolar gas equation, V E /VCO 2 is inversely related to ventilatory drive and positively to dead space ventilation. 9 Partial pressure of end-tidal carbon dioxide (P ET CO 2 ) shares these same physiologic determinants with V E /VCO 2 10 and may be easily measured at rest, suggesting that P ET CO 2 may be an alternative to V E /VCO 2 for those patients who are not able or do not want to exercise.…”

mentioning

confidence: 99%

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Prediction of Postoperative Complications: Ventilatory Efficiency and Rest End-tidal Carbon Dioxide

Brat

Homolka

Merta

et al. 2023

The Annals of Thoracic Surgery

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Section: Resultsmentioning

confidence: 96%

mentioning

confidence: 99%

Prediction of Postoperative Complications: Ventilatory Efficiency and Rest End-tidal Carbon Dioxide

Brat

Homolka

Merta

et al. 2023

The Annals of Thoracic Surgery

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“…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.…”

Section: Impact Of Copd Comorbidities On V′ E /V′ Comentioning

confidence: 89%

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

et al. 2021

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There is well established evidence that the minute ventilation (V′E)/carbon dioxide output (V′CO2) relationship is relevant to a number of patient-related outcomes in COPD. In most circumstances, an increased V′E/V′CO2 reflects an enlarged physiological dead space (“wasted” ventilation), although alveolar hyperventilation (largely due to increased chemosensitivity) may play an adjunct role, particularly in patients with coexistent cardiovascular disease. The V′E/V′CO2 nadir, in particular, has been found to be an important predictor of dyspnoea and poor exercise tolerance, even in patients with largely preserved forced expiratory volume in 1 s. As the disease progresses, a high nadir might help to unravel the cause of disproportionate breathlessness. When analysed in association with measurements of dynamic inspiratory constraints, a high V′E/V′CO2 is valuable to ascertain a role for the “lungs” in limiting dyspnoeic patients. Regardless of disease severity, cardiocirculatory (heart failure and pulmonary hypertension) and respiratory (lung fibrosis) comorbidities can further increase V′E/V′CO2. A high V′E/V′CO2 is a predictor of poor outcome in lung resection surgery, adding value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of disease severity. Considering its potential usefulness, the V′E/V′CO2 should be valued in the clinical management of patients with COPD.

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“…In this case, the patient's exercise capacity, as reflected by the peak VO 2 was reassuringly normal. The VE/CO 2 slope was also suggestive of a low perioperative risk [9,[12], [13], [14]]. Given the patient's history of severe COPD, previous lung resection surgery, and severe derangements in differential lung perfusion and ventilation testing, this intraoperative oxygen challenge test was an effective intervention to definitely assess safety and tolerance of single lung function under general anaesthesia and provide an informed decision for the patient about the appropriate therapeutic options.…”

Section: Discussionmentioning

confidence: 99%

“…1). However peak oxygen consumption was reassuringly normal measured at 16.7 ml/min/kg and the nadir minute ventilation/carbon dioxide (VE/VCO 2 ) slope was of 24 implying a limited risk of perioperative cardiovascular morbidity [10,[12], [13], [14], [15]]. The estimated anaerobic threshold was 10.9 ml/kg/min.…”

Section: Presentation Of Casementioning

confidence: 99%

Intraoperative oxygen challenge for toleration of single lung ventilation in a patient with severe obstructive airway disease: A case report

Weinberg

Cosic

Louis

et al. 2020

Annals of Medicine and Surgery

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Perioperative risk assessment is complex in patients with chronic obstructive pulmonary disease who have undergone previous lung resection surgery. A 70-year-old female with severe chronic obstructive pulmonary disease and previous right middle and lower lobectomy, presented for left lower lobe superior segmentectomy. Respiratory function tests revealed a forced expiratory volume in 1 second of 0.72L, a forced vital capacity of 1.93L, and a carbon monoxide transfer factor of 10.0 ml/min/mmHg. A cardiopulmonary exercise test demonstrated little ventilatory reserve with profound arterial desaturation on peak exercise, however, a normal peak oxygen consumption (16.7 ml/min/kg) and a nadir minute ventilation/carbon dioxide slope of 24 implied a limited risk of perioperative cardiovascular morbidity. Given these conflicting results we performed an intraoperative oxygen challenge test under general anaesthesia with sequential ventilation of different lobes of the lung. We demonstrate the use of the oxygen challenge test as an effective intervention to further assess safety and tolerance of anaesthesia of patients with limited respiratory reserve being assessed for further complex redo lung resection surgery. Further, this test was a risk stratification tool that allowed informed decisions to be made by the patient about therapeutic options for treating their lung cancer. The prognostic value of traditional physiological parameters in patients with chronic obstructive pulmonary disease who have undergone previous lung resection surgery is uncertain. The intraoperative oxygen challenge test is another risk stratification tool to assist clinicians in assessment of safety and tolerance of anaesthesia for patients being considered for lung resection.

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Minute ventilation-to-carbon dioxide slope is associated with postoperative survival after anatomical lung resection

Cited by 23 publications

References 18 publications

Prediction of Postoperative Complications: Ventilatory Efficiency and Rest End-tidal Carbon Dioxide

Prediction of Postoperative Complications: Ventilatory Efficiency and Rest End-tidal Carbon Dioxide

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

Intraoperative oxygen challenge for toleration of single lung ventilation in a patient with severe obstructive airway disease: A case report

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