Chest
Volume 95, Issue 2, February 1989, Pages 267-273
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Submaximal Invasive Exercise Testing and Quantitative Lung Scanning in the Evaluation for Tolerance of Lung Resection

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Lung resection in patients with cardiopulmonary dysfunction is associated with increased risk. We studied 52 elderly male patients with airflow obstruction and a lung mass. Studies were performed at rest with routine ventilatory tests and lung scan quantitation of right-left lung function. Cycle ergometry exercise was then performed at 2 submaximal work loads (25 and 40 watts). Data were obtained using systemic and pulmonary artery catheterization for blood pressures, thermal dilution cardiac output, and blood gases. Twenty-nine patients underwent lung resection and seven failed to tolerate the procedure (death within 60 days or prolonged ventilator dependence). Those parameters most clearly separating the group tolerating surgery (n = 22) from the intolerant group (n = 7) were obtained during exercise and included: cardiac index (tolerant 5.5 ±1.3 vs intolerant 3.9 ± 0.3 L/min/m2, p<.01), O2 delivery (p<.01) and calculated V˙o2 ml/kg/min (tolerant 11.3 ± 2.1 vs intolerant 7.8 ± 1.5 ml/kg/min, p<.001). Pulmonary vascular pressures and calculated resistance did not predict intolerance. Calculated V˙o2 at 40 watts did not separate those patients who had survivable complications from those who did not (p>>.05). Multivariate analysis suggests that exercise V˙o2 is an important predictor of tolerance of lung resection because it reflects the effects of cardiac function and O2 transport. In our patients with COPD, submaximal exercise testing predicted intolerance of lung resection better than calculation using quantitative lung scanning. Exercise testing may accomplish this goal by uncovering deficits in O2 transport.

(Chest 1989; 95:267-73)

Section snippets

Patients

Between July 1981 and June 1987, those patients demonstrating roentgenographically, a lung mass or infiltrate either diagnosed or suspected as malignant, were referred for routine pulmonary function testing. If, after appropriate therapy, their postbronchodilator FEV1 was$lj2.0 L or MVV <50 percent predicted, they were accepted for the study. Following an extensive explanation, they then gave written consent to participate in the study. The study itself and the form used for consent were

RESULTS

A group of 52 male patients qualified for the protocol. The data on the entire group reveal the mean age to be 64 ± 5 years, FEV1 = 1.56 ± 0.29 L, MVV = 61 ± 16 percent of predicted and DL/VA = 3.61 ±1.46 (normal = 6.93 - .033 age). Twenty-nine patients underwent an operation and their data are available for analysis. The remaining 23 patients are excluded for the reasons listed in Table 1. In seven of the excluded patients, anatomic unresectability became apparent either during, or shortly

DISCUSSION

In this study of patients with a lung mass and abnormal spirometry, submaximal exercise testing revealed differences between those tolerating and those intolerant of lung resection. Using preoperative physiologic criteria of PVR and predicted postoperative FEV1, we only rejected two patients as inoperable. However, seven patients failed to tolerate the resection. The major factors which characterized this intolerance appeared to be death following postoperative pneumonia and ventilator

ACKNOWLEDGMENT

We thank all previous pulmonary fellows who assisted with these studies; Mildred Corbett, Celeste Reynolds, and Melissa Fisher for their technical assistance; and Mrs Hume Fulmer for her secretarial skill.

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Manuscript received March 31; revision accepted June 13.

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