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Different measures of ventilatory efficiency in preoperative cardiopulmonary exercise testing are useful for predicting postoperative complications in abdominal cancer surgery

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Titel: Different measures of ventilatory efficiency in preoperative cardiopulmonary exercise testing are useful for predicting postoperative complications in abdominal cancer surgery
Autoren: Stark, Elin, Gerring, Edvard, Hylander, Johan, Björnsson, Bergthor, 1975, Sandström, Per A, 1965, Hedman, Kristofer, Docent, 1984, Kristenson, Karolina, 1984
Quelle: Acta Anaesthesiologica Scandinavica. 69(1)
Schlagwörter: CPET, end-tidal CO2, functional capacity, oesophageal cancer, risk stratification, VE/VCO2 slope
Beschreibung: BackgroundVentilation as a function of elimination of CO2 during incremental exercise (VE/VCO2 slope) has been shown to be a valuable predictor of complications and death after major non-cardiac surgery. VE/VCO2 slope and partial pressure of end-tidal carbon dioxide (PetCO2) are both affected by ventilation/perfusion mismatch, but research on the utility of PetCO2 for risk stratification in major abdominal surgery is limited. AimWe aimed to determine the correlation between VE/VCO2 slope and PetCO2 measured during preoperative cardiopulmonary exercise testing (CPET) and its association with major cardiopulmonary complications (MCPCs) or death following oesophageal and other major abdominal cancer surgeries. MethodIn a retrospective cohort of 116 patients undergoing preoperative CPET 2008-2023, VE/VCO2 slope and PetCO2 (kPa) were recorded. The main outcome was MCPC during hospitalisation or death <= 90 days of surgery. We determined threshold values for each measure, corresponding to 90% specificity, using receiver operating characteristics analysis. ResultsA strong negative correlation was found between PetCO2 after a 5-minute warm-up and VE/VCO2 slope (Pearson r = -.88). In oesophagus cancer, VE/VCO2 slope >38 and PetCO2 < 4.1 kPa (30.8 mmHg) were both significant thresholds for the main outcome. For other major abdominal surgery patients, threshold analyses were non-significant. The area under the curve to predict outcome was similar using VE/VCO2 slope (0.70, 95% confidence interval 0.51-0.89) as compared to PetCO2 (0.71, 0.53-0-90). ConclusionBoth preoperative VE/VCO2 slope and PetCO2 could identify subjects with a very high risk of complications following oesophageal resection, with similar prognostic utility. PetCO2 can be measured with simpler equipment and could therefore be useful when CPET is not available.
Dateibeschreibung: electronic
Zugangs-URL: https://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-210645
https://doi.org/10.1111/aas.14562
Datenbank: SwePub
Beschreibung
Abstract:BackgroundVentilation as a function of elimination of CO2 during incremental exercise (VE/VCO2 slope) has been shown to be a valuable predictor of complications and death after major non-cardiac surgery. VE/VCO2 slope and partial pressure of end-tidal carbon dioxide (PetCO2) are both affected by ventilation/perfusion mismatch, but research on the utility of PetCO2 for risk stratification in major abdominal surgery is limited. AimWe aimed to determine the correlation between VE/VCO2 slope and PetCO2 measured during preoperative cardiopulmonary exercise testing (CPET) and its association with major cardiopulmonary complications (MCPCs) or death following oesophageal and other major abdominal cancer surgeries. MethodIn a retrospective cohort of 116 patients undergoing preoperative CPET 2008-2023, VE/VCO2 slope and PetCO2 (kPa) were recorded. The main outcome was MCPC during hospitalisation or death <= 90 days of surgery. We determined threshold values for each measure, corresponding to 90% specificity, using receiver operating characteristics analysis. ResultsA strong negative correlation was found between PetCO2 after a 5-minute warm-up and VE/VCO2 slope (Pearson r = -.88). In oesophagus cancer, VE/VCO2 slope >38 and PetCO2 < 4.1 kPa (30.8 mmHg) were both significant thresholds for the main outcome. For other major abdominal surgery patients, threshold analyses were non-significant. The area under the curve to predict outcome was similar using VE/VCO2 slope (0.70, 95% confidence interval 0.51-0.89) as compared to PetCO2 (0.71, 0.53-0-90). ConclusionBoth preoperative VE/VCO2 slope and PetCO2 could identify subjects with a very high risk of complications following oesophageal resection, with similar prognostic utility. PetCO2 can be measured with simpler equipment and could therefore be useful when CPET is not available.
ISSN:00015172
13996576
DOI:10.1111/aas.14562