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Clinical Investigations: SURGERY |

Gas Exchange and Pulmonary Hemodynamics During Lung Resection in Patients at Increased Risk*: Relationship With Preoperative Exercise Testing

Jesús Ribas, MD; María J. Jiménez, MD; Joan A. Barberà, MD; Josep Roca, MD; Carmen Gomar, MD; Emili Canalís, MD, FCCP; Robert Rodriguez-Roisin, MD
Author and Funding Information

*From the Serveis de Pneumologia i Allèrgia Respiratòria (Drs. Ribas, Barberà, Roca, and Rodriguez-Roisin), Anestesiologia i Reanimació (Drs. Jiménez and Gomar), and Cirurgia Toràcica (Dr. Canalís), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.

Correspondence to: Joan A. Barberà, MD, Servei de Pneumologia i Allèrgia Respiratòria. Hospital Clínic. Villarroel 170, 08036 Barcelona, Spain; e-mail: jbarbera@clinic.ub.es



Chest. 2001;120(3):852-859. doi:10.1378/chest.120.3.852
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Study objectives: To evaluate the intraoperative evolution of patients with COPD during lung resection and to test whether exercise testing could be helpful in the prediction of the intraoperative course.

Design: Prospective study.

Setting: University teaching hospital.

Patients: Forty patients (mean [± SD] age, 65 ± 9 years) with COPD (ie, FEV1, 55 ± 11% of predicted) and resectable lung neoplasms.

Interventions: Preoperatively, pulmonary function testing, quantitative lung perfusion scanning, and exercise performance testing were administered. Intraoperatively, pulmonary, hemodynamic, and blood gas measurements were performed at five stages, including periods of two-lung ventilation (TLV) and periods of one-lung ventilation (OLV).

Results: During OLV, compared with TLV, the Pao2/fraction of inspired oxygen (Fio2) ratio decreased from 458 ± 120 to 248 ± 131 mm Hg (p < 0.05), whereas pulmonary artery pressure (PAP) increased from 18 ± 5 to 23 ± 5 mm Hg (p < 0.05). Cardiac output (Q̇t) also increased from 4.0 ± 1.2 to 5.1 ± 1.9 L/min (p < 0.05), yielding to a higher mixed venous Po2. Both Pao2 and Q̇t during OLV were significantly lower in patients who had undergone right thoracotomies compared with those who had undergone left thoracotomies. The Pao2/Fio2 ratio during OLV correlated with the Pao2 during exercise (r = 0.39; p = 0.01) and with the perfusion of the non-neoplastic lung (r = 0.44; p = 0.005).

Conclusions: In COPD patients, OLV leads to a significant derangement of gas exchange, which is more pronounced in right thoracotomies. Preoperative measurement of Pao2 during exercise and the distribution of perfusion by lung scan might be useful to identify those patients who are at the greatest risk of abnormal gas exchange during lung resections.

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