PMID: 9543294May 16, 1998Paper

Functional evaluation of the lung resection candidate

The European Respiratory Journal
Chris Thomas Bolliger, André P Perruchoud

Abstract

Advances in operative technique and perioperative care have considerably reduced surgical morbidity and mortality after pulmonary resections. Various single and combined parameters of functional operability have been proposed to assess the surgical risk. Pulmonary function tests adequately assess the pulmonary risk, and baseline or stress electrocardiography, echocardiography and nuclear cardiac studies assess the cardiac risk. Patients with normal or only slightly impaired pulmonary function (forced expiratory volume in one second (FEV1) and transfer factor of the lung for carbon monoxide (TL,CO) > or = 80% of predicted) and no cardiovascular risk factors can undergo pulmonary resections up to a pneumonectomy without further investigation. For others, exercise testing, pulmonary split-function studies, or a combination of these two methods are recommended. Exercise testing, most frequently performed as a symptom-limited test with the measurement of maximal oxygen uptake (V'O2,max), assesses both the pulmonary and cardiovascular reserves. A V'O2,max of <10 mL.kg(-1).min(-1) is generally considered prohibitive for any resection, a value of >20 mL.kg(-1).min(-1) or >75% of predicted normal, safe for major resections. Split-functi...Continue Reading

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