Department of Anesthesiology and Intensive Care, St. Anne's University Hospital Brno, Brno, Czech Republic.
Faculty of Medicine, Masaryk University, Brno, Czech Republic.
PLoS One. 2022 Aug 12;17(8):e0272984. doi: 10.1371/journal.pone.0272984. eCollection 2022.
Ventilatory efficiency (VE/VCO2 slope) has been shown superior to peak oxygen consumption (VO2) for prediction of post-operative pulmonary complications in patients undergoing thoracotomy. VE/VCO2 slope is determined by ventilatory drive and ventilation/perfusion mismatch whereas VO2 is related to cardiac output and arteriovenous oxygen difference. We hypothesized pre-operative VO2 predicts post-operative cardiovascular complications in patients undergoing lung resection.
Lung resection candidates from a published study were evaluated by post-hoc analysis. All of the patients underwent preoperative cardiopulmonary exercise testing. Post-operative cardiovascular complications were assessed during the first 30 post-operative days or hospital stay. One-way analysis of variance or the Kruskal-Wallis test, and multivariate logistic regression were used for statistical analysis and data summarized as median (IQR).
Of 353 subjects, 30 (9%) developed pulmonary complications only (excluded from further analysis), while 78 subjects (22%) developed cardiovascular complications and were divided into two groups for analysis: cardiovascular only (n = 49) and cardiovascular with pulmonary complications (n = 29). Compared to patients without complications (n = 245), peak VO2 was significantly lower in the cardiovascular with pulmonary complications group [19.9 ml/kg/min (16.5-25) vs. 16.3 ml/kg/min (15-20.3); P<0.01] but not in the cardiovascular only complications group [19.9 ml/kg/min (16.5-25) vs 19.0 ml/kg/min (16-23.1); P = 0.18]. In contrast, VE/VCO2 slope was significantly higher in both cardiovascular only [29 (25-33) vs. 31 (27-37); P = 0.05] and cardiovascular with pulmonary complication groups [29 (25-33) vs. 37 (34-42); P<0.01)]. Logistic regression analysis showed VE/VCO2 slope [OR = 1.06; 95%CI (1.01-1.11); P = 0.01; AUC = 0.74], but not peak VO2 to be independently associated with post-operative cardiovascular complications.
VE/VCO2 slope is superior to peak VO2 for prediction of post-operative cardiovascular complications in lung resection candidates.
通气效率（VE/VCO2 斜率）已被证明优于最大摄氧量（VO2），可用于预测接受剖胸术的患者术后肺部并发症。VE/VCO2 斜率由通气驱动和通气/灌注不匹配决定，而 VO2 与心输出量和动静脉氧差有关。我们假设术前 VO2 可预测接受肺切除术的患者术后心血管并发症。
对一项已发表研究中的肺切除术候选者进行了事后分析。所有患者均接受术前心肺运动测试。在术后 30 天或住院期间评估术后心血管并发症。采用单因素方差分析或 Kruskal-Wallis 检验和多变量逻辑回归进行统计分析，数据以中位数（IQR）表示。
在 353 例患者中，30 例（9%）仅发生肺部并发症（排除进一步分析），78 例（22%）发生心血管并发症，并分为两组进行分析：仅心血管并发症组（n=49）和心血管与肺部并发症组（n=29）。与无并发症患者（n=245 例）相比，心血管与肺部并发症组的峰值 VO2 显著降低[19.9ml/kg/min（16.5-25）比 16.3ml/kg/min（15-20.3）；P<0.01]，但心血管仅并发症组无显著差异[19.9ml/kg/min（16.5-25）比 19.0ml/kg/min（16-23.1）；P=0.18]。相反，仅心血管并发症组[29（25-33）比 31（27-37）；P=0.05]和心血管与肺部并发症组[29（25-33）比 37（34-42）；P<0.01]的 VE/VCO2 斜率均显著升高。逻辑回归分析显示 VE/VCO2 斜率[OR=1.06；95%CI（1.01-1.11）；P=0.01；AUC=0.74]，而不是峰值 VO2，与术后心血管并发症独立相关。
VE/VCO2 斜率优于峰值 VO2，可用于预测肺切除术患者术后心血管并发症。
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