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Article Dans Une Revue European Journal of Cardio-Thoracic Surgery Année : 2024

Minute ventilation to carbon dioxide slope and risk stratification before lung cancer resection.

Anne Olland
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Pierre-Emmanuel Falcoz
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Résumé

Functional assessment before lung cancer resection was originally based on resting pulmonary function tests. In the 1980s, the maximal oxygen uptake (VO2max, approached in routine through peakVO2) measured during symptom-limited exercise was shown to be a better predictor of operative mortality than ventilatory function tests. Today, peakVO2 is integrated in most algorithms for risk stratification. One aim of exercise tests is to stress the whole cardiopulmonary system to estimate the physiological reserve and, thus, to evaluate the ability of patients to survive the physical stress of surgery. Loewen et al. [1] in a prospective multi-institutional study validated the use of peakVO2 to assess operability and also showed that a subset of patients with low peakVO2 values (<15 ml/min/kg) had good tolerance to lung resection. In addition, it has been shown that low peakVO2 was not associated with an increased surgical risk after video-assisted thoracoscopic lobectomy, contrary to open-surgery lobectomy [2]. Besides peakVO2, the minute ventilation (VE)/carbon dioxide output (VCO2) slope demonstrated to be a strong predictor of mortality in heart failure [3], chronic obstructive pulmonary disease and pulmonary hypertension. The VE/VCO2 slope evaluates the ventilatory cost of CO2 removal from the blood, justifying the name of ‘ventilatory efficiency’. The VE/VCO2 slope gives insights into the ventilation-perfusion matching efficiency in the lung and also of gas exchange during physical effort, which may be impaired before pulmonary mechanics in lung disorders. Therefore, it provides additional information to peakVO2, which reflects the integrity of O2 transport chain and utilization during exercise, from ambient air to mitochondria.

Domaines

Cancer
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Dates et versions

hal-04547639 , version 1 (15-04-2024)

Identifiants

Citer

Anne Charloux, Anne Olland, Pierre-Emmanuel Falcoz. Minute ventilation to carbon dioxide slope and risk stratification before lung cancer resection.. European Journal of Cardio-Thoracic Surgery, 2024, 65 (4), ⟨10.1093/ejcts/ezad390⟩. ⟨hal-04547639⟩

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