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Am. J. Respir. Crit. Care Med., Volume 162, Number 4, October 2000, 1435-1444

Role of CO Diffusing Capacity during Exercise in the Preoperative Evaluation for Lung Resection

JENG-SHING WANG, RAJA T. ABBOUD, KENNETH G. EVANS, RICHARD J. FINLEY, and BRIAN L. GRAHAM

Respiratory and Thoracic Surgery Divisions and Lung Function Laboratory, University of British Columbia, and Vancouver General Hospital, Vancouver, British Columbia; and Division of Respiratory Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada

We conducted a prospective study to evaluate whether lack of an adequate increase in diffusing capacity for carbon monoxide (DLCO) during exercise is associated with a greater postoperative complication rate after lung resection. We used the three-equation method (3EQ-DLCO), a modification of the single breath DLCO technique to determine DLCO during exercise in 57 patients undergoing lung resection at Vancouver General Hospital from October 1998 to May 1999. 3EQ-DLCO was determined during steady-state exercise at 35% and 70% of the maximal workload reached in a progressive exercise test. Maximal oxygen uptake (V O2max), DLCO at rest, and the increase in DLCO during exercise were compared in relation to postoperative complications. Patients with complications had lower resting values of DLCO (R-DLCO), a smaller increase in DLCO from rest to 70% of maximal workload expressed as a percent of the predicted DLCO at rest ([70% - R]-DLCO%), and a lower V O2max than did patients without complications. Results suggested that (70% - R)-DLCO% was the best preoperative predictor of postoperative complications; a cutoff limit of 10% was the best index to identify complications, yielding a complication rate of 100% in patients with (70% - R)-DLCO% < 10% as compared with a complication rate of 10% in patients with (70% - R)-DLCO% >=  10% (sensitivity = 78%, specificity = 100%). Patients who do not increase their DLCO sufficiently during exercise ([70% - R]-DLCO% < 10%) have a greater complication rate after lung resection.




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