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CARDIOVASCULAR ANESTHESIA

Lung Volume Reduction Surgery: Preoperative Functional Predictors for Postoperative Outcome

Edda M. Tschernko, MD^*,, Meinhard Kritzinger, MD, Eva M. Gruber, MD, Ursula Jantsch-Watzinger, MD, Oliver Jandrasits, MD, Peter Mares, MD, Wilfried Wisser, MD, Walter Klepetko, MD, and Wolfram Haider, MD

Departments of *Clinical Pharmacology, Cardiothoracic Anesthesia & Critical Care Medicine, and Cardiothoracic Surgery, University of Vienna, Vienna, Austria

Address correspondence and reprint requests to Edda M. Tschernko, MD, Department of Cardiothoracic Anesthesia & Intensive Care, Vienna General Hospital, University of Vienna, A-1090 Vienna, Austria. Address e-mail to Edda.Tschernko{at}univie.ac.at

Approximately 20% of patients undergoing lung volume reduction surgery (LVRS) exhibit no functional improvement postoperatively. Therefore, we examined whether variables characterizing ventilatory mechanics before LVRS could serve as predictors for outcome. In 32 patients undergoing LVRS, lung function, dyspnea score, and ventilatory mechanics were assessed preoperatively and 3 mo after LVRS. Ventilatory mechanics were characterized by total resistive work of breathing (WOB), mean airway resistance (R_awm), and dynamic intrinsic positive end-expiratory pressure (PEEP_i,dyn). Calculations of WOB, R_awm, and PEEP_i,dyn were made from measurements of airflow, volume, and esophageal pressure. Preoperative PEEP_i,dyn correlated well with the increase in forced expiratory volume percent predicted (r = 0.75; P < 0.0001) and the decrease in dyspnea score (r = -0.74; P < 0.0001) after LVRS. R_awm and WOB showed inferior correlation compared with PEEP_i,dyn. The examination of distinct threshold values for WOB, R_awm, and PEEP_i,dyn with respect to predicting improvement resulted in a sensitivity of 93% and specificity of 88% for a cutoff point of preoperative PEEP_i,dyn 5 cm H₂O. Preoperative PEEP_i,dyn correlated well with improvement in forced expiratory volume and dyspnea score after LVRS. Thus, preoperative assessment of PEEP_i,dyn could improve risk to benefit stratification before LVRS.

Implications: We examined the preoperative ventilatory mechanics of patients with emphysema undergoing lung volume reduction surgery with respect to their value in predicting outcome. Preoperative intrinsic positive end-expiratory pressure correlated well with the increase in forced expiratory volume in 1 s after surgery. Thus, this variable seems promising for improved patient selection.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999