Izvorni znanstveni članak
Stairs Climbing Test with Pulse Oximetry as Predictor of Early Postoperative Complications in Functionally Impaired Patients with Lung Cancer and Elective Lung Surgery: Prospective Trial of Consecutive Series of Patients
Igor Nikolić
; Zavod za torakalnu kirurgiju, ''Jordanovac'' Klinika za kronične bolesti, Zagreb, Hrvatska
Višnja Majerić-Kogler
; Klinika za anesteziologiju i intenzivno liječenje, Klinički bolnički centar Zagreb, Zagreb, Hrvatska
Davor Plavec
; Centar za istraživanja, dječja bolnica ''Srebrenjak'', Zagreb, Hrvatska
Ivana Maloča
; Centar za istraživanja, dječja bolnica ''Srebrenjak'', Zagreb, Hrvatska
Zoran Slobodnjak
; Zavod za torakalnu kirurgiju, ''Jordanovac'' Klinika za kronične bolesti, Zagreb, Hrvatska
Sažetak
Aim To test the predictive value of stairs climbing test for the development of
postoperative complications in lung cancer patients with forced expiratory volume
in one second (FEV1)<2 L, selected for an elective lung surgery.
Methods The prospective study was conducted in 101 consecutive patients with
an FEV1<2 L selected for elective lung surgery for lung cancer. Preoperative examination
included medical history and physical examination, lung function
testing, electrocardiography, laboratory testing, and chest radiography. All patients
underwent stairs climbing with pulse oximetry before the operation with
the number of steps climbed and the time to complete the test recorded. Oxygen
saturation and pulse rate were measured every 20 steps. Data on postoperative
complications including oxygen use, prolonged mechanical ventilation, and early
postoperative mortality were collected.
Results Eighty-seven of 101 patients (86%) had at least one postoperative complication.
The type of surgery was significantly associated with postoperative
complications (25.5% patients with lobectomy had no early postoperative complications),
while age, gender, smoking status, postoperative oxygenation, and
artificial ventilation were not. There were more postoperative complications in
more extensive and serious types of surgery (P<0.001). The stairs climbing test
produced a significant decrease in oxygen saturation (-1%) and increase in pulse
rate (by 10/min) for every 20 steps climbed. The stairs climbing test was predictive
for postoperative complications only in lobectomy group, with the best
predictive parameter being the quotient of oxygen saturation after 40 steps and
test duration (positive likelihood ratio [LR], 2.4; 95% confidence interval [CI],
1.71-3.38; negative LR, 0.53; 95% CI, 0.38-0.76). In patients with other types of
surgery the only significant predictive parameter for incident severe postoperative
complications was the number of days on artificial ventilation (P = 0.006).
Conclusion Stairs climbing test should be done in routine clinical practice as
a standard test for risk assessment and prediction of the development of postoperative
complications in lung cancer patients selected for elective surgery
(lobectomy). Comparative to spirometry, it detects serious disorders in oxygen
transport that are a baseline for a later development of cardiopulmonary postoperative
complications and mortality in this subgroup of patients.
Ključne riječi
Stairs climbing test; pulse oximetry; lung cancer; thoracic surgery
Hrčak ID:
26092
URI
Datum izdavanja:
15.2.2008.
Posjeta: 2.708 *