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Vol. 47. Issue S3.
I Foro Nacional de Cirujanos Torácicos en Formación
Pages 2-4 (May 2011)
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Vol. 47. Issue S3.
I Foro Nacional de Cirujanos Torácicos en Formación
Pages 2-4 (May 2011)
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Estimación preoperatoria del riesgo de la resección pulmonar
Preoperative estimation of the risk of lung resection
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Ángel Cilleruelo Ramosa, Carlos Martínez Barenysb, Marina Paradela de La Morenac, Gonzalo Varelad,
Corresponding author
gvs@usal.es

Autor para correspondencia.
a Servicio de Cirugía Torácica, Hospital Universitario de Valladolid, Valladolid, España
b Servicio de Cirugía Torácica, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
c Servicio de Cirugía Torácica, Complexo Hospitalario Universitario de A Coruña, A Coruña, España
d Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, España
Article information
Resumen

En este artículo se comentan las 2 guías de práctica clínica más actuales que contienen las recomendaciones de las sociedades científicas europeas y norteamericana acerca de la evaluación preoperatoria del riesgo de la resección pulmonar. A pesar de algunas diferencias entre los 2 documentos, ambas guías coinciden en la importancia de la medición preoperatoria rutinaria de la difusión pulmonar de monóxido de carbono (DLCO) y en el valor predictivo de las pruebas de ejercicio, especialmente la medición del consumo máximo de oxígeno por minuto (VO2max). Precisamente debido a su capacidad predictiva del riesgo de muerte operatoria, se debe medir la VO2max en los casos de pacientes con FEV1 o DLCO por debajo del 80% de su valor teórico. Los autores recomiendan utilizar alguna de las 2 guías citadas en la práctica clínica y auditar periódicamente los resultados propios para compararlos con la mortalidad hospitalaria de la resección pulmonar en Europa que, actualmente, están disponibles a través de la European Association of Thoracic Surgeons. Actualmente, no existe ningún índice de riesgo validado y que se pueda aplicar directamente en la toma de decisiones clínicas en resección pulmonar.

Palabras clave:
Resección pulmonar
Evaluación preoperatoria
Predicción del riesgo quirúrgico
Mortalidad operatoria
Abstract

The present article discusses the two most up-to-date clinical practice guidelines containing the recommendations of US and European scientific societies on preoperative assessment of the risk of lung resection. Despite some differences between the two documents, both guidelines agree on the importance of routine preoperative measurement of diffusion lung capacity for carbon monoxide (DLCO) in the predictive value of exercise tests, especially measurement of maximal oxygen uptake per minute (VO2max). Precisely because of its ability to predict the risk of operative death, VO2max should be measured in patients with a forced expiratory volume in 1 second (FEV1) or DLCO below 80% of the theoretical value. The authors recommend using one of the two above-mentioned guidelines in clinical practice and periodically auditing the results to compare them with in-hospital mortality for lung resection in Europe, currently available through the European Association of Thoracic Surgeons. There is currently no validated risk index that could be directly applied in clinical decision making in lung resection.

Keywords:
Lung resection
Preoperative evaluation
Surgical risk prediction
Operative mortality
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Copyright © 2011. Sociedad Española de Neumología y Cirugía Torácica
Archivos de Bronconeumología

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