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Vol. 34. Issue 3.
Pages 127-132 (March 1998)
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Vol. 34. Issue 3.
Pages 127-132 (March 1998)
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Valor de la estimación de la captación de oxígeno máxima postoperatoria en la predicción de insuficiencia cardiorrespiratoria en el postoperatorio inmediato de cirugía de tórax
Usefulnes of estimating maximum oxygen uptake after surgery for predicting cardiorespiratory insufficiency son after chest surgery
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L. Puente Maestu*, J.L. Rodríguez Hermosa, J.M. Ruiz de Oña, A. Santa-Cruz Seminiani, P. de Lucas Ramos, J. García de Pedro, E. Tatay Martí
Servicio de Neumología. Hospital General Universitario Gregorio Marañón. Madrid
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Nos planteamos determinar si la captación máxima de oxígeno estimado postoperatoria (VO2max/kg-PPO) se relaciona con la insuficiencia cardiorrespiratoria postoperatoria inmediata (60 días) tras cirugía de tórax y evaluar su validez como criterio de operabilidad. Estudiamos 47 pacientes con limitación crónica al flujo aéreo, FEV1 estimado postoperatorio > 0,8 1 y sin hipercapnia preoperatoria, sometidos a resección pulmonar por cáncer de pulmón. La edad fue 56 años (DE=11), FEV1=1,8 1 (DE=0,5), (61% [DE=13]) y FEV1/FVC=55% (DE=7,5). Diez pacientes presentaron insuficiencia respiratoria o cardíaca (tres murieron). El RV, TLCOsb-PPO, VO2max/kg, tamaño de resección y VO2max/kg-PPO mostraron correlación significativa con la aparición de complicaciones. VO2max/kg-PPO tenía una correlación (-0,73), significativamente mejor (p=0,0016) que las pruebas funcionales (PFB) y que VO2max/kg (p=0,049). Los puntos de corte y valores predictivos positivos y negativos fueron, respectivamente, 12,6ml/min/kg, 0,75 y 0,9 para VO2max/kg-PPO; 17 m1/min/kg 0,83 y 0,87 para el VO2max/kg y 148%, 0,67 y 0,82 para RV (la mejor de las pruebas funcionales). Los modelos multivariables no incrementaron el poder discriminativo. Concluimos que, de las variables estudiadas, VO2max/kg-PPO presentaba una correlación significativamente mayor que las PFB y que el VO2max/kg con la aparición de insuficiencia cardiorrespiratoria en los primeros 60 días postoperatorios. Como criterio para predecir dichas complicaciones, con la prevalencia observada, su valor predictivo negativo fue bueno, pero el valor predictivo positivo fue relativamente bajo. Ningún otro parámetro se comportó mejor.

Palabras clave:
Prueba de esfuerzo
Complicaciones postoperatorias
Cirugía torácica

We sought to determine if predicted post-operative maxi-mal oxygen uptake (VO2max/kg-PPO) was associated to the occurrence of respiratory or cardiac failure within the 60 days following lung surgery and to evaluate its validity as operability criterion. We studied 47 patients with chronic air-flow limitation (COPD) with FEV1> 0.8 1 and without hypercapnia, that underwent lung surgery. Age was 56 (SD 11) years, FEV1=1.8 (SD 0.5) 1 (61% predicted (SD 13%) and FEV1/FVC=55 (SD 7.5). Ten patients presented serious cardiac or repiratory complications (3 died). Significant correlation with complications was found for RV, TL-COsb-PPO, VO2max/kg, resection size and VO2max/kg-PPO. VO2max/kg-PPO correlation (-0.73) was significantly higher (p=0.0016) than all the pulmonary function test (PFT) correlation and than VO2max/kg correlation (p=0.049) as well. Cut-off points, positive and negative predictive values were respectively: 12.6ml/min/kg, 0.75 y 0.90% for VO2max/kg-PPO; 17ml/min/kg 0.83 and 0.87 for VO2max/kg and 148%, 0.67 and 0.82 for RV (the best of the pulmonary function tests). Multivariable models did not improve discriminant power. We conclude that, out of the studied variables, VO2max/kg-PPO showed higher correlation with the complications sought than PFT or VO2max/kg. As criterion to predict cardiac or respiratory failure, with the observed prevalence, its negative predictive values is good, but its positive predictive value is relatively low. None parameter was able to predict all the complications.

Key words:
Exercise test
Postoperative complications
Thoracic surgery
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Copyright © 1998. Sociedad Española de Neumología y Cirugía Torácica
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