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

Nikolić, Igor and Majerić-Kogler, Višnja and Plavec, Davor and Maloča, Ivana and Slobodnjak, Zoran (2008) 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. Croatian Medical Journal, 49 (1). pp. 50-57. ISSN 0353-9504

Preview

PDF - Published Version Download (561kB) | Preview

Abstract

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.

Abstract in Croatian

CILJ: Procijeniti prediktivnu vrijednost testa uspinjanja uza stube za razvitak poslijeoperacijeskih komplikacija u bolesnika s rakom pluća koji su odabrani za elektivnu operaciju, a u kojih je forsirani izdisajni volumen u prvoj sekundi (FEV1) manji od 2 L. ----- POSTUPCI: Prospektivno složeno istraživanje provedeno je u 101 bolesnika redom kako su dolazili, pod uvjetom da su imali FEV1<2 L i bili odabrani za elektivnu resekciju pluća zbog plućnoga zloćudnog tumora. Preoperacijski pregled obuhvatio je anamnezu i fizikalni pregled, ispitivanje plućnih funkcija, EKG, laboratorijske testove i rendgensku sliku pluća. Svi su prije operacije podvrgnuti testu uspinjanja uza stube s pulsnom oksimetrijom gdje im je mjeren broj stuba koje su svladali i vrijeme potrebno za dovršenje testa. Zasićenje krvi kisikom i frekvencija pulsa mjereni su svakih 20 stuba. Poslijeoperacijske komplikacije procijenjene su u odnosu na davanje kisika, produljenje mehaničke ventilacije i ranu smrtnost. ----- REZULTATI: Najmanje jedna poslijeoperacijska komplikacija pojavila se u 87 (86%) bolesnika. Vrsta operacije bila je značajno povezana s poslijeoperacijskim komplikacijama (25.5% bolesnika s lobektomijom nije imalo ranih poslijeoperacijskih komplikacija), a dob, spol, pušenje cigareta, poslijeoperacijska oksigenacija i mehanička ventilacija nisu. Više je komplikacija bilo nakon većih i ozbiljnijih operacija (P<0,001). Test uspinjanja uza stube izazivao je značajno sniženje zasićenja krvi kisikom (-1%) i povišenje frekvencije pulsa (10/minute) nakon svladanih svakih 20 stuba. Test je upućivao na poslijeoperacijske komplikacije samo u bolesnika s lobektomijom, pri čemu je najjači prediktor bio kvocijent zasićenja kisikom nakon 40 stuba i trajanje testa (+omjer vjerojatnosti [likelihood ratio, LR], 2,4; 95% raspon pouzdanosti [confidence interval, CI], 1,71- 3,38; -LR, 0,53; 95% CI, 0,38-0,76). Jedini značajan prediktor za incidentne poslijeoperacijske komplikacije u bolesnika s drugim vrstama operacije bio je broj dana provedenih na mehaničkoj ventilaciji (P=0,006). ----- ZAKLJUČAK: Test uspinjanja uza stube treba primijeniti u rutinskoj kliničkoj praksi kao standardni test za procjenu rizika i predviđanje razvoja poslijeoperacijskih komplikacija u bolesnika s rakom pluća koji su odabrani za elekrivnu resekciju pluća (lobektomiju). Za razliku od spirometrije, taj test otkriva ozbiljnije poremećaje prijenosa kisika koji su osnova susljednom razvitku kardiopulmonarnih poslijeoperaciskih komplikacija u toj podskupini bolesnika.

Actions (login required)

View Item

Downloads