Predicted versus observed FEV1 in the immediate postoperative period after pulmonary lobectomy

We have shown that postoperative forced expiratory value in 1 s % in the immediate days after lobectomy is approximately 30% lower than predicted postoperative FEV1 % and this fact could seriously affect the clinical reliability of ppoFEV1 when used for selecting surgical candidates

Gonzalo Varela

2006

Scholarcy highlights

  • Estimation of postoperative forced expiratory value in 1 s% is a frequently used criterion to define functional operability in patients undergoing lung resection since low predicted postoperative FEV1% value correlates with the occurrence of postoperative morbidity and mortality as a single predictor or in combination with other variables .It has been demonstrated that simple calculation of ppoFEV1% based on resected pulmonary segments is as accurate as calculation using perfusion scanning and correlates well with true FEV1% measured several months after surgery
  • Scanty information can be found regarding ppoFEV1% correlation with true FEV1% in the immediate days after surgery, when most cardio-respiratory complications are developed. The objectives of this prospective multicentric investigation were to describe the evolution of FEV1 in a series of lobectomy patients before hospital discharge, and to identify factors associated with the variation of postoperative residual FEV1, with the ratio between the actual and the
  • Random effects time-series cross-sectional regression analyses were performed to identify factors associated with variation of postoperative residual function), and of FEV1 ratio
  • FEV1% was lower at first postoperative day and increased gradually up to day 6 but mean values never reached ppoFEV1%
  • We have shown that postoperative FEV1% in the immediate days after lobectomy is approximately 30% lower than ppoFEV1% and this fact could seriously affect the clinical reliability of ppoFEV1 when used for selecting surgical candidates
  • We found that the residual FEV1 was greater in patients with lower values of preoperative FEV1, and in those with lower postoperative pain score
  • As the focus of the present analysis was not to provide corrective predictive equations but to identify factors associated with postoperative function, we chose to include among the variables the postoperative pain score, which may be a potentially modifiable factor affecting forced expiratory efforts

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