Prediction of Postoperative Complications: Ventilatory Efficiency and Rest End-tidal Carbon Dioxide.

Brat K; Homolka P; Merta Z; Chobola M; Heroutova M; Bratova M; Mitas L; Chovanec Z; Horvath T; Benej M; Ivicic J; Svoboda M; Sramek V; Olson LJ; Cundrle I Jr;

The Annals of thoracic surgery [Ann Thorac Surg] 2022 Jan 21.
Date of Electronic Publication: 2022 Jan 21.

Background: Cardiopulmonary exercise testing parameters including ventilatory efficiency (VE /VCO 2 slope) are used for risk assessment of lung resection candidates. However, many patients are unable or unwilling to undergo exercise. VE /VCO 2 slope is closely related to the partial pressure of end-tidal carbon dioxide (PET CO 2 ). We hypothesized PET CO 2 at rest predicts post-operative pulmonary complications.
Methods: Consecutive lung resection candidates were included in this prospective multicenter study. Post-operative respiratory complications were assessed from the first 30 post-operative days or from the hospital stay. Student t-test or Mann-Whitney U test was used for comparison. Multivariate stepwise logistic regression analysis was used to analyze association with the development of post-operative pulmonary complications. The De Long test was used to compare AUCs. Data are summarized as median (IQR).
Results: Three hundred fifty-three subjects were analyzed of which 59 (17%) developed post-operative pulmonary complications. PET CO 2 at rest was significantly lower [27 (24-30) vs. 29 (26-32) mmHg; P<0.01] and VE /VCO 2 slope during exercise significantly higher [35 (30-40) vs. 29 (25-33); P<0.01] in patients who developed post-operative pulmonary complications. Both rest PET CO 2 with OR=0.90 (95%CI 0.83; 0.97); P=0.01 and VE /VCO 2 slope with OR=1.10 (95%CI 1.05; 1.16); P<0.01 were independently associated with post-operative pulmonary complications by multivariate stepwise logistic regression analysis. There was no significant difference between AUCs of both models (rest PET CO 2 : AUC=0.79 (95%CI 0.74; 0.85); VE /VCO 2 slope: AUC=0.81 (95%CI 0.75; 0.86); P=0.48).
Conclusions: PET CO 2 at rest has similar prognostic utility as VE /VCO 2 slope suggesting rest PET CO 2 may be used for post-operative pulmonary complications prediction in lung resection candidates.