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Cardiopulmonary exercise testing is recommended for preoperative evaluation and risk stratification of lung resection candidates. Ventilatory efficiency (VE/VCO2 slope) has been shown to predict morbidity and mortality in lung resection candidates and has been shown superior to peak oxygen consumption (VO2). Patients with increased VE/VCO2 during exercise also exhibit increased VE/VCO2 ratio and decreased end-tidal CO2 at rest. Our first hypothesis is that rest ventilatory parameters predict morbidity and mortality in patients undergoing thoracic surgery. VE/VCO2 is well correlated with ventilation-perfusion mismatch, therefore it may be useful in hypoxemia prediction during one-lung ventilation during thoracic surgery. Our second hypothesis is that patients with high VE/VCO2 will be prone to hypoxemia development during one-lung ventilation.
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Thoracic surgery | Procedure | Lung resection surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Pulmonary complications | Respiratory complications definition: pneumonia, atelectasis; respiratory failure needing mechanical ventilation; adult respiratory distress syndrome; pneumothorax present on the 3rd post-operative day; long-lasting pleural effusions present on the 3rd post-operative day | Respiratory complications will be assessed from the first 30 post-operative days or from the hospital stay. |
| Measure | Description | Time Frame |
|---|---|---|
| Intensive care length of stay | In all subjects, intensive care unit length of stay will be assessed. | From the first 30 post-operative days or from the hospital stay. |
| Hospital length of stay | In all subjects, hospital length of stay will be assessed. |
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Inclusion Criteria:
Exclusion Criteria:
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Consecutive patients planned for thoracotomy because of lung infiltration (confirmed or highly suspicious lung tumor). Patients will be recruited from 2 centers in the Czech Republic (St. Anne's University Hospital, Brno, Czech Republic and University Hospital in Brno).
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| Name | Affiliation | Role |
|---|---|---|
| Ivan Cundrle, M.D., Ph.D. | St. Anne's University Hospital Brno, Czech Republic | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University Hospital Brno | Brno | Czech Republic | 60200 | Czechia | ||
| St. Anne's University Hospital Brno |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22560968 | Background | Brunelli A, Belardinelli R, Pompili C, Xiume F, Refai M, Salati M, Sabbatini A. Minute ventilation-to-carbon dioxide output (VE/VCO2) slope is the strongest predictor of respiratory complications and death after pulmonary resection. Ann Thorac Surg. 2012 Jun;93(6):1802-6. doi: 10.1016/j.athoracsur.2012.03.022. Epub 2012 May 4. | |
| 25486485 |
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| ID | Term |
|---|---|
| D019616 | Thoracic Surgical Procedures |
| ID | Term |
|---|---|
| D013514 | Surgical Procedures, Operative |
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| From the first 30 post-operative days or from the hospital stay. |
| Cardiovascular complications | Cardiovascular complications definition: new arrhythmias (atrial fibrillation, supraventricular tachycardia, etc.); hypotension; heart failure; pulmonary edema; pulmonary embolism; myocardial infarction/minimal myocardial lesion; cardiopulmonary resuscitation | Cardiovascular complications will be assessed from the first 30 post-operative days or from the hospital stay. |
| Mortality | In all subjects, 30 and 90 days mortality will be assessed. | 30 and 90 days after surgery. |
| Brno |
| Czech Republic |
| 65691 |
| Czechia |
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| 41043965 | Derived | Filakovszky A, Brat K, Tschoellitsch T, Bartos S, Mazur A, Meier J, Olson L, Cundrle I. Cardiopulmonary exercise testing before lung resection surgery: still indicated? Evaluating predictive utility using machine learning. Thorax. 2026 Apr 16;81(5):474-482. doi: 10.1136/thorax-2024-221485. |
| 31630177 | Derived | Brat K, Chobola M, Homolka P, Heroutova M, Benej M, Mitas L, Olson LJ, Cundrle I. Poor ventilatory efficiency during exercise may predict prolonged air leak after pulmonary lobectomy. Interact Cardiovasc Thorac Surg. 2020 Feb 1;30(2):269-272. doi: 10.1093/icvts/ivz255. |