RESUMO
Over the past decades, major progress in patient selection, surgical techniques and anaesthetic management have largely contributed to improved outcome in lung cancer surgery. The purpose of this study was to identify predictors of post-operative cardiopulmonary morbidity in patients with a forced expiratory volume in 1 s <80% predicted, who underwent cardiopulmonary exercise testing (CPET). In this observational study, 210 consecutive patients with lung cancer underwent CPET with completed data over a 9-yr period (2001-2009). Cardiopulmonary complications occurred in 46 (22%) patients, including four (1.9%) deaths. On logistic regression analysis, peak oxygen uptake (peak V'(O2) and anaesthesia duration were independent risk factors of both cardiovascular and pulmonary complications; age and the extent of lung resection were additional predictors of cardiovascular complications, whereas tidal volume during one-lung ventilation was a predictor of pulmonary complications. Compared with patients with peak V'(O2) >17 mL·kg⻹·min⻹, those with a peak V'(O2) <10 mL·kg⻹·min⻹ had a four-fold higher incidence of cardiac and pulmonary morbidity. Our data support the use of pre-operative CPET and the application of an intra-operative protective ventilation strategy. Further studies should evaluate whether pre-operative physical training can improve post-operative outcome.
Assuntos
Exercício Físico/fisiologia , Neoplasias Pulmonares/mortalidade , Resistência Física/fisiologia , Complicações Pós-Operatórias/fisiopatologia , Lesão Pulmonar Aguda/mortalidade , Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Adenocarcinoma de Pulmão , Adulto , Idoso , Envelhecimento , Arritmias Cardíacas/etiologia , Arritmias Cardíacas/mortalidade , Broncopneumonia/mortalidade , Estudos de Coortes , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/mortalidade , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Incidência , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/mortalidade , Consumo de Oxigênio/fisiologia , Complicações Pós-Operatórias/etiologia , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/mortalidade , Estudos Retrospectivos , Fatores de RiscoRESUMO
Pulmonary rehabilitation is an evidence-based, multidisciplinary and comprehensive intervention for chronic pulmonary diseases, adressed to symptomatic patients and to patients with impairment of activities of daily life. The major outcomes of this intervention are an increased exercise capacity, a decrease in dyspnea and thereby a better quality of life. Underweight patients may benefit from a caloric and protein supplementation. Smoking cessation programs should be integrated in any pulmonary rehabilitation program.