How is cardiopulmonary stress testing used in the preoperative evaluation for pneumonectomy?

Updated: May 14, 2020
  • Author: Kevin McCarthy, RPFT; Chief Editor: Nader Kamangar, MD, FACP, FCCP, FCCM  more...
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Answer

Answer

VO2 maximum values greater than 20/mL/kg/min or 75% of predicted indicate the ability to withstand pneumonectomy when the cardiac history is negative.

A VO2 maximum between 10 and 20 mL/kg/min and 40-75% of predicted require prediction of postoperative FEV1, DLCO, and VO2. Prediction of postoperative function is calculated by multiplying the preoperative value by the fraction of total perfusion ascribed to the remaining lung, as follows:

Predicted postoperative (PPO) (FEV1, DLCO, or VO2) = preoperative (FEV1, DLCO, or VO2) × Q% of the remaining lung

When the FEV1 PPO and DLCO PPO are greater than 40% and the VO2 PPO is greater than 10 mL/kg/min and 35% of predicted, resection up to the calculated extent is feasible.

A VO2 maximum of less than 40% or 10 mL/kg/min or VO2 maximum PPO of less than 35% or 10 mL/kg/min strongly suggest inoperability for lung resection candidates.


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