Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in Patients Undergoing Thoracic Surgical Procedures

Kristian Brat, Zuzana Tothova, Zdenek Merta, Alice Taskova, Pavel Homolka, Martina Vasakova, Jana Skrickova, Vladimir Sramek, Lyle J. Olson, Ivan Cundrle

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background Ventilatory efficiency (V˙E/V˙CO2 slope [minute ventilation to carbon dioxide output slope]) has been shown to predict morbidity and mortality in lung resection candidates. Patients with increased V˙E/V˙CO2 during exercise also exhibit an increased V˙E/V˙CO2 ratio and a decreased end-tidal CO2 at rest. This study hypothesized that ventilatory values at rest predict respiratory complications and death in patients undergoing thoracic surgical procedures. Methods Inclusion criteria for this retrospective, multicenter study were thoracotomy and cardiopulmonary exercise testing as part of routine preoperative assessment. Respiratory complications were assessed from the medical records (from the hospital stay or from the first 30 postoperative days). For comparisons, Student's t test or the Mann-Whitney U test was used. Logistic regression and receiver operating characteristic analyses were performed for evaluation of measurements associated with respiratory complications. Data are summarized as mean ± SD; p <0.05 is considered significant. Results Seventy-six subjects were studied. Postoperatively, respiratory complications developed in 56 (74%) patients. Patients with postoperative respiratory complications had significantly lower resting tidal volume (0.8 ± 0.3 vs 0.9 ± 0.3L; p = 0.03), lower rest end-tidal CO2 (28.1 ± 4.3vs 31.5 ± 4.2 mm Hg; p < 0.01), higher resting V˙E/V˙CO2 ratio (45.1 ± 7.1 vs 41.0 ± 6.4; p = 0.02), and higher V˙E/V˙CO2 slope (34.9 ± 6.4 vs 31.2 ± 4.3; p = 0.01). Logistic regression (age and sex adjusted) showed resting end-tidal CO2 to be the best predictor of respiratory complications (odds ratio: 1.21; 95% confidence interval: 1.06 to 1.39; area under the curve: 0.77; p = 0.01). Conclusions Resting end-tidal CO2 may identify patients at increased risk for postoperative respiratory complications of thoracic surgical procedures.

Original languageEnglish (US)
Pages (from-to)1725-1730
Number of pages6
JournalAnnals of Thoracic Surgery
Volume102
Issue number5
DOIs
StatePublished - Nov 1 2016

Fingerprint

Carbon Dioxide
Thoracic Surgical Procedures
Logistic Models
Exercise
Tidal Volume
Thoracotomy
Nonparametric Statistics
ROC Curve
Multicenter Studies
Area Under Curve
Medical Records
Ventilation
Length of Stay
Retrospective Studies
Odds Ratio
Confidence Intervals
Students
Morbidity
Lung
Mortality

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in Patients Undergoing Thoracic Surgical Procedures. / Brat, Kristian; Tothova, Zuzana; Merta, Zdenek; Taskova, Alice; Homolka, Pavel; Vasakova, Martina; Skrickova, Jana; Sramek, Vladimir; Olson, Lyle J.; Cundrle, Ivan.

In: Annals of Thoracic Surgery, Vol. 102, No. 5, 01.11.2016, p. 1725-1730.

Research output: Contribution to journalArticle

Brat, K, Tothova, Z, Merta, Z, Taskova, A, Homolka, P, Vasakova, M, Skrickova, J, Sramek, V, Olson, LJ & Cundrle, I 2016, 'Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in Patients Undergoing Thoracic Surgical Procedures', Annals of Thoracic Surgery, vol. 102, no. 5, pp. 1725-1730. https://doi.org/10.1016/j.athoracsur.2016.05.070
Brat, Kristian ; Tothova, Zuzana ; Merta, Zdenek ; Taskova, Alice ; Homolka, Pavel ; Vasakova, Martina ; Skrickova, Jana ; Sramek, Vladimir ; Olson, Lyle J. ; Cundrle, Ivan. / Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in Patients Undergoing Thoracic Surgical Procedures. In: Annals of Thoracic Surgery. 2016 ; Vol. 102, No. 5. pp. 1725-1730.
@article{4eebe89860f349549bb2b5268fbcbdaa,
title = "Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in Patients Undergoing Thoracic Surgical Procedures",
abstract = "Background Ventilatory efficiency (V˙E/V˙CO2 slope [minute ventilation to carbon dioxide output slope]) has been shown to predict morbidity and mortality in lung resection candidates. Patients with increased V˙E/V˙CO2 during exercise also exhibit an increased V˙E/V˙CO2 ratio and a decreased end-tidal CO2 at rest. This study hypothesized that ventilatory values at rest predict respiratory complications and death in patients undergoing thoracic surgical procedures. Methods Inclusion criteria for this retrospective, multicenter study were thoracotomy and cardiopulmonary exercise testing as part of routine preoperative assessment. Respiratory complications were assessed from the medical records (from the hospital stay or from the first 30 postoperative days). For comparisons, Student's t test or the Mann-Whitney U test was used. Logistic regression and receiver operating characteristic analyses were performed for evaluation of measurements associated with respiratory complications. Data are summarized as mean ± SD; p <0.05 is considered significant. Results Seventy-six subjects were studied. Postoperatively, respiratory complications developed in 56 (74{\%}) patients. Patients with postoperative respiratory complications had significantly lower resting tidal volume (0.8 ± 0.3 vs 0.9 ± 0.3L; p = 0.03), lower rest end-tidal CO2 (28.1 ± 4.3vs 31.5 ± 4.2 mm Hg; p < 0.01), higher resting V˙E/V˙CO2 ratio (45.1 ± 7.1 vs 41.0 ± 6.4; p = 0.02), and higher V˙E/V˙CO2 slope (34.9 ± 6.4 vs 31.2 ± 4.3; p = 0.01). Logistic regression (age and sex adjusted) showed resting end-tidal CO2 to be the best predictor of respiratory complications (odds ratio: 1.21; 95{\%} confidence interval: 1.06 to 1.39; area under the curve: 0.77; p = 0.01). Conclusions Resting end-tidal CO2 may identify patients at increased risk for postoperative respiratory complications of thoracic surgical procedures.",
author = "Kristian Brat and Zuzana Tothova and Zdenek Merta and Alice Taskova and Pavel Homolka and Martina Vasakova and Jana Skrickova and Vladimir Sramek and Olson, {Lyle J.} and Ivan Cundrle",
year = "2016",
month = "11",
day = "1",
doi = "10.1016/j.athoracsur.2016.05.070",
language = "English (US)",
volume = "102",
pages = "1725--1730",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Resting End-Tidal Carbon Dioxide Predicts Respiratory Complications in Patients Undergoing Thoracic Surgical Procedures

AU - Brat, Kristian

AU - Tothova, Zuzana

AU - Merta, Zdenek

AU - Taskova, Alice

AU - Homolka, Pavel

AU - Vasakova, Martina

AU - Skrickova, Jana

AU - Sramek, Vladimir

AU - Olson, Lyle J.

AU - Cundrle, Ivan

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Background Ventilatory efficiency (V˙E/V˙CO2 slope [minute ventilation to carbon dioxide output slope]) has been shown to predict morbidity and mortality in lung resection candidates. Patients with increased V˙E/V˙CO2 during exercise also exhibit an increased V˙E/V˙CO2 ratio and a decreased end-tidal CO2 at rest. This study hypothesized that ventilatory values at rest predict respiratory complications and death in patients undergoing thoracic surgical procedures. Methods Inclusion criteria for this retrospective, multicenter study were thoracotomy and cardiopulmonary exercise testing as part of routine preoperative assessment. Respiratory complications were assessed from the medical records (from the hospital stay or from the first 30 postoperative days). For comparisons, Student's t test or the Mann-Whitney U test was used. Logistic regression and receiver operating characteristic analyses were performed for evaluation of measurements associated with respiratory complications. Data are summarized as mean ± SD; p <0.05 is considered significant. Results Seventy-six subjects were studied. Postoperatively, respiratory complications developed in 56 (74%) patients. Patients with postoperative respiratory complications had significantly lower resting tidal volume (0.8 ± 0.3 vs 0.9 ± 0.3L; p = 0.03), lower rest end-tidal CO2 (28.1 ± 4.3vs 31.5 ± 4.2 mm Hg; p < 0.01), higher resting V˙E/V˙CO2 ratio (45.1 ± 7.1 vs 41.0 ± 6.4; p = 0.02), and higher V˙E/V˙CO2 slope (34.9 ± 6.4 vs 31.2 ± 4.3; p = 0.01). Logistic regression (age and sex adjusted) showed resting end-tidal CO2 to be the best predictor of respiratory complications (odds ratio: 1.21; 95% confidence interval: 1.06 to 1.39; area under the curve: 0.77; p = 0.01). Conclusions Resting end-tidal CO2 may identify patients at increased risk for postoperative respiratory complications of thoracic surgical procedures.

AB - Background Ventilatory efficiency (V˙E/V˙CO2 slope [minute ventilation to carbon dioxide output slope]) has been shown to predict morbidity and mortality in lung resection candidates. Patients with increased V˙E/V˙CO2 during exercise also exhibit an increased V˙E/V˙CO2 ratio and a decreased end-tidal CO2 at rest. This study hypothesized that ventilatory values at rest predict respiratory complications and death in patients undergoing thoracic surgical procedures. Methods Inclusion criteria for this retrospective, multicenter study were thoracotomy and cardiopulmonary exercise testing as part of routine preoperative assessment. Respiratory complications were assessed from the medical records (from the hospital stay or from the first 30 postoperative days). For comparisons, Student's t test or the Mann-Whitney U test was used. Logistic regression and receiver operating characteristic analyses were performed for evaluation of measurements associated with respiratory complications. Data are summarized as mean ± SD; p <0.05 is considered significant. Results Seventy-six subjects were studied. Postoperatively, respiratory complications developed in 56 (74%) patients. Patients with postoperative respiratory complications had significantly lower resting tidal volume (0.8 ± 0.3 vs 0.9 ± 0.3L; p = 0.03), lower rest end-tidal CO2 (28.1 ± 4.3vs 31.5 ± 4.2 mm Hg; p < 0.01), higher resting V˙E/V˙CO2 ratio (45.1 ± 7.1 vs 41.0 ± 6.4; p = 0.02), and higher V˙E/V˙CO2 slope (34.9 ± 6.4 vs 31.2 ± 4.3; p = 0.01). Logistic regression (age and sex adjusted) showed resting end-tidal CO2 to be the best predictor of respiratory complications (odds ratio: 1.21; 95% confidence interval: 1.06 to 1.39; area under the curve: 0.77; p = 0.01). Conclusions Resting end-tidal CO2 may identify patients at increased risk for postoperative respiratory complications of thoracic surgical procedures.

UR - http://www.scopus.com/inward/record.url?scp=84992493221&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84992493221&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2016.05.070

DO - 10.1016/j.athoracsur.2016.05.070

M3 - Article

C2 - 27496629

AN - SCOPUS:84992493221

VL - 102

SP - 1725

EP - 1730

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 5

ER -