Lung resection outcome: PFTs

Three-Legged Stool (15-30-40 rule)

Cardiopulmonary Reserve (VO₂)

Patients with a VO₂ max < 10 mL/kg/min are at very high risk [Bechard D et al. Ann Thorac Surg 44: 344, 1987; Bollinger CT et al. Chest 108: 341, 1995], and 15 mL/kg/min may be a reasonable cutoff [Miller’s Anesthesia, 7th ed. 2009. p 1821] Stair climbing is a reasonable alternative (five flights = 15 mL/kg/min)

Spirometry

ppoFEV1

(ppoFEV1 = FEV1 x [1 – %resected/100]). < 30% is high risk for pulmonary complications (> 40% is safe [Nakara et al. Ann Thor Surg 46: 549, 1988]). Alternatively, one can attempt to assess quality of life

Other Spirometric Criteria

FEV1 < 2L, MVV > 50%, RV/TLC < 50%. If criteria are not met (i.e. high risk) then consider split function testing to determine which lung contributes more. Occlusion of the PA to the lung being resected must result in PAS < 35, or PaO₂ > 45mmHg. (Jaffe)

Parenchyma (DLCO)

< 40% is high risk for pulmonary complications [Markos J et al. Am Rev Respir Dis 139: 902, 1989; Pierce RJ et al. Am J Respir Crit Care Med 150: 947, 1994], although the true cutoff for this metric is controversial. Not correlated with ppoFEV1, thus should be assessed independently. Predictive of perioperative complications, not long term mortality

Additional Considerations

Identification of Difficult Airways, Maximal Extent of Resection, Post-Operative Disposition (? ICU bed), Bronchodilatory Needs

Poor Outcomes after Pulmonary Resection

• Oxygen use: VO₂ max < 15 mL/kg/min
• Oxygen removal: ppoFEV1 < 30%
• Oxygen delivery: DLCO < 40%
• Other: FEV1 < 2L, MVV < 50%, RV/TLC > 50%