Abstract
Perioperative risk assessment is complex in patients with chronic obstructive pulmonary disease who have undergone previous lung resection surgery. A 70-year-old female with severe chronic obstructive pulmonary disease and previous right middle and lower lobectomy, presented for left lower lobe superior segmentectomy. Respiratory function tests revealed a forced expiratory volume in 1 second of 0.72L, a forced vital capacity of 1.93L, and a carbon monoxide transfer factor of 10.0 ml/min/mmHg. A cardiopulmonary exercise test demonstrated little ventilatory reserve with profound arterial desaturation on peak exercise, however, a normal peak oxygen consumption (16.7 ml/min/kg) and a nadir minute ventilation/carbon dioxide slope of 24 implied a limited risk of perioperative cardiovascular morbidity. Given these conflicting results we performed an intraoperative oxygen challenge test under general anaesthesia with sequential ventilation of different lobes of the lung. We demonstrate the use of the oxygen challenge test as an effective intervention to further assess safety and tolerance of anaesthesia of patients with limited respiratory reserve being assessed for further complex redo lung resection surgery. Further, this test was a risk stratification tool that allowed informed decisions to be made by the patient about therapeutic options for treating their lung cancer. The prognostic value of traditional physiological parameters in patients with chronic obstructive pulmonary disease who have undergone previous lung resection surgery is uncertain. The intraoperative oxygen challenge test is another risk stratification tool to assist clinicians in assessment of safety and tolerance of anaesthesia for patients being considered for lung resection.
Highlights
Lung resection surgery is the standard curative treatment for lung cancer but is only feasible in patients with local tumour and some preservation of respiratory function [1,2,3,4,5]
We present such a case where the traditional physiological parameters obtained during cardiopulmonary exercise testing (CPET) and pulmonary function tests were unable to provide an informed decision to the patient about the appropriate therapeutic approach to treating their cancer
In this report we demonstrate the use of an oxygen challenge test as an effective intervention to further assess safety and tolerance of anaesthesia of patients with limited respiratory reserve being assessed for further complex redo lung resection surgery
Summary
Lung resection surgery is the standard curative treatment for lung cancer but is only feasible in patients with local tumour and some preservation of respiratory function [1,2,3,4,5]. Perioperative risk assessment is even more complex in patients with severe COPD who have undergone previous chemotherapy and lung resection surgery, as surgery itself leads to a 13%–28% decrease in peak exercise capacity, lasting up to 24 months after resection [10]. We present such a case where the traditional physiological parameters obtained during CPET and pulmonary function tests were unable to provide an informed decision to the patient about the appropriate therapeutic approach to treating their cancer.
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