Using quantitative breath sound measurements to predict lung function following resection.

Rodolfo C Morice,Carlos A Jimenez,David Ost,Georgie A Eapen,Reza J Mehran,Leendert Keus

doi:10.1186/1749-8090-5-81

Rodolfo C Morice, Carlos A Jimenez + Show 4 more

Open Access

https://doi.org/10.1186/1749-8090-5-81

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Abstract

BackgroundPredicting postoperative lung function is important for estimating the risk of complications and long-term disability after pulmonary resection. We investigated the capability of vibration response imaging (VRI) as an alternative to lung scintigraphy for prediction of postoperative lung function in patients with intrathoracic malignancies.MethodsEighty-five patients with intrathoracic malignancies, considered candidates for lung resection, were prospectively studied. The projected postoperative (ppo) lung function was calculated using: perfusion scintigraphy, ventilation scintigraphy, and VRI. Two sets of assessments made: one for lobectomy and one for pneumonectomy. Clinical concordance was defined as both methods agreeing that either a patient was or was not a surgical candidate based on a ppoFEV1% and ppoDLCO% > 40%.ResultsLimits of agreement between scintigraphy and VRI for ppo following lobectomy were -16.47% to 15.08% (mean difference = -0.70%;95%CI = -2.51% to 1.12%) and for pneumonectomy were -23.79% to 19.04% (mean difference = -2.38%;95%CI = -4.69% to -0.07%). Clinical concordance between VRI and scintigraphy was 73% for pneumonectomy and 98% for lobectomy. For patients who had surgery and postoperative lung function testing (n = 31), ppoFEV1% using scintigraphic methods correlated with measured postoperative values better than projections using VRI, (adjusted R2 = 0.32 scintigraphy; 0.20 VRI), however the difference between methods failed to reach statistical significance. Limits of agreement between measured FEV1% postoperatively and ppoFEV1% based on perfusion scintigraphy were -16.86% to 23.73% (mean difference = 3.44%;95%CI = -0.29% to 7.16%); based on VRI were -19.56% to 28.99% (mean difference = 4.72%;95%CI = 0.27% to 9.17%).ConclusionsFurther investigation of VRI as an alternative to lung scintigraphy for prediction of postoperative lung function is warranted.

Highlights

Predicting postoperative lung function is important for estimating the risk of complications and long-term disability after pulmonary resection
In a search for simpler alternatives to radionuclide tests for estimation of postoperative lung function, we studied quantitative measurements of acoustic vibratory energy at the chest wall generated by breath sounds during spontaneous breathing using a vibratory response imaging system (VRI)
Comparative analyses of predicted versus actual postoperative lung function measurements were based on 4 pneumonectomy and 27 lobectomy procedures

Summary

Introduction

Predicting postoperative lung function is important for estimating the risk of complications and long-term disability after pulmonary resection. In assessing operability of patients with resectable lung malignancies, it is essential to define both the immediate perioperative risk and the long-term risk of pulmonary disability associated with loss of functional lung [1]. For patients with abnormalities on initial pulmonary function evaluation, quantitative radionuclide ventilation and perfusion studies are commonly used to evaluate split lung function and have been demonstrated to accurately. In this pilot study, our primary objective was to assess the agreement of ppoFEV1% and ppoDLCO% as determined by VRI, perfusion, and ventilation scintigraphy. Our secondary objective was to obtain exploratory data comparing actual postoperative FEV1 values with ppoFEV1% values as determined by VRI or lung scintigraphy

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