Preoperative Pulmonary Function Tests Research Articles

Impact of chronic lung disease on quality-of-life outcomes in patients undergoing transcatheter aortic valve replacement.

As the symptoms for both chronic lung disease (CLD) and aortic stenosis (AS) frequently overlap, it may be challenging to determine the degree of symptomatic improvement expected for a patient with CLD after correction of AS. Our aim was to determine if patients with CLD have the same degree of quality-of-life improvement following transcatheter aortic valve replacement (TAVR) as patients without CLD. A retrospective review of 238 TAVR patients from January 2017 to November 2018 who underwent preoperative pulmonary function tests and completed 30-day follow-up was performed. Patients were identified as having CLD with FEV1 more than 75% predicted. Postoperative outcomes and changes in Kansas City Cardiomyopathy Questionnaire-12 (KCCQ-12) were compared between groups. Of the 238 patients identified, 143 (60.0%) had CLD, 50 (35.0%) of whom had an obstructive disease pattern. Patients with CLD were more likely to be male, had higher rates of peripheral artery disease, and had lower baseline ejection fraction. There was no difference in STS Predicted Risk of Mortality, but patients with CLD were more likely to be designated as high-risk by surgeon evaluation. While initial and follow-up KCCQ-12 was lower for patients with CLD, there was no significant difference in degree of improvement (p = .900). When comparing patients with obstructive lung disease (FEV1/FVC < 0.70) to those without CLD, there was also no significant difference in the change of quality of life (p = .720). Although patients with concomitant severe AS and CLD have reduced baseline quality of life compared to patients without CLD, they experience a comparable degree of improvement following TAVR.

Pulmoner Endarterektomi Operasyonlarında Anestezi ve Komplikasyonların Yönetimi

Objective: Chronic thromboembolic pulmonary hypertension is a chronic progressive disease developing obstruction ocurring in pulmonary vascular bed. Pulmonary endarterectomy is the surgical procedure described in the management of chronic pulmonary hypertension which excises, and removes the obstructing thromboembolic material from the affected vascular structures. Our aim is to share our approaches to the management of anesthesia and complications in pulomanry endarterectomy operations performed in our center. Methods: The data of 200 PEA cases conducted in June 2017-2020 were retrospectively analyzed. The demographic data of the patients, preoperative pulmonary function tests, cardiac catheterization findings, peroperative cardiac output measurement values, aortic cross clamp, extubation, intensive care unit, and hospital stay times and complications were recorded. Results: Average age of the patients’ ages was 50.8 years, and female/male ratio was 108/92. In the thermodilution measurements of the patients after induction, mean values of CO, PVR and mPAP were determined as 4.4 l/min, 594 dyn/s/cm-5, 40 mmHg, respectively. The corresponding measurements made after the sternal closure were stated as 6 l/min, 241 dyn/s/cm-5 and 28 mmHg, respectively. The patients were hospitalized in the intensive care unit for 4 days. In our patient group residual pulmonary hypertension occurred in 21%, reperfusion pulmonary edema in 10% and pulmonary bleeding in 4% of the cases. Conclusion: Only a very few centers in the world are experienced in PEA surgery. Anesthesia management and treatment of the complications of PEA surgery are quite difficult. Therefore, PEA surgery shl be performed in experienced centers.

Surgical Strategy and Clinical Outcome in Patients with Bronchial Carcinoids.

Carcinoids are malignant neuroendocrine neoplasms showing good long-term survival after oncologic therapy. The study evaluated the influence of operative strategies and individual decision-making on the outcome and long-term survival in 222 patients with bronchial carcinoids. The patients underwent preoperative pulmonary function tests and bronchoscopy to facilitate surgical decision-making. A hundred and twelve tumors were detected endoscopically, including 32 in the main and lobar bronchi. We performed 5 isolated bronchus resections, 4 segmentectomies, 15 wedge resections, 10 pneumonectomies, 19 sleeve resections, 26 bilobectomies, 138 lobectomies, and 2 chest wall resections. Three patients were technically inoperable. Systematic mediastinal lymphadenectomy was routinely performed although most patients' computer tomography scans showed N0. A hundred and sixty-two patients had typical (155N0, 7N+) and 60 patients had atypical carcinoids (39N0, 21N+). There was no intraoperative mortality. The hospital mortality was below 2%. Overall, 1-, 5-, and 10-year survival rates were 99%, 94%, and 89%, respectively, in typical carcinoids. Atypical carcinoids show similar 1- and 5-year survival rates, but the 10-year survival rate was below 70%, decreasing in higher N-stages. The N-stage was the most important survival factor. In conclusion, bronchial carcinoids should be surgically treated the way lung cancer is. Anatomic resection and systematic lymphadenectomy are the treatments of choice. The availability of bronchoplastic techniques and preoperative assessment is essential for individual decision-making, focusing predominantly on postoperative quality of life.

Examination of predictable factors of perioperative respiratory complications by preoperative forced oscillation technique parameters.

In this study, we investigated whether pulmonary function tests such as forced oscillation technique parameters could predict perioperative respiratory complications. In the results of our study, perioperative respiratory complications cannot be predicted using the results of preoperative pulmonary function tests and forced oscillation technique parameters. Patients who are judged by comprehensive preoperative judgment to be suitable for general anesthesia may not need to consider the risk of perioperative complications using pulmonary function test.

Evaluation of factors determining pulmonary function in paediatric scoliosis

Scoliosis affects approximately 7 million people in the United States. Infantile scoliosis is a rare entity, amounting for less than 1% of population. Aims and Objectives: To evaluate the factors determining the pulmonary function tests in cases of idiopathic paediatric scoliosis. Materials and Methods: The proposed study was conducted in the department of Orthopaedic Surgery, King George’s Medical University Lucknow. The open ended study had been conducted on children having scoliosis in Paediateric age group and attending our outpatient department during August 2011 to July 2012. Detailed history and clinic-radiological examination was done. Total 33 patients were included in the study as per inclusion-exclusion criteria. Results and Discussion: Clinic-radiological factors have an effect on pulmonary function test in scoliosis patients of paediatric age group. There is significant reduction in FVC and other parameters of PFT in Idiopathic scoliosis patients of paediatric age group. Conclusion: Cardiopulmonary status of the patient is an important and vital parameter in the follow up of natural history of scoliosis, as it may affect the overall performance of the individual affected by this condition. Preoperative pulmonary function tests are essential to assess surgical risk in a patient with scoliosis because of the possibility of further compromising the pulmonary function. Keywords: Idiopathicscoliosis, Pulmonary function test, Paediatric age, Cobb’s angle, Cardiopulmonary Status.

The predictive value of preimplant pulmonary function testing in LVAD patients

The predictive value of preoperative pulmonary function testing (PFT) in left ventricular assist device (LVAD) patients remains unknown. This study evaluates the relationship between abnormal PFTs and postimplant outcomes in LVAD patients. LVAD implants from January 2004 to December 2018 at a single institution were included. Patients were stratified based on the presence of abnormal preoperative PFTs, and the primary outcome was respiratory adverse events (AE). Secondary outcomes included 1-year overall postimplant survival, and complications including bleeding, renal failure, thromboembolism, and device malfunction. The total of 333 patients underwent LVAD implant, 46.5% (n = 155) with normal PFTs and 53.5% (n = 178) with abnormal PFTs. Patients with abnormal PFTs were noted to have higher rates of respiratory AEs (25.9% vs. 15.1%, p = .049). In multivariable analysis, the impact of PFTs was most significant when forced expiratory volume in 1 s/forced expiratory volume (FEV1/FVC) ratio was less than 0.5 (hazard ratio [HR] 16.32, 95% confidence interval [CI], 1.70-156.78). The rates of other AEs including bleeding, renal failure, right heart failure, and device malfunction were similar. One-year overall postimplant survival was comparable between the groups (56.8% vs. 68.8%, p = .3183), though patients in the lowest strata of FEV1 (<60% predicted) and FEV1/FVC (<0.5) had elevated risk-adjusted hazards for mortality (HR 2.63, 95% CI, 1.51-4.60 and HR 18.92, 95% CI, 2.10-170.40, respectively). The presence of abnormal preoperative PFTs is not prohibitory for LVAD implantation although it can be used for risk stratification for respiratory AEs and mortality, particularly in patients with severely reduced metrics. The importance of careful patient selection should be underscored in this higher risk patient subset.

Paradoxical Motion on Sniff Test Predicts Greater Improvement Following Diaphragm Plication

Diaphragm plication (DP) improves pulmonary function and quality of life for those with diaphragm paralysis or dysfunction. It is unknown whether differing degrees of diaphragm dysfunction as measured by sniff testing affect results after plication. Patients who underwent minimally invasive DP from 2008 to 2019 were dichotomized based on sniff test results: paradoxical motion (PM) versus no paradoxical motion (NPM); the latter included normal, decreased, and no motion. Preoperative and postoperative pulmonary function testing (PFT) after DP was compared between groups. The impact of the diaphragm height index, a measure of diaphragm elevation, was also assessed. A total of 26 patients underwent preoperative sniff testing, DP, and postoperative PFT. Including all patients, DP resulted in a 17.8% ± 5.5% improvement in forced expiratory volume in 1 second (P < .001), a 14.4% ± 5.3% improvement in forced vital capacity (P < .001), and a 4.7% ± 4.6% improvement in the diffusing capacity of carbon monoxide (P= .539). There were greater improvements in the PM group (n= 16) compared with the NPM group (n= 10) for forced expiratory volume in 1 second (27.2% ± 6.0% versus 3.9% ± 6.2%; P= .017) and forced vital capacity (28.1% ± 5.3% versus -0.5% ± 3.3%; P= .001). There was no difference in the change in the diffusing capacity of carbon monoxide between groups. There were no differences between patients with PM and NPM in the postoperative course or complications. No value for diaphragm height index predicted improvement in PFT after DP. Patients with PM on sniff test have dramatically greater objective improvements in pulmonary function after plication compared with those without PM. Most patients without PM do not demonstrate improvement in standard PFT. Improvements in dyspnea require additional study.

Clinicopathological characteristics of lung cancer in patients with systemic sclerosis.

Background and objectivesSystemic sclerosis (SSc) is a connective tissue disorder (CTD) associated with an increased risk of malignancy including lung cancer (LC). Our objective was to provide a description of demographics and clinicopathological characteristics of LC patients with SSc.MethodsLung cancer patients with SSc admitted to Peking Union Medical College Hospital from January 2000 to August 2017 were reviewed. Demographic and clinicopathologic data were collected.ResultsOf the 12 cases included in our study, all were female. No patients had a history of smoking. The most common histological type was adenocarcinoma, followed by squamous cell carcinoma and small‐cell carcinoma. No driver mutation was identified in the five patients undergoing genetic testing. Eight patients had interstitial lung disease (ILD). Six were manifested as nonspecific interstitial pneumonia (NSIP) and two as usual interstitial pneumonia (UIP). Four (33.3%) patients underwent surgical resection. Among them, two had ILD with a normal preoperative pulmonary function tests (PFT). Eight (66.7%) patients received chemotherapy. Radiotherapy was administered in only one (8.3%) patient. No grade 3/4 adverse events were documented.ConclusionThe predominance of female patients in our study is different from that reported in general lung cancer patients. A high proportion of patients has SSc‐ILD, including NSIP and UIP. Surgery or radiotherapy could still be considered in carefully selected patients with ILD.

A study on the effect of intraoperative continuous positive airway pressure (CPAP) on the postoperative pulmonary function in overweight patients undergoing lower limb, lower abdominal or vaginal surgeries under spinal anesthesia.

Spinal anaesthesia, supine position and higher BMI are risk factors for pulmonary atelectasis. NIV, PEEP and CPAP are employed in ICU's to treat atelectasis postoperatively. However, we wanted to investigate whether CPAP was protective against atelectasis when used intraoperatively, in high risk patients. This study was a randomized controlled trial. Overweight patients, who were to undergo surgeries under spinal anesthesia were included in the study. After informed consent, 126 patients underwent preoperative pulmonary function tests (PFT: FEV1, FVC, PEFR). Following the onset of spinal anaesthesia patients were randomised into group E (n = 63, received CPAP) and control group, group C ( n =63, received nil intervention). Postoperative PFT was done at 20 minutes, 1 hour, 2 hours and 3 hours after surgery. Patients were followed up till discharge for pulmonary complications. We observed significant reduction in pulmonary function (FEV1, FVC and PEFR) postoperatively compared to base-line. CPAP group had better pulmonary function when compared to control group, the difference being significant 20 minu-tes after the surgery(p < 0.05). No postoperative pulmonary complication was reported among the 126 patients studied. Intraoperative use of CPAP in overweight patients undergoing surgeries under spinal anaesthesia could be beneficial in improving pulmonary function in the immediate post-operative period.

Robotic diaphragmatic plication for eventration: A retrospective analysis of efficacy, safety, and feasibility.

Eventration of the diaphragm results in impaired respiratory mechanics, which leads to symptoms of dyspnea. Robotic diaphragmatic plication is a recently reported technique that has had good immediate outcomes. The aim of this study was to describe our transthoracic and transabdominal plication techniques and to analyze the safety, efficacy, and feasibility of robotic diaphragmatic plication in an Indian setting. This retrospective study was conducted at a large tertiary care center in a dedicated thoracic surgery unit. To measure the efficacy of plication, we administered a pulmonary function test to each patient at baseline and 6 months postoperatively and then compared the results. Eighteen patients underwent robotic diaphragmatic plication during the study period. Of these 18 patients, 12 underwent surgery via a transabdominal approach, and 6 underwent surgery via a transthoracic approach. Surgery was completed robotically in 17 patients. The comparison of the preoperative and postoperative pulmonary function test results showed that the mean ± SD increase in forced expiratory volume in 1 second (FEV1 ) was 19.9 ± 22.0% (P = .002) and the mean increase in FEV1 /forced vital capacity was 5.7 ± 2.5 % (P = .225), indicating a significant improvement in FEV1 after surgery. Robotic diaphragmatic plication can be performed transthoracically or transabdominally with good surgical outcomes. It is safe, effective, and feasible.

Factors Influencing Complications after Therapeutic Lung Resection in Lung Cancer Patients

Purpose: The purpose of this study was to assess postoperative complications and factors influencing complications in lung cancer patients undergoing therapeutic lung resection. Methods: This was a retrospective comparative study investigating participants’ individual characteristics, nutritional status, operative characteristics, and disease characteristics as found in the electronic medical records of patients undergoing therapeutic lung resection for lung cancer. Data were collected from 191 participants who received the therapeutic lung resection in 1 general hospital. Analysis was done using x&lt;sup&gt;2&lt;/sup&gt; test or independent t-test, Pearson correlation and multiple regression analysis. Results: The incidence of complications according to the characteristics of the patients was significantly higher for men over 65 years old, smokers (former smokers included), FEV&lt;sub&gt;1&lt;/sub&gt;/FVC ratio less than 70%. Other factors influencing outcomes were lengthy operation time, FEV&lt;sub&gt;1&lt;/sub&gt;/FVC ratio less than 70% and post OP stageII.Conclusion: Results show that a FEV&lt;sub&gt;1&lt;/sub&gt;/FVC ratio less than 70%, and post OP stageII are factors influencing complications after therapeutic lung resection. Determination of chronic obstructive pulmonary disease through preoperative pulmonary function tests and plans to provide nursing interventions that improve lung function contribute to prevention of postoperative complications.

Preoperative Assessment of Pulmonary Function Tests and Outcomes After Cardiac Surgery.

To investigate the association between preoperative pulmonary function evaluations and surgical outcomes of patients with chronic lung disease following cardiac surgery. This retrospective observational study evaluated 148 patients using preoperative pulmonary function tests before undergoing cardiac surgery. Patients were divided into 4 groups (normal, obstructive, restrictive, and combined disorder), based on the result of the pulmonary function tests. Additionally, we evaluated the percent predicted forced expiratory volume in 1 second. Finally, we investigated the mechanical ventilation duration, length of postoperative hospital stay, and the 30-day mortality rate between the groups in each study. The mechanical ventilation duration and length of postoperative hospital stay in the combined group was significantly longer than that in the other groups (P < .0001, P < .0001, respectively). Patients in the restrictive group had a significantly longer postoperative ventilation or hospitalization than those in the normal group (P = .0479, P = .0164, respectively). However, there were no significant differences in the 30-day mortality rates between the groups. There also was a significant negative correlation between the percent predicted forced expiratory volume in 1 second and mechanical ventilation (R2 = 0.052, P = .0054) and postoperative hospitalization (R2 = 0.042, P = .0122). Risk stratification by preoperative pulmonary function tests may be used to accurately identify the postoperative outcomes in chronic lung disease patients following cardiac surgery.

The Prognostic Value of Preoperative Pulmonary Function Testing in Patients Undergoing Left Ventricular Assist Device Implantation

This study evaluates the prognostic value of preoperative pulmonary function tests (PFTs) on post implant outcomes in LVAD patients. Durable LVAD implants from January 2004 to December 2018 at a single institution were included. The primary outcome was rates of respiratory adverse events (AEs): prolonged intubation >72 hours, pneumonia, reintubation or tracheostomy. Secondary outcome included survival. Criteria for abnormal PFTs was met with an FEV1 <80% predicted, FEV1/FVC <0.70, DLCO <45% predicted or TLC <80% predicted. Multivariable Cox regression was used for risk adjustment. 333 patients underwent LVAD implant, including 40.8% (n=136) with normal PFTs and 59.2% (n=197) with abnormal PFTs. Patients with abnormal PFTs had higher rates of respiratory AEs overall (26.1% vs 14.6%, p=0.04) (Figure A). Patients with abnormal PFTs had a 2-fold increased risk for respiratory AEs (HR 1.93, 95%CI 1.02, 1.64). After risk-adjustment, the impact of abnormal PFTs was most pronounced when FEV1 was <60% (HR 2.8, 95% CI 1.5, 6.7) and FEV1/FVC ratio was <0.5 (HR 43.6, 95% CI 5.8, 68.1). Although 43% (n=144) had a history of smoking and 25% (n=50) had a diagnosis of COPD, these factors did not influence the hazards for respiratory AEs. The rates of other AEs including bleeding, renal failure and right heart failure were similar (all p>0.05). Post-implant survival at 1 year follow-up was comparable between the groups (58.1% vs 73.7%, p=0.09) (Figure B), although patients in the lowest strata of FEV1 (<60%) and FEV1/FVC (<0.5) also had elevated hazards for risk-adjusted mortality (HR 2.7 95% CI 1.5, 4.9 and HR 36.4, 95% CI 4.2, 75.6). PFTs are a useful preoperative risk assessment tool for stratification and patient counseling regarding the likelihood of post-LVAD respiratory AEs. Patients with a FEV1 <60% or FEV1/FVC ratio <0.5 are at particularly high risk, demonstrating substantially increased hazards for respiratory AEs and 1-year mortality.

Changes in Lung Function Parameters after Total Intravenous Anaesthesia and Balanced Anaesthesia with Desflurane: A Prospective Randomised Study.

ObjectiveFollowing anaesthesia, there is a decrease in pulmonary function. Unlike volatile anaesthetics, propofol decreases the upper airway tone, and total intravenous anaesthesia (TIVA) with propofol may decrease coughing on emergence. Coughing may reduce postoperative atelectasis. Thus, TIVA may lead to greater decreases in lung function postoperatively as compared to balanced anaesthesia with desflurane.MethodsSixty patients of either sex, aged 18–60 years and American Society of Anaesthesiologists (ASA) status I/II, who were to undergo mastoid surgery, were randomly allocated to Group B and Group T. Anaesthesia was maintained with desflurane, nitrous oxide and oxygen in Group B, and with TIVA in Group T. Pulmonary function tests (PFT) were done preoperatively, and 1, 3 and 24 hours postoperatively.ResultsDemographic data and preoperative PFT were comparable in both groups. One hour after surgery, there was a greater decrease in FEV1 and peak expiratory flow rate (PEFR) in Group T (p=0.044 and 0.042, respectively). Three hours postoperatively, the decrease in MEFR and PEFR was again greater in Group T (p=0.005 and 0.008, respectively), while the MEFR recovered to preoperative values in Group B. By 24 hours, the forced vital capacity (FVC), MEFR and PEFR recovered to preoperative values in Group T, while FVC remained reduced in Group B (p=0.006).ConclusionBoth anaesthetic techniques cause a postoperative impairment in the lung function, but while TIVA causes a greater reduction in PFT in the early postoperative period, recovery is also earlier. On the other hand, balanced anaesthesia with desflurane was associated with a greater reduction in PFT at 24 hours.

Bilateral scapulothoracic arthrodesis for facioscapulohumeral muscular dystrophy: function, fusion, and respiratory consequences

Scapulothoracic arthrodesis (STA) has been proposed for the treatment of painful scapular winging in patients with facioscapulohumeral muscular dystrophy (FSHD). However, the rate of osseous fusion is variable, and there is a theoretical risk of reduced respiratory function after bilateral STA. This was a retrospective study of 10 STAs, performed sequentially, in 5 FSHD patients. The surgical technique involved use of a semitubular plate and wire construct with autograft (iliac crest) interposed between the scapula and rib cage. Osseous fusion, respiratory function, and shoulder function were evaluated. The mean follow-up period was 141 ± 67 months (range, 24-225 months). Early complications included 1 pneumothorax and 1 pleural effusion. No late complications occurred, and no patients underwent reoperation. On postoperative computed tomography images, complete bony union of the scapula to the ribs was observed in 90%of shoulders (9 of 10). Comparison of preoperative and postoperative pulmonary function test results showed no significant difference in vital capacity (from 87% ± 14% to 85% ± 12%) and forced vital capacity (from 86% ± 16% to 77% ± 15%). Patients gained on average 40° of active forward elevation (from 62° ± 20° to 102° ± 4°) and 22° of abduction (from 58° ± 21° to 89° ± 7°) (P < .001). The mean Subjective Shoulder Value increased from 25% ± 8% to 72% ± 18% (P < .001). All patients were pleased with the results and would recommendthe procedure to other persons. In patients with FSHD, bilateral STA provides satisfactory shoulder function with a high rate of scapulothoracic fusion and few or no significant respiratory repercussions.

Randomized Control Trial on the Efficacy of Dual Bronchodilator of Glycopyrronium/Indacaterol for Lung Cancer Surgery: Improvement of Postoperative Pulmonary Function in Both Patients with Chronic Obstructive Pulmonary Disease and Normal Pulmonary Function

Background: A dual bronchodilator, long-acting anticholine drugs (glycopyrronium, LAMA) and the long running β-2 stimulant (indacaterol, LABA), are effective for the treatment of chronic obstructive pulmonary disease (COPD). To evaluate the effectiveness of the perioperative intervention of LAMA/LABA, a randomized prospective trial was performed for the lung cancer patients receiving a lobectomy with normal pulmonary function and COPD. Methods: Based on the results of the preoperative pulmonary function test, 25 patients were diagnosed with COPD [% forced expiratory volume in 1 second (%FEV1) 1), who were randomized into two groups, the LAMA/LABA (n = 19) and the Control group (n = 18). The LAMA/LABA and the COPD groups daily received inhaled LAMA (50 μg) and LABA (110 μg) for 1 week before surgery and for least 4 weeks after surgery. The Control group had no treatment of the dual bronchodilator. The actual values were measured during the perioperative pulmonary function at three points of the preoperative baseline, the postoperative 1 week and the postoperative 4 weeks; these changes and changed ratios were then calculated. The patient-reported outcomes of the quality of life (PRO-QOL) were evaluated by the Cancer Dyspnea Scale (CDS), the COPD assessment test, and the St. George’s Respiratory Questionnaire. Results: Regarding the value of FEV1 at the baseline, that in the LAMA/LABA group was 79.2% ± 6.4% and that in the Control group was 80.9% ± 6.4%, but that in the COPD groups was 57.9% ± 8.7%; there was a significant difference between the COPD and the Control group (p 1 value in the Control group was 1.3 ± 0.5 L and that in the LAMA/LABA group was 1.7 ± 0.5 L. On the other hand, that in the COPD group was 1.7 ± 0.5 L, which was significantly higher compared to that in the Control group (p = 0.0251 and p = 0.0369). The intervention of LAMA/LABA for the COPD and non-obstructive patients resulted in the less decreased degree of the pulmonary function in FEV1 compared to that in the Control group. Based on the PRO-QOL by the CDS, the intervention of LAMA/LABA significantly reduced the total dyspnea in the LAMA/LABA group compared to that in the Control group (p = 0.0348). Conclusion: The perioperative intervention of LAMA/LABA should lead to maintaining the postoperative pulmonary function of the FEV1 during the lobectomy with COPD and non-obstructive patients and the improvement of PRO-QOL.

Preoperative Pulmonary Function Testing to Predict Recurrence of Chronic Rhinosinusitis With Nasal Polyps.

BackgroundAlthough the close relationship between the upper and lower airways has been highlighted previously, little is known about the association between lung function and the recurrence of chronic rhinosinusitis with nasal polyps (CRSwNP). This study aimed to evaluate the factors associated with pulmonary function that affect CRSwNP recurrence after surgery.MethodsWe performed a series of routine pulmonary function tests for general anesthesia prior to CRSwNP surgery. The values for each parameter were compared in the presence or absence of recurrence.ResultsSixty-nine patients with CRSwNP were included. The percent predicted forced expiratory volume in one second (%FEV1) in the recurrent group was significantly lower than that in the non-recurrent group (P = .005). A multivariable logistic regression model revealed that %FEV1 was a positive predictor of recurrence (odds ratio: 0.96, 95% CI: 0.92-0.99, P = .023). There were no significant differences in the other pulmonary functions between the two groups.ConclusionsWe found that %FEV1 may be a predictor of CRSwNP recurrence after surgery. As %FEV1 is a pulmonary function test that is routinely performed before surgery, this parameter is readily applicable. Moreover, as %FEV1 appears to have the potential to reveal concealed asthma, %FEV1 might be a particularly useful tool for the prediction of CRSwNP recurrence after surgery.

Lung Volume Reduction Surgery in Patients with Heterogenous Emphysema: Selecting Perspective.

BACKGROUND:Lung volume reduction surgery (LVRS) was introduced to alleviate clinical conditions in selected patients with heterogenous emphysema. Clarifying the most suitable patients for LVRS remained unclear.AIM:This study was undertaken to specifically analyze the preoperative factor affecting to LVRS.METHODS:The prospective study was conducted at 103 Military Hospital between July 2014 and April 2016. Severe heterogenous emphysema patients were selected to participate in the study. The information, spirometry, and body plethysmographic pulmonary function tests in 31 patients who underwent LVRS were compared with postoperative outcomes (changing in FEV1 and CAT scale).RESULTS:Of the 31 patients, there was statistically significant difference in the outcome of functional capacity, lung function between two groups (FEV1 ≤ 50% and > 50%) (∆FEV1: 22.46 vs 18.32%; p = 0.042. ∆ CAT: 6.85 vs 5.07; p = 0.048). Changes of the FEV1 and CAT scale were no statistically significant differences in three groups residual volume. Patients with total lung capacity < 140% had more improved than others (∆FEV1: 23.81 vs 15.1%; p = 0.031).CONCLUSION:Preoperative spirometry and body plethysmographic pulmonary function tests were useful measures to selected severe heterogenous emphysema patients for LVRS. Patients with FEV1 ≤ 50%, TLC in the range of 100-140% should be selected.

Preoperative pulmonary function tests do not predict the development of pulmonary complications after elective major abdominal surgery: A prospective cohort study.

Data describing the association of preoperative pulmonary function testing (PFT) with postoperative pulmonary complications (PPC) are inconsistent. We conducted this prospective study to determine the ability of PFT to predict PPC. Data were prospectively collected from 676 patients who underwent elective abdominal surgery (emergency and thoracic operations excluded). The primary outcome was the occurrence of PPC within 30 days. Patient and procedure-related factors were examined as risk factors. Multivariate logistic regression analysis was performed using risk factors identified with univariate analysis and area under the curve (AUC) analysis performed. PPC occurred in 29 patients (4.9%). History of smoking or abnormal physical examination were not significantly associated. Multivariate analysis identified age (p=0.03), operative time (p=0.02), blood transfusions (p=0.002), and %VC (p=0.001) as significant risk factors. AUC with a model including age, operative time, and blood transfusion was 0.83. The addition of %VC to these three variables increased the AUC to 0.89 (p=0.1). Age, operative time, blood transfusion, and %VC are significantly associated with an increased risk of PPC. The addition of %VC to other risk factors did not significantly improve the ability to predict PPC, showing that preoperative PFT is not helpful to predict PPC.

Correlation analysis between the pulmonary function test and the radiological parameters of the main right thoracic curve in adolescent idiopathic scoliosis

BackgroundScoliosis causes thoracic deformities, and it is necessary to assess these changes in pulmonary function test (PFT). To determine how measurements of spinal and thoracic cage deformities are related to pulmonary function.MethodsSeventy-two patients with main right thoracic curvature in adolescent idiopathic scoliosis (AIS) underwent a PFT and a radiological parameter evaluation of spinal and thoracic cage deformities. Simple and multiple linear regressions were also used to note whether a combination of variables might better predict PFT values. Means were compared using the two-sample t test or one-way ANOVA with Tukey’s multiple comparison methods.ResultsForced vital capacity (FVC)% predicted had significantly negative correlations with main thoracic curve Cobb (MT-Cobb) (R2 = 0.648, p < 0.001), main thoracic curve-rib hump (MT-RH) (R2 = 0.522, p < 0.001), main thoracic curve apical vertebral body-to-rib ratio (MT-AVB-R) (R2 = 0.536, p < 0.001), and main thoracic curve apical vertebra translation (MT-AVT) (R2 = 0.383, p < 0.001). Multiple regression analysis was performed with FVC% predicted as the dependent variable and MT-Cobb, MT-RH, MT-AVB-R, and MT-AVT as the independent variables. MT-Cobb, MT-RH, MT-AVB-R, and MT-AVT were factors with a significant effect on FVC% predicted (p < 0.001). For 45 patients who had preoperative FVC impairment (FVC% predicted < 80%), their MT-Cobb averaged 76.71°. Twenty-seven patients with normal preoperative FVC (FVC% predicted ≥ 80%) had a smaller mean MT-Cobb of 52.03° (p < 0.001). In other radiological parameters, the impaired FVC group had a MT-AVT of 54.29 mm compared to 38.06 mm for the normal FVC group (p < 0.001). MT-AVB-R averaged 2.92 for the impaired FVC group and 1.78 for the normal FVC group (p < 0.001). MT-RH averaged 28.79 mm for the impaired group and 16.62 mm for the normal group (p < 0.001). Further stratification of preoperative PFT results is divided into three groups. The three groups also showed significant differences in MT-Cobb, MT-RH, MT-AVB-R, and MT-AVT (p < 0.001).ConclusionSevere scoliosis leads to an increased degree of thoracic deformity, which increases the risk of lung damage in AIS. Moreover, a more accurate assessment of pulmonary function is achieved through radiological parameters and PFTs.