Early exercise pulmonary diffusing capacity of carbon monoxide after anatomical lung resection: a word of caution for fast-track programmes

2019 ◽  
Vol 56 (1) ◽  
pp. 143-149 ◽  
Author(s):  
Nuria M Novoa ◽  
Pedro Esteban ◽  
Maria Teresa Gómez Hernández ◽  
Marta G Fuentes ◽  
Gonzalo Varela ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Lung Resection ◽  
Linear Regression Analysis ◽  
Diffusing Capacity ◽  
Early Exercise ◽  
The Third ◽  
Single Breath ◽  
Before And After

Abstract OBJECTIVES In healthy individuals, increasing pulmonary blood flow during exercise also increases the % of the diffusing capacity of the lungs for carbon monoxide (DLCO%), but its evolution after lung resection is unknown. In this study, our goal was to measure changes in exercise DLCO% during the first 3 days after anatomical lung resection. METHODS We performed a prospective observational study on consecutive patients with non-small-cell lung cancer scheduled for anatomical resection, except pneumonectomy, during a 6-month period. Patients underwent measurement of the DLCO% by a single-breath technique adjusted by the concentration of haemoglobin—before and after standardized exercise the day before and 3 consecutive days after surgery. The delta (Δ) variation (basal versus exercise) was calculated. The number of functioning resected segments was calculated by bronchoscopy. Postoperative pain and pleural air leak were estimated using a visual analogue scale and graduated conventional pleural drainage systems, respectively, and their influence on ΔDLCO each postoperative day was evaluated by linear regression analysis. RESULTS Fifty-seven patients were included. The visual analogue scale of pain and pleural air leaks were not correlated to Δ values (model R2: 0.0048). The evolution of Δ values during 3 postoperative days showed a progressive recovery of values, but on the third day, DLCO% capacity during exercise was still impaired (P < 0.01), especially in patients who underwent a resection of more than 3 functioning segments. CONCLUSIONS Physiological increase in DLCO% during exercise is still impaired on the third postoperative day in patients undergoing resection of more than 3 functioning pulmonary segments. This fact should be considered before discharging those patients after anatomical lung resection.

The effect of conductive ventilation heterogeneity on diffusing capacity measurement

2008 ◽  
Vol 104 (4) ◽  
pp. 1094-1100 ◽  
Author(s):  
Sylvia Verbanck ◽  
Daniel Schuermans ◽  
Sophie Van Malderen ◽  
Walter Vincken ◽  
Bruce Thompson
Keyword(s):  
Carbon Monoxide ◽  
Vital Capacity ◽  
Experimental Situation ◽  
Normal Subjects ◽  
Diffusing Capacity ◽  
Capacity Measurement ◽  
Alveolar Volume ◽  
Estimation Errors ◽  
Single Breath ◽  
Ventilation Heterogeneity

It has long been assumed that the ventilation heterogeneity associated with lung disease could, in itself, affect the measurement of carbon monoxide transfer factor. The aim of this study was to investigate the potential estimation errors of carbon monoxide diffusing capacity (DlCO) measurement that are specifically due to conductive ventilation heterogeneity, i.e., due to a combination of ventilation heterogeneity and flow asynchrony between lung units larger than acini. We induced conductive airway ventilation heterogeneity in 35 never-smoker normal subjects by histamine provocation and related the resulting changes in conductive ventilation heterogeneity (derived from the multiple-breath washout test) to corresponding changes in diffusing capacity, alveolar volume, and inspired vital capacity (derived from the single-breath DlCO method). Average conductive ventilation heterogeneity doubled ( P < 0.001), whereas DlCO decreased by 6% ( P < 0.001), with no correlation between individual data ( P > 0.1). Average inspired vital capacity and alveolar volume both decreased significantly by, respectively, 6 and 3%, and the individual changes in alveolar volume and in conductive ventilation heterogeneity were correlated ( r = −0.46; P = 0.006). These findings can be brought in agreement with recent modeling work, where specific ventilation heterogeneity resulting from different distributions of either inspired volume or end-expiratory lung volume have been shown to affect DlCO estimation errors in opposite ways. Even in the presence of flow asynchrony, these errors appear to largely cancel out in our experimental situation of histamine-induced conductive ventilation heterogeneity. Finally, we also predicted which alternative combination of specific ventilation heterogeneity and flow asynchrony could affect DlCO estimate in a more substantial fashion in diseased lungs, irrespective of any diffusion-dependent effects.

scholarly journals Validity of a frustration-induction procedure

2007 ◽  
Vol 30 (1) ◽  
pp. 47-49 ◽  
Author(s):  
Elaine Henna ◽  
Monica L Zilberman ◽  
Valentim Gentil ◽  
Clarice Gorenstein
Keyword(s):  
Visual Analogue Scale ◽  
Experimental Research ◽  
Research Method ◽  
Analogue Scale ◽  
Experimental Studies ◽  
Normal Subjects ◽  
Induction Procedure ◽  
Overt Behavior ◽  
Before And After

OBJECTIVE: To test a reliable and easily administered frustration-induction procedure for experimental research. METHOD: One hundred volunteers (81 women, mean age ± SD 34.2 ± 8 years) physically and psychiatrically healthy submitted to the frustration induction procedure were prevented from reaching reward level scores. Subjective aggressiveness feelings related to frustration were self-rated in a 13-item visual analogue scale before and after the procedure. RESULTS: Significant increases in aggressiveness-related feelings were detected in 12 of the 13 items. This was consistent with the observed overt behavior of the subjects during the task. CONCLUSIONS: The frustration-induction procedure is a simple, easy to administer frustration-induction procedure that can be used in experimental studies in normal subjects.

Single Breath Carbon Monoxide Diffusing Capacity

1988 ◽  
Vol 137 (5) ◽  
pp. 1244-1244
Author(s):  
Edith Rosenberg ◽  
Margaret R. Becklake
Keyword(s):  
Carbon Monoxide ◽  
Diffusing Capacity ◽  
Single Breath

scholarly journals 2017 ERS/ATS standards for single-breath carbon monoxide uptake in the lung

2017 ◽  
Vol 49 (1) ◽  
pp. 1600016 ◽  
Author(s):  
Brian L. Graham ◽  
Vito Brusasco ◽  
Felip Burgos ◽  
Brendan G. Cooper ◽  
Robert Jensen ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Recent Literature ◽  
American Thoracic Society ◽  
Common Type ◽  
Diffusing Capacity ◽  
Tracer Gas ◽  
European Respiratory Society ◽  
Technical Standards ◽  
Single Breath ◽  
The World

This document provides an update to the European Respiratory Society (ERS)/American Thoracic Society (ATS) technical standards for single-breath carbon monoxide uptake in the lung that was last updated in 2005. Although both DLCO (diffusing capacity) and TLCO (transfer factor) are valid terms to describe the uptake of carbon monoxide in the lung, the term DLCO is used in this document. A joint taskforce appointed by the ERS and ATS reviewed the recent literature on the measurement of DLCO and surveyed the current technical capabilities of instrumentation being manufactured around the world. The recommendations in this document represent the consensus of the taskforce members in regard to the evidence available for various aspects of DLCO measurement. Furthermore, it reflects the expert opinion of the taskforce members on areas in which peer-reviewed evidence was either not available or was incomplete. The major changes in these technical standards relate to DLCO measurement with systems using rapidly responding gas analysers for carbon monoxide and the tracer gas, which are now the most common type of DLCO instrumentation being manufactured. Technical improvements and the increased capability afforded by these new systems permit enhanced measurement of DLCO and the opportunity to include other optional measures of lung function.

Palatoplasty for Snoring: A Randomized Controlled Trial of Three Surgical Methods

1998 ◽  
Vol 119 (3) ◽  
pp. 288-292 ◽  
Author(s):  
R. W. Clarke ◽  
M. P. J. Yardley ◽  
C. M. Davies ◽  
A. Panarese ◽  
R. T. Clegg ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Postoperative Morbidity ◽  
Controlled Trial ◽  
Randomized Controlled ◽  
Surgical Methods ◽  
Before And After ◽  
A New Technique ◽  
Surgical Treatments

In a randomized, controlled trial, 62 patients (47 men and 15 women) with severe antisocial snoring, but no sleep apnea, were allocated to one of three surgical treatments. These were uvulopalato-pharyngoplasty, laser palatoplasty, and diathermy palatoplasty. Postoperative morbidity was measured on a visual analogue scale of severity of pain, dysphagia, and nasal regurgitation at 1, 2, and 7 days after the operation. Efficacy of each procedure was measured by asking the sleeping partner to record the severity of snoring before and after the operation, again on a visual analogue scale. Measurements were taken at 1, 3, and 6 months. There were no significant differences in early postoperative morbidity among the treatment groups. Diathermy palatoplasty is a new technique for the relief of snoring that is associated with low morbidity and requires little in the way of expensive equipment.

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