[The evaluation of lung vascular compliance by the dobutamine stress test in patients who are candidates for extensive lung resections].
This prospective descriptive study evaluated the utility of dobutamine in studying pulmonary vascular compliance in patients with lung neoplasms who are high risk candidates for lung resection. Seventeen consecutive patients meeting one of the following inclusion criteria were enrolled: FEV1 < 60% of theoretical value, FVC < 65%, residual volume > 130%. postoperative predictive FEV1 < 1,000 ml or PaO2 < 70 mmHg breathing room air. A Swan-Ganz catheter was inserted in the right side 24 h before surgery. The following data were recorded: heart rate (HR), mean pulmonary artery pressure (PAP), cardiac output, pulmonary vascular resistance (PVR) and arterial blood gas readings. Measurements were taken as follows: a) with the patient at rest breathing room air; b) after infusion of dobutamine 10 micrograms/kg/min; c) 30 min after breathing room air, and d) after surgery. Eleven of the 17 patients underwent pneumonectomy (5 left sided and 6 right sided). Bi-lobectomy was performed in 3 patients, segmentectomy was performed in 1 and lobectomy in 1. One patient did not undergo surgery because PAP was over 34 mmHg at baseline and did not decrease after oxygen administration. Dobutamine administration was associated with a significant increase in cardiac output (p < 0.001) and PAP (p < 0.05), with a significant decrease in PVR (p < 0.05), indicating good pulmonary vascular reserve in our cohort. No patient suffered serious complications in the postoperative period and all were released from the hospital. There were no complications related to dobutamine perfusion. We conclude that the study of pulmonary vascular function with dobutamine in high risk candidates for extensive lung resection may be a simple method for evaluating pulmonary vascular compliance before surgery, although its possible usefulness still remains to be determined.
Rubia
M V
MV
Servicio de Medicina Intensiva, Hospital Clínico Universitario, Valladolid.
Gandía
F
F
Duque
J L
JL
D000368:Aged; D002316:Cardiotonic Agents; D002407:Catheterization, Swan-Ganz; D004280:Dobutamine; D005080:Exercise Test / Q000379:methods* / Q000706:statistics & numerical data; D006439:Hemodynamics; D006801:Humans; D008170:Lung Compliance; D008175:Lung Neoplasms / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D018579:Patient Selection; D011013:Pneumonectomy; D011446:Prospective Studies; D018709:Statistics, Nonparametric
D002316:Cardiotonic Agents; D004280:Dobutamine
Evaluación de la compliancia vascular pulmonar mediante prueba de esfuerzo con dobutamina en pacientes candidatos a resecciones pulmonares amplias.