title: Chronic hypercapnia should not exclude patients from lung volume reduction surgery.
abstract: OBJECTIVE
  Chronic hypercapnia is still considered to increase the risk for perioperative mortality and therefore to be a contraindication for lung volume reduction surgery (LVRS). The aim of this study was to analyse the influences of hypercapnia upon postoperative outcome.
  
  
  METHODS
  The functional improvement (preop vs. 3 months postop) and clinical outcome was studied in 22 patients with chronic hypercapnia (preoperative arterial pCO2 > or = 45 mmHg) who underwent LVRS between 9/94 and 2/97 and were compared to all other patients (n = 58) without hypercapnia. Data are expressed as the mean +/- SEM.
  
  
  RESULTS
  The 30-day mortality was 9.1% (2/22) in patients with chronic hypercapnia (HC) and 5.2% (3/58) in patients with normal arterial pCO2 levels (control) (P = n.s). The stay on the ICU (3.5 +/- 0.8 vs. 2.1 +/- 0.3 days) and duration of chest drainage (7.3 +/- 1.2 vs. 7.2 +/- 0.8 days) was similar between both groups (HC vs. control) (P = n.s). The preoperative lung function (% of predicted) and blood gas (mmHg) parameters were significantly worse in HC patients compared to control patients. In both groups significant functional improvements were observed: FeV1 in the control group increased by 37% within the first 3 months (29.1 +/- 1.7% of predicted vs. 39.9 +/- 3.1% of predicted, P = 0.0198). In the HC group, FeV1 increased by 73% which was even higher than in the controls (19.5 +/- 1.5% of predicted vs. 33.7 +/- 4.7% of predicted, P = 0.0385). All patients of both groups who died perioperatively had a significantly higher severity of parenchymal destruction than those who survived (P = 0.0277 and 0.0380, respectively).
  
  
  CONCLUSIONS
  Patients with chronic hypercapnia alone, had no significantly higher mortality and morbidity, and therefore should not be excluded from LVRS. However, the presence of additional risk factors, such as homogeneity of disease, high degree of parenchymal destruction or pulmonary hypertension should be considered as contraindications for the procedure.
authors.affiliation: Department of Cardiothoracic Surgery, University of Vienna, Austria. Wilfried.Wisser@akh-wien.ac.at
authors.forename: W
authors.initials: W
authors.lastname: Wisser
authors.forename: W
authors.initials: W
authors.lastname: Klepetko
authors.forename: O
authors.initials: O
authors.lastname: Senbaklavaci
authors.forename: T
authors.initials: T
authors.lastname: Wanke
authors.forename: E
authors.initials: E
authors.lastname: Gruber
authors.forename: E
authors.initials: E
authors.lastname: Tschernko
authors.forename: E
authors.initials: E
authors.lastname: Wolner
mesh_terms: D016022:Case-Control Studies; D000075202:Contraindications; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006935:Hypercapnia / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000453:epidemiology* / Q000401:mortality; D011656:Pulmonary Emphysema / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012129:Respiratory Function Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome