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Eur J Cardiothorac Surg 2006;29:267
© 2006 Elsevier Science NL
Letters to the Editor |
U.O. Thoracic Surgery, Department of Surgical Science, University of Parma, Via Gramsci 14, 43100 Parma, Italy
Received 23 November 2005; accepted 25 November 2005.
* Tel.: +39 0521 702005; fax: +39 0521 702219. (Email: antonio.bobbio{at}unipr.it; antonboa{at}hotmail.com).
Key Words: Lung surgery • Pulmonary rehabilitation
We would like to thank Dr Ferri and his colleagues for their attention to our work as well as for their comments and questions. On the basis of their personal experience and with the support of a literature review, they conclude that postoperative pulmonary rehabilitation (PR) should take a central place in the comprehensive management of all patients undergoing lung resection and not only in those with underlying COPD [1,2].
In the experience of authors who attempted to quantify the permanent loss of VO2,max after lung resection, a time-point of six months after surgery was generally used to assess the postoperative functional recovery, and in these studies a specific postoperative PR was generally not provided [3,4]. As reported by Bollinger and colleagues, the modifications in exercise capacity in the subgroup of patients with an impaired preoperative pulmonary function are similar to that found in patients with a preoperative normal lung function.
The results of our study, when compared to other reports, also failed to find a difference, in terms of loss of VO2,max, between COPD and healthy individuals at a time-point of functional evaluation established at three months postoperatively [5]; however, in our study we observed a significant impairment of postoperative VEVCO2 (slope between minute ventilation and CO2 production) in these COPD patients and also, through Visual Analogue Scale analysis, that exercise performance was more limited by dyspnea than by leg fatigue.
On the basis of these data it seems possible to affirm that surgical trauma and loss of lung parenchyma are the principal causes of postoperative deconditioning after lung resection, both in COPD and in non-COPD patients; the characteristics of the postoperative limitation to exercise in COPD patients, however, seems mainly due to ventilatory limitation rather than to skeletal muscle deconditioning.
A postoperative PR program will probably be helpful in all patients undergoing lung resection, with the aim of quickly restoring the exercise tolerance and ameliorating the quality of life; however, it seems crucial to specifically tailor the PR program in the subgroup of patients with COPD in order to take into account individual ventilatory patterns.
Unfortunately, in our Department the assigning of patients to a postoperative PR program is not part of a specific protocol; the decision to assign patients is left to the care of the referral physician.
In conclusion, we firmly support Dr Ferri and his colleagues in their goal of designing a feasible and reproducible strategy to reverse the natural attitude of patients to deconditioning after lung resection. We hope to read shortly about their personal methods and results in postoperative PR of patients undergoing lung resection.
References
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