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• W198529138 abstract "To the Editor:We read with great interest the article of Miyoshi et al (August 2000)1Miyoshi S Yoshimasu T Hirai T et al.Exercise capacity of thoracotomy patients in the early postoperative period.Chest. 2000; : 384-390Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar on the early postoperative exercise capacity of 16 patients who had undergone to standard posterolateral thoracotomy and lung resection.In one of their analyses, they compared the patients (31.3% of those in their series) who did not reach the empirical anaerobic threshold expressed by the venous blood lactate level of 2.2 mmol/L (La-2.2) during oxygen uptake ( V˙o2) with those who reached the threshold during the first postoperative cycle ergometer exercise test (mean [± SD], 9 ± 2 postoperative days). Miyoshi et al found that the circulatory and ventilatory parameters were larger in patients with La-2.2 than in those without, and that both heart rate and respiratory reserves were smaller in the patients with La-2.2 than in those without. They concluded that pain from the surgical wound in the chest could be the most important limiting factor for patients without La-2.2 in the early postoperative period, even though subjective factors were not obtained in their study.We performed a similar prospective study on 122 patients who were enrolled in our study from December 1999 through February 2001 and had undergone muscle-sparing thoracotomies and lung resections (segmentectomy/wedge resection, 15 patients; lobectomy, 88 patients; pneumonectomy, 19 patients) for lung carcinoma. Our exercise methodology consisted of a maximal symptom-limited, stair-climbing test that was administered at the time of the patient’s discharge from the hospital (mean, 8.2 ± 3.3 postoperative days). In our study, 24 patients (19.7% of our series) did not reach the empirical anaerobic threshold of La-2.2 V˙o2. However, no significant differences were detected between this group of patients and the others who reached the La-2.2 V˙o2, in terms of calculated work, maximal V˙o2 ( V˙o2max; expressed as milliliters per minute, milliliters per minute per kilogram, or as the percentage of the predicted value), V˙o2max/body surface area ratio, and O2 pulse.2Olsen GN Bolton JWR Weiman DS et al.Stair climbing as an exercise test to predict the postoperative complications of lung resection: two years experience.Chest. 1991; 99: 587-590Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar Moreover, hemodynamic variables (ie, cardiac output, cardiac index, oxygen delivery, extraction ratio, and heart rate reserve), which were calculated by the Fick method, did not result in significant differences between the two groups of patients.The only parameter that was significantly reduced in the group without La-2.2 vs the group with La-2.2 was the number of steps climbed (mean, 77.2 ± 30.8 vs 101.6 ± 33.2, respectively; p = 0.001[Student’s t test]).We performed also a subjective analysis concerning the main symptoms that limited the patients’ exercise, and we found no difference between the two groups of patients. In particular, only three patients in the group without La-2.2 stopped exercising because of chest pain at the surgical wound. Dyspnea was the predominant symptom, followed by leg pain and physical exhaustion, in both groups of patients.Contrary to what was reported by Miyoshi et al,1Miyoshi S Yoshimasu T Hirai T et al.Exercise capacity of thoracotomy patients in the early postoperative period.Chest. 2000; : 384-390Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar we believe that in the early postoperative period the chest pain from thoracotomy is not the most important limiting factor for the patients who do not reach the empirical anaerobic threshold. However, differences in the type of thoracotomy incision and in the methodology of the exercise test have to be taken into account.Since there was no difference in the values of ergometric variables between the two groups of patients in our series, a low level of arterial blood lactates at peak exercise in some patients may be explained by a previously reported intersubject variability of the anaerobic threshold value3Jones NL Makrides L Hitchcock DC et al.Normal standards for an incremental progressive cycle ergometer test.Am Rev Respir Dis. 1985; 131: 700-708PubMed Google Scholar or may simply reflect the better fitness of some individuals for endurance (aerobic) exercise.4Wasserman K The anaerobic threshold measurement to evaluate exercise performance.Am Rev Respir Dis. 1984; 129: 535-540Google Scholar To the Editor: We read with great interest the article of Miyoshi et al (August 2000)1Miyoshi S Yoshimasu T Hirai T et al.Exercise capacity of thoracotomy patients in the early postoperative period.Chest. 2000; : 384-390Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar on the early postoperative exercise capacity of 16 patients who had undergone to standard posterolateral thoracotomy and lung resection. In one of their analyses, they compared the patients (31.3% of those in their series) who did not reach the empirical anaerobic threshold expressed by the venous blood lactate level of 2.2 mmol/L (La-2.2) during oxygen uptake ( V˙o2) with those who reached the threshold during the first postoperative cycle ergometer exercise test (mean [± SD], 9 ± 2 postoperative days). Miyoshi et al found that the circulatory and ventilatory parameters were larger in patients with La-2.2 than in those without, and that both heart rate and respiratory reserves were smaller in the patients with La-2.2 than in those without. They concluded that pain from the surgical wound in the chest could be the most important limiting factor for patients without La-2.2 in the early postoperative period, even though subjective factors were not obtained in their study. We performed a similar prospective study on 122 patients who were enrolled in our study from December 1999 through February 2001 and had undergone muscle-sparing thoracotomies and lung resections (segmentectomy/wedge resection, 15 patients; lobectomy, 88 patients; pneumonectomy, 19 patients) for lung carcinoma. Our exercise methodology consisted of a maximal symptom-limited, stair-climbing test that was administered at the time of the patient’s discharge from the hospital (mean, 8.2 ± 3.3 postoperative days). In our study, 24 patients (19.7% of our series) did not reach the empirical anaerobic threshold of La-2.2 V˙o2. However, no significant differences were detected between this group of patients and the others who reached the La-2.2 V˙o2, in terms of calculated work, maximal V˙o2 ( V˙o2max; expressed as milliliters per minute, milliliters per minute per kilogram, or as the percentage of the predicted value), V˙o2max/body surface area ratio, and O2 pulse.2Olsen GN Bolton JWR Weiman DS et al.Stair climbing as an exercise test to predict the postoperative complications of lung resection: two years experience.Chest. 1991; 99: 587-590Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar Moreover, hemodynamic variables (ie, cardiac output, cardiac index, oxygen delivery, extraction ratio, and heart rate reserve), which were calculated by the Fick method, did not result in significant differences between the two groups of patients. The only parameter that was significantly reduced in the group without La-2.2 vs the group with La-2.2 was the number of steps climbed (mean, 77.2 ± 30.8 vs 101.6 ± 33.2, respectively; p = 0.001[Student’s t test]). We performed also a subjective analysis concerning the main symptoms that limited the patients’ exercise, and we found no difference between the two groups of patients. In particular, only three patients in the group without La-2.2 stopped exercising because of chest pain at the surgical wound. Dyspnea was the predominant symptom, followed by leg pain and physical exhaustion, in both groups of patients. Contrary to what was reported by Miyoshi et al,1Miyoshi S Yoshimasu T Hirai T et al.Exercise capacity of thoracotomy patients in the early postoperative period.Chest. 2000; : 384-390Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar we believe that in the early postoperative period the chest pain from thoracotomy is not the most important limiting factor for the patients who do not reach the empirical anaerobic threshold. However, differences in the type of thoracotomy incision and in the methodology of the exercise test have to be taken into account. Since there was no difference in the values of ergometric variables between the two groups of patients in our series, a low level of arterial blood lactates at peak exercise in some patients may be explained by a previously reported intersubject variability of the anaerobic threshold value3Jones NL Makrides L Hitchcock DC et al.Normal standards for an incremental progressive cycle ergometer test.Am Rev Respir Dis. 1985; 131: 700-708PubMed Google Scholar or may simply reflect the better fitness of some individuals for endurance (aerobic) exercise.4Wasserman K The anaerobic threshold measurement to evaluate exercise performance.Am Rev Respir Dis. 1984; 129: 535-540Google Scholar" @default.
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• W198529138 title "Anaerobic Threshold and Thoracotomy Chest Pain" @default.
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