Peak oxygen consumption measured during the stair-climbing test in lung resection candidates

Abstract

Background: The stair-climbing test is commonly used in the preoperative evaluation of lung resection candidates, but it is difficult to standardize and provides little physiologic information on the performance.

Objective: To verify the association between the altitude and the V(O2peak) measured during the stair-climbing test.

Methods: 109 consecutive candidates for lung resection performed a symptom-limited stair-climbing test with direct breath-by-breath measurement of V(O2peak) by a portable gas analyzer. Stepwise logistic regression and bootstrap analyses were used to verify the association of several perioperative variables with a V(O2peak) <15 ml/kg/min. Subsequently, multiple regression analysis was also performed to develop an equation to estimate V(O2peak) from stair-climbing parameters and other patient-related variables.

Results: 56% of patients climbing <14 m had a V(O2peak) <15 ml/kg/min, whereas 98% of those climbing >22 m had a V(O2peak) >15 ml/kg/min. The altitude reached at stair-climbing test resulted in the only significant predictor of a V(O2peak) <15 ml/kg/min after logistic regression analysis. Multiple regression analysis yielded an equation to estimate V(O2peak) factoring altitude (p < 0.0001), speed of ascent (p = 0.005) and body mass index (p = 0.0008).

Conclusions: There was an association between altitude and V(O2peak) measured during the stair-climbing test. Most of the patients climbing more than 22 m are able to generate high values of V(O2peak) and can proceed to surgery without any additional tests. All others need to be referred for a formal cardiopulmonary exercise test. In addition, we were able to generate an equation to estimate V(O2peak), which could assist in streamlining the preoperative workup and could be used across different settings to standardize this test.