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Alveolar-Membrane Diffusing Capacity Improves in the Morbidly Obese after Bariatric Surgery

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Abstract

Background

Morbidly obese individuals may have impaired alveolar-membrane diffusing capacity (DmCO). The purpose of this study was to measure pulmonary diffusing capacity for NO (DLNO) as an index of DmCO pre- and postbariatric surgery in the morbidly obese.

Methods

Twenty-one patients [age = 40 ± 9 years, body mass index (BMI) = 48.5 ± 7.2 kg/m2] with an excess weight of 72 ± 17 kg scheduled for bariatric surgery were recruited. Pulmonary function and arterial blood-gases were measured pre- and postsurgery.

Results

DmCO was 88 ± 23% of predicted before surgery (p < 0.05). There was loss in BMI and excess weight of 7.7 ± 2.0 kg/m2 and 31 ± 8%, respectively. Because DmCO = DLNO/2.42, the increase in DLNO postsurgery resulted in a normalization of the predicted DmCO to 97 ± 29% predicted, or an improvement of DLNO by 11 ± 18 (95% CI = 3.5, 19.1; p = 0.01) milliliters per minute per millimeter of mercury without any improvement in DLCO. The DLNO/DLCO ratio and alveolar volume both increased, respectively (p < 0.05), and pulmonary capillary blood volume to DmCO ratio decreased postsurgery (p < 0.01). Multiple linear regression revealed that the change in DLNO was most strongly associated with changes in alveolar volume and the waist-to-hip ratio (adjusted r 2 = 0.76; p < 0.001) and was not related to the reduction in the alveolar-to-arterial PO2 difference.

Conclusion

Alveolar-membrane diffusion normalizes within 10 weeks after bariatric surgery. This is likely due to the increase in alveolar volume from the reduction in the waist-to-hip ratio.

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Acknowledgments

This data was initially presented as a poster at the 2007 Canadian Anesthesiologist’s Society (CAS) annual meeting in Calgary, Alberta. It was awarded as one of the top 50 abstracts of the conference. The authors would like to thank the CAS for partially funding this project. The authors would also like to thank the volunteers for being a part of this research study, and the Anesthesiologists’ from the Department of Anesthesia at the Montreal General Hospital who inserted the arterial lines in the subjects.

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Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Women’s Health, School of Medicine, Saint Mary’s Health Center, Saint Louis University, 6420 Clayton Road, Suite 290, Saint Louis, MO, 63117, USA

    Gerald S. Zavorsky & Do Jun Kim

  2. Department of Pharmacological and Physiological Science, School of Medicine, Saint Louis University, 402 South Grand Blvd., Saint Louis, MO, 63104, USA

    Gerald S. Zavorsky

  3. Department of Surgery, Bariatric Clinic, Royal Victoria Hospital, McGill University Health Center, 687 Pine Ave. West., Rm S9.030, Montreal, Quebec, H3A-1A1, Canada

    Jean-Loup Sylvestre & Nicolas V. Christou

Authors
  1. Gerald S. Zavorsky
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  2. Do Jun Kim
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  3. Jean-Loup Sylvestre
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  4. Nicolas V. Christou
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Corresponding author

Correspondence to Gerald S. Zavorsky.

Additional information

G.S. Zavorsky is the recipient of the 2005 Baxter Corporation Award in Anesthesia from the Canadian Anesthesiologist’s Society. G.S. Zavorsky was a previous Research Scholar – Junior 1 from the Quebec Health Research Foundation (Fonds de la Recherche en Santé du Québec, FRSQ). N.V. Christou is a consultant for Ethicon Endo-Surgery and has stock ownership in Weight Loss Surgery.

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Zavorsky, G.S., Kim, D.J., Sylvestre, JL. et al. Alveolar-Membrane Diffusing Capacity Improves in the Morbidly Obese after Bariatric Surgery. OBES SURG 18, 256–263 (2008). https://doi.org/10.1007/s11695-007-9294-9

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  • DOI: https://doi.org/10.1007/s11695-007-9294-9

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