scholarly journals Risks of perioperative complications in patients of older age groups: causes, mechanisms and prognostic possibilities

2021 ◽  
Vol 5 (3) ◽  
pp. 150-155
Author(s):  
D.V. Trotsyuk ◽  
◽  
D.S. Medvedev ◽  
Z.A. Zaripova ◽  
A.E. Chikov ◽  
...  
Keyword(s):  
Exercise Testing ◽  
Perioperative Complications ◽  
Objective Assessment ◽  
Cardiopulmonary Exercise Testing ◽  
Age Groups ◽  
The Body ◽  
Older Age ◽  
Operational Stress ◽  
Cardiopulmonary Exercise ◽  
Age Related

Age-related changes in the body and concomitant somatic pathology can have a significant impact on the body adaptation processes to operational stress, which is associated with the development of adverse events in the intraoperative period, postoperative complications and long-term prognosis. Both the initial state of the body and the severity of changes in metabolism in response to operational stress, as well as the involvement degree of the body functional reserves, are important. Traditionally used methods for risk stratification, based on a patient’s survey or assessment of his daily activity, do not always provide a comprehensive, objective assessment of the body functional capabilities, especially in patients of older age groups. The prognostic value of cardiopulmonary exercise testing for determining the indications and the risk of complications in various types of surgical interventions has been proved. Based on the results of preoperative cardiopulmonary exercise testing, it is possible to make a more complete, comprehensive assessment of the patient’s body functional status, which is especially important for polymorbid patients. However, at present, there are no clearly defined normative limits for the indicators of cardiopulmonary exercise testing for patients of older age groups, which determines the future prospects for studying the use of this method for patients over 60 years of age with various pathological conditions. KEYWORDS: aging, operational stress, adaptation, functional reserve, prognosis, age-related features, cardiopulmonary exercise testing. FOR CITATION: Trotsyuk D.V., Medvedev D.S., Zaripova Z.A., Chikov A.E. Risks of perioperative complications in patients of older age groups: causes, mechanisms and prognostic possibilities. Russian Medical Inquiry. 2021;5(3):150–155. DOI: 10.32364/2587-6821-2021-5-3-150-155.

scholarly journals Utility of Cardiopulmonary Exercise Testing (CPET) in the Post-COVID-19 Context: Retrospective Analysis of a Single Centre Experience.

2021 ◽  
Author(s):  
Edward Parkes ◽  
Joanna Shakespeare ◽  
Timothy Robbins ◽  
Ioannis Kyrou ◽  
Harpal Randeva ◽  
...  
Keyword(s):  
Exercise Testing ◽  
Objective Assessment ◽  
Cardiopulmonary Exercise Testing ◽  
Clinical Information ◽  
Pulmonary Vascular Disease ◽  
Single Centre ◽  
Exercise Limitation ◽  
Cardiopulmonary Exercise ◽  
Single Centre Experience ◽  
Single Centre Study

Abstract Cardiopulmonary exercise testing (CPET) allows objective assessment of a patient’s global response to maximal incremental exercise. CPET has been proposed to have a role in investigating post-COVID syndrome. However, CPET is resource intensive, and essential for restoration of other clinical services (e.g. cancer surgery). The aim of this study was to explore utility of CPET in assessing functional status of COVID-19 survivors with persistent dyspnoea. Of the 600 patients reviewed in a post-COVID-19 assessment clinic between May 2020 and April 2021, 12 (male/female: 8/4; age: 4±15.2 years; BMI: 32.8±5.9 kg/m2; non-smokers/ smokers: 8/4) were referred for CPET due to persistent breathlessness out-keeping with disease severity. Of these patients, 10 patients demonstrated reduced peak VO2, whilst five had an exercise limitation attributed to physical deconditioning. Two patients had mainly a cardiac limitation to exercise, with a further three patients demonstrating breathing pattern disorder, pulmonary vascular disease and lung disease. The findings of this single-centre study suggest that intensive CPET testing may not add substantial additional clinical information to aid patient investigation/management in the context of post-COVID. Such resource intensive procedures may be better utilised in selected patients and in the restoration of NHS services following the COVID-19 pandemic.

scholarly journals Cardiopulmonary exercise testing in systolic heart failure: from basic to advanced practice

2016 ◽  
Vol 86 (1-2) ◽  
Author(s):  
Ugo Corrà
Keyword(s):  
Exercise Testing ◽  
Objective Assessment ◽  
Cardiopulmonary Exercise Testing ◽  
Systolic Heart Failure ◽  
Objective Measure ◽  
Invasive Procedure ◽  
Computer Assisted ◽  
Non Invasive ◽  
Cardiopulmonary Exercise ◽  
Technological Advances

Cardiopulmonary exercise testing (CPET) is a specialized subtype of exercise testing that provides a more accurate and objective measure of cardiorespiratory fitness (CRF). CPET relies on measurement of ventilatory gases during exercise, <em>i.e</em>., a non-invasive procedure that involves the acquisition of expired ventilation and concentrations of oxygen (O<sub>2</sub>) and carbon dioxide (CO<sub>2</sub>) during progressive exercise. The non-invasive measurement of ventilation and expired gases permits the most accurate and reproducible quantification of CRF, a grading of the etiology and severity of impairment, and an objective assessment of the response to an intervention. Moreover, a particularly large volume of research has been directed toward the utility of CPET as a prognostic tool; CPET is a scientifically sound and therefore clinically valuable method for accurately estimating prognosis in various disease states. Although still underutilized, CPET has gained popularity not only due to the recognition of its clear value in the functional assessment of patients with cardiovascular, pulmonary and musculoskeletal disease/disorders, but also because technological advances (<em>e.g.,</em> rapid response analyzers and computer-assisted data processing) have made this modality easier to use.

The influence of osteopathic correction on the rate of various rhythms of the body

2019 ◽  
pp. 64-71 ◽  
Author(s):  
A. E. Chernikova ◽  
Yu. P. Potekhina
Keyword(s):  
Heart Rate ◽  
Respiratory Rate ◽  
Age Groups ◽  
Biomechanical Properties ◽  
Dispersion Analysis ◽  
The Body ◽  
Body Tissues ◽  
Age Related ◽  
Significant Difference ◽  
Before And After

Introduction. An osteopathic examination determines the rate, the amplitude and the strength of the main rhythms (cardiac, respiratory and cranial). However, there are relatively few studies in the available literature dedicated to the influence of osteopathic correction (OC) on the characteristics of these rhythms.Goal of research — to study the influence of OC on the rate characteristics of various rhythms of the human body.Materials and methods. 88 adult osteopathic patients aged from 18 to 81 years were examined, among them 30 men and 58 women. All patients received general osteopathic examination. The rate of the cranial rhythm (RCR), respiratory rate (RR) heart rate (HR), the mobility of the nervous processes (MNP) and the connective tissue mobility (CTM) were assessed before and after the OC session.Results. Since age varied greatly in the examined group, a correlation analysis of age-related changes of the assessed rhythms was carried out. Only the CTM correlated with age (r=–0,28; p<0,05) in a statistically significant way. The rank dispersion analysis of Kruskal–Wallis also showed statistically significant difference in this indicator in different age groups (p=0,043). With the increase of years, the CTM decreases gradually. After the OC, the CTM, increased in a statistically significant way (p<0,0001). The RCR varied from 5 to 12 cycles/min in the examined group, which corresponded to the norm. After the OC, the RCR has increased in a statistically significant way (p<0,0001), the MNP has also increased (p<0,0001). The initial heart rate in the subjects varied from 56 to 94 beats/min, and in 15 % it exceeded the norm. After the OC the heart rate corresponded to the norm in all patients. The heart rate and the respiratory rate significantly decreased after the OC (р<0,0001).Conclusion. The described biorhythm changes after the OC session may be indicative of the improvement of the nervous regulation, of the normalization of the autonomic balance, of the improvement of the biomechanical properties of body tissues and of the increase of their mobility. The assessed parameters can be measured quickly without any additional equipment and can be used in order to study the results of the OC.

scholarly journals Motor Pathophysiology Related to Dyspnea in COPD Evaluated by Cardiopulmonary Exercise Testing

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 364
Author(s):  
Keisuke Miki
Keyword(s):  
Exercise Testing ◽  
Systemic Disease ◽  
Cardiopulmonary Exercise Testing ◽  
Treatment Strategies ◽  
Chronic Obstructive ◽  
Exertional Dyspnea ◽  
Obstructive Pulmonary Disease ◽  
Medicine Department ◽  
Cardiopulmonary Exercise ◽  
Dynamic Lung Hyperinflation

In chronic obstructive pulmonary disease (COPD), exertional dyspnea, which increases with the disease’s progression, reduces exercise tolerance and limits physical activity, leading to a worsening prognosis. It is necessary to understand the diverse mechanisms of dyspnea and take appropriate measures to reduce exertional dyspnea, as COPD is a systemic disease with various comorbidities. A treatment focusing on the motor pathophysiology related to dyspnea may lead to improvements such as reducing dynamic lung hyperinflation, respiratory and metabolic acidosis, and eventually exertional dyspnea. However, without cardiopulmonary exercise testing (CPET), it may be difficult to understand the pathophysiological conditions during exercise. CPET facilitates understanding of the gas exchange and transport associated with respiration-circulation and even crosstalk with muscles, which is sometimes challenging, and provides information on COPD treatment strategies. For respiratory medicine department staff, CPET can play a significant role when treating patients with diseases that cause exertional dyspnea. This article outlines the advantages of using CPET to evaluate exertional dyspnea in patients with COPD.

scholarly journals Cardiopulmonary exercise testing (CPET) in patients with end-stage kidney disease (ESKD): principles, methodology and clinical applications of the optimal tool for exercise tolerance evaluation

2021 ◽  
Author(s):  
Eva Pella ◽  
Afroditi Boutou ◽  
Aristi Boulmpou ◽  
Christodoulos E Papadopoulos ◽  
Aikaterini Papagianni ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Exercise Testing ◽  
Cardiopulmonary Exercise Testing ◽  
Exercise Intolerance ◽  
End Stage Kidney Disease ◽  
Exercise Limitation ◽  
Cardiopulmonary Exercise ◽  
Functional Reserves ◽  
Increased Risk ◽  
End Stage

Abstract Chronic kidney disease (CKD), especially end-stage kidney disease (ESKD), is associated with increased risk for cardiovascular events and all-cause mortality. Exercise intolerance as well as reduced cardiovascular reserve are extremely common in patients with CKD. Cardiopulmonary exercise testing (CPET) is a non-invasive, dynamic technique that provides an integrative evaluation of cardiovascular, pulmonary, neuropsychological and metabolic function during maximal or submaximal exercise, allowing the evaluation of functional reserves of these systems. This assessment is based on the principle that system failure typically occurs when the system is under stress and, thus, CPET is currently considered to be the gold-standard for identifying exercise limitation and differentiating its causes. It has been widely used in several medical fields for risk stratification, clinical evaluation and other applications but its use in everyday practice for CKD patients is scarce. This article describes the basic principles and methodology of CPET and provides an overview of important studies that utilized CPET in patients with ESKD, in an effort to increase awareness of CPET capabilities among practicing nephrologists.

PETCO2 gradient: a novel prognostic parameter in cardiopulmonary exercise testing

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
I.D Poveda Pinedo ◽  
I Marco Clement ◽  
O Gonzalez ◽  
I Ponz ◽  
A.M Iniesta ◽  
...  
Keyword(s):  
Exercise Testing ◽  
Proportional Hazards ◽  
Cardiopulmonary Exercise Testing ◽  
Cox Proportional Hazards ◽  
Prognostic Parameter ◽  
Cardiopulmonary Exercise ◽  
Proportional Hazards Regression ◽  
Kaplan Meier ◽  
Baseline Characteristics ◽  
The Difference

Abstract Background Previous parameters such as peak VO2, VE/VCO2 slope and OUES have been described to be prognostic in heart failure (HF). The aim of this study was to identify further prognostic factors of cardiopulmonary exercise testing (CPET) in HF patients. Methods A retrospective analysis of HF patients who underwent CPET from January to November 2019 in a single centre was performed. PETCO2 gradient was defined by the difference between final PETCO2 and baseline PETCO2. HF events were defined as decompensated HF requiring hospital admission or IV diuretics, or decompensated HF resulting in death. Results A total of 64 HF patients were assessed by CPET, HF events occurred in 8 (12.5%) patients. Baseline characteristics are shown in table 1. Patients having HF events had a negative PETCO2 gradient while patients not having events showed a positive PETCO2 gradient (−1.5 [IQR −4.8, 2.3] vs 3 [IQR 1, 5] mmHg; p=0.004). A multivariate Cox proportional-hazards regression analysis revealed that PETCO2 gradient was an independent predictor of HF events (HR 0.74, 95% CI [0.61–0.89]; p=0.002). Kaplan-Meier curves showed a significantly higher incidence of HF events in patients having negative gradients, p=0.002 (figure 1). Conclusion PETCO2 gradient was demonstrated to be a prognostic parameter of CPET in HF patients in our study. Patients having negative gradients had worse outcomes by having more HF events. Time to first event, decompensated heart Funding Acknowledgement Type of funding source: None

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