scholarly journals Importance of Cardiopulmonary Exercise Testing Amongst Subjects Recovering from COVID-19

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 507
Author(s):  
Gianluigi Dorelli ◽  
Michele Braggio ◽  
Daniele Gabbiani ◽  
Fabiana Busti ◽  
Marco Caminati ◽  
...  
Keyword(s):  
Minute Ventilation ◽  
Objective Assessment ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise Test ◽  
Gas Analysis ◽  
Carbon Dioxide Output ◽  
Cardiopulmonary Exercise ◽  
The Relationship ◽  
Male Subjects ◽  
Ventilatory Limitation

The cardiopulmonary exercise test (CPET) provides an objective assessment of ventilatory limitation, related to the exercise minute ventilation (VE) coupled to carbon dioxide output (VCO2) (VE/VCO2); high values of VE/VCO2 slope define an exercise ventilatory inefficiency (EVin). In subjects recovered from hospitalised COVID-19, we explored the methodology of CPET in order to evaluate the presence of cardiopulmonary alterations. Our prospective study (RESPICOVID) has been proposed to evaluate pulmonary damage’s clinical impact in post-COVID subjects. In a subgroup of subjects (RESPICOVID2) without baseline confounders, we performed the CPET. According to the VE/VCO2 slope, subjects were divided into having EVin and exercise ventilatory efficiency (EVef). Data concerning general variables, hospitalisation, lung function, and gas-analysis were also collected. The RESPICOVID2 enrolled 28 subjects, of whom 8 (29%) had EVin. As compared to subjects with EVef, subjects with EVin showed a reduction in heart rate (HR) recovery. VE/VCO2 slope was inversely correlated with HR recovery; this correlation was confirmed in a subgroup of older, non-smoking male subjects, regardless of the presence of arterial hypertension. More than one-fourth of subjects recovered from hospitalised COVID-19 have EVin. The relationship between EVin and HR recovery may represent a novel hallmark of post-COVID cardiopulmonary alterations.

Respiratory compensation point

2021 ◽  
pp. 93-96
Author(s):  
William J.M. Kinnear ◽  
James H. Hull
Keyword(s):  
Carbon Dioxide ◽  
Minute Ventilation ◽  
Cardiopulmonary Exercise Test ◽  
Compensation Point ◽  
Respiratory Compensation Point ◽  
Carbon Dioxide Output ◽  
Respiratory Compensation ◽  
Cardiopulmonary Exercise ◽  
The Subject ◽  
Maximal Effort

This chapter describes how acidaemia stimulates ventilation in the later stages of a cardiopulmonary exercise test (CPET). This happens after the anaerobic threshold, once the capacity of the blood to buffer lactic acid has been used up. The respiratory compensation point (RCP) can be identified from an increase in the slope when minute ventilation (VE) is plotted against carbon dioxide output (VCO2), or from a rise in the ventilatory equivalents for carbon dioxide (VeqCO2). The presence of a clear RCP indicates that the subject has made a fairly maximal effort during the CPET. An RCP also argues against significant lung disease, since it implies the ability to increase ventilation in response to acidaemia.

scholarly journals Cardiopulmonary exercise testing in thoracic surgery

Pneumologia ◽  
2020 ◽  
Vol 69 (1) ◽  
pp. 3-10
Author(s):  
Irina Pele ◽  
Florin-Dumitru Mihălțan
Keyword(s):  
Thoracic Surgery ◽  
Exercise Test ◽  
Objective Assessment ◽  
Preoperative Evaluation ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise Test ◽  
Risk Profile ◽  
Training Level ◽  
Cardiopulmonary Exercise ◽  
Thoracic And Abdominal

AbstractThe assessment of functional capacity is a significant part of the preoperative evaluation of patients proposed for both thoracic and abdominal surgery. The cardiopulmonary exercise test (CPET) is the most comprehensive exercise test currently used. It provides an objective assessment of the patient's training level and an individualised risk profile for complications and guides the perioperative care. This article provides a brief description of the roles of CPET in thoracic surgery. Guidelines recommend it for perioperative assessments because of its prognostic value, its utility in the postoperative period and in pulmonary rehabilitation programmes.

Idiopathic subglottic stenosis and the consequences in cardiopulmonary exercise testing

2021 ◽  
Vol 14 (11) ◽  
pp. e242149
Author(s):  
Rick Verjans ◽  
Sietske van Berkel ◽  
Tom Brandon ◽  
Hans Grotjohan
Keyword(s):  
Exercise Test ◽  
Cardiopulmonary Exercise Testing ◽  
Balloon Dilation ◽  
Blood Gas Analysis ◽  
Cardiopulmonary Exercise Test ◽  
Gas Analysis ◽  
Subglottic Stenosis ◽  
Progressive Dyspnoea ◽  
Cardiopulmonary Exercise ◽  
History Of

A 15-year-old male patient with progressive dyspnoea and exercise-related wheezing was analysed with spirometry, ECG and a cardiopulmonary exercise test with blood gas analysis. Earlier analysis by a paediatrician concluded no abnormalities. However, the previously performed spirometry test may have clarified the diagnosis in an earlier stage.Severe hypoventilation was seen during the exercise test with hypercapnia and hypoxaemia while hearing a stridor during exercise. Eventually, a circular subglottic stenosis was seen on a CT scan of the chest. No malignancy or granulomatosis with polyangiitis was seen in biopsy and pathologic examination. There was no history of trauma, intubation or infection. Therefore, the diagnosis idiopathic subglottic stenosis was established. Bronchoscopic balloon dilation followed several times, leading to full recovery.

Carbon dioxide output

2021 ◽  
pp. 63-71
Author(s):  
William J.M. Kinnear ◽  
James H. Hull
Keyword(s):  
Carbon Dioxide ◽  
Lactic Acid ◽  
Oxygen Uptake ◽  
Dead Space ◽  
Exercise Test ◽  
Minute Ventilation ◽  
Cardiopulmonary Exercise Test ◽  
Carbon Dioxide Output ◽  
Cardiopulmonary Exercise ◽  
Ventilatory Equivalent

This chapter describes how carbon dioxide is produced from metabolism and also from buffering of lactic acid. The volume of carbon dioxide exhaled (VCO2) is calculated from the concentration in exhaled gas and minute ventilation. If the lungs are less efficient than normal, with a high dead space, the amount of ventilation needed to achieve any given VCO2 is much higher. This index, known as the ventilatory equivalent for carbon dioxide, is an important prognostic marker. Early on in a cardiopulmonary exercise test (CPET), VCO2 is slightly less than the oxygen uptake (VO2). As exercise reaches its maximum, VCO2 increases more quickly when acidaemia starts to stimulate ventilation.

scholarly journals Cardiopulmonary exercise testing for the measurement of maximal oxygen uptake in people with cancer-related fatigue: a retrospective analysis

2020 ◽  
Author(s):  
Rosemary Twomey ◽  
Colin Lavigne ◽  
Tristan Martin ◽  
S. Nicole Culos-Reed ◽  
Guillaume Y. Millet
Keyword(s):  
Oxygen Uptake ◽  
Maximal Oxygen Uptake ◽  
Perceived Exertion ◽  
Cardiopulmonary Exercise Testing ◽  
Cardiopulmonary Exercise Test ◽  
Cycle Ergometer ◽  
Gas Analysis ◽  
Rating Of Perceived Exertion ◽  
Recent Analysis ◽  
Cardiopulmonary Exercise

Purpose: The measurement of cardiorespiratory fitness (maximal oxygen uptake) using a cardiopulmonary exercise test (CPET) has several applications in oncology. A recent analysis reported that in people with cancer, the vast majority of CPETs are discontinued before the attainment of a plateau in oxygen uptake (V̇O2) or secondary criteria. The objective of this study was to describe the attainment of a V̇O2 plateau and secondary criteria from CPET in a sample of people with cancer-related fatigue.Methods: This was a retrospective and exploratory analysis of data from 51 participants who completed a CPET as part of baseline testing for a clinical trial. The CPETs were conducted in a single laboratory by the same lead experimenter, using a cycle ergometer, standard ramp protocol and breath-by-breath gas analysis. The incidence of a V̇O2 plateau was compared for ∆V̇O2 of ≤150 ml·min-1 and a more conservative ∆V̇O2 of ≤50 ml·min-1. Independent groups dichotomized using the latter criterion were compared, including for the attainment of common secondary criteria for heart rate, rating of perceived exertion and the respiratory exchange ratio.Results: A plateau in V̇O2 was observed in 100% of tests using a criterion of ∆V̇O2 ≤150 mL·min-1, and this was reduced to 57% using a more conservative criterion of ∆V̇O2 ≤50 mL·min-1. There were no differences in the attainment of secondary criteria (or any other variable) between groups dichotomized using observation of a V̇O2 plateau.Conclusion: The validity of classic plateau criteria (∆V̇O2 ≤150 mL·min-1) to verify V̇O2max in people diagnosed with cancer is questionable (100% attainment in the present study, 57% attainment with a more conservative definition of a V̇O2 plateau). Comparing our data with previous reports, we suggest that exercising maximally to elicit V̇O2max may be more tolerable in this population using a standard ramp protocol, recumbent cycle ergometer and facemask.

scholarly journals Cardiopulmonary Exercise Test in heart failure: A Sine qua non

2020 ◽  
Vol 9 (2) ◽  
pp. 1-8 ◽  
Author(s):  
Stefanos Sakellaropoulos ◽  
Dimitra Lekaditi ◽  
Stefano Svab
Keyword(s):  
Heart Failure ◽  
Exercise Test ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Critical Evaluation ◽  
Research Area ◽  
Cardiopulmonary Exercise Test ◽  
Exercise Intolerance ◽  
Reduced Ejection Fraction ◽  
Cardiopulmonary Exercise

A robust literature, over the last years, supports the indication of cardiopulmonary exercise testing (CPET) in patients with cardiovascular diseases. Understanding exercise physiology is a crucial component of the critical evaluation of exercise intolerance. Shortness of breath and exercise limitation is often treated with an improper focus, partly because the pathophysiology is not well understood in the frame of the diagnostic spectrum of each subspecialty. A vital field and research area have been cardiopulmonary exercise test in heart failure with preserved/reduced ejection fraction, evaluation of heart failure patients as candidates for LVAD-Implantation, as well as for LVAD-Explantation and ultimately for heart transplantation. All the CPET variables provide synergistic prognostic discrimination. However, Peak VO2 serves as the most critical parameter for risk stratification and prediction of survival rate.

Cardiopulmonary Exercise Testing

2018 ◽  
pp. 413-436
Author(s):  
Andrew Kao
Keyword(s):  
Exercise Testing ◽  
Exercise Physiology ◽  
Cardiopulmonary Exercise Testing ◽  
Gas Analysis ◽  
Peak Oxygen Consumption ◽  
Normative Values ◽  
Cardiopulmonary Exercise ◽  
Expired Gas Analysis ◽  
Expired Gas

The chapter Cardiopulmonary Exercise Testing focuses on the opportunities provided by cardiopulmonary exercise (CPX) testing. The coordination of 5 organ systems is described in normal exercise physiology to understand abnormal exercise findings. From a few measured expired gas analysis parameters, most of the important exercise variables can be derived, including the peak oxygen consumption (peak VO2). The contribution of both the aerobic and anaerobic phases of exercise to total exercise capacity are described, including the methods for determination of the anaerobic threshold. The calculation of the normative values of peak VO2 are included, and a suggested template of a CPX report is included. The use of CPX testing in the determination of prognosis in heart failure patients is included.

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