1. . Exercise testing in survivors of intensive care— is there a role for cardiopulmonary exercise training? Benington S, McWilliams D, Eddleston J, Atkinson D. Exercise testing in survivors of intensive care- is there a role for cardiopulmonary exercise training? Critical Care. 2012; 40: 89-94. ParametersPost Test Measurements Peak VO256% + 16% predicted AT41% + 13% of peak predicted VO2 HRR at peak exercise25% + 14% BR at peak exercise47 + 19% EqCO239 + 9 Mean oxygen pulse8.6 + 2.5 mL per beat Mean time from hospital discharge to CPET 24 + 14 days Abstract The aim of this study was to see the role for cardiopulmonary exercise testing in survivors of intensive care. Background/Introduction Little published evidence on optimal physical rehabilitation for survivors of critical illnesses once they leave the hospital A common assessment tool used is the 6-minute walk test (6MWT); however this test does not indicate what contributes to a patient’s exercise limitations By using cardiopulmonary exercise testing (CPET), information may be collected that can indicate whether there are cardiac, respiratory, or musculoskeletal contributions to any present limitation. Purpose To determine the feasibility of cardiopulmonary exercise testing (CPET) for the early assessment of cardiorespiratory fitness in general adult intensive care unit (ICU) survivors and to characterize the pathophysiology of exercise limitation in this population. Article #1 and Evidence Smith T.B., Stonell C, Purkayastha S, Parakevas P. Cardiopulmonary exercise testing as a risk assessment method in non cardio-pulmonary surgery: a systematic review. Anaesthesia. 2009; 64: 883-893. This study supported the original article and looked at the validity of CPET. This study was slightly different from the original article because it looked at CPET as a useful predictor of post-operative complications. The study found CPET to be valid in a pre-operative population. Article #2 and Evidence Ong K-C, Ng A. W-K, Lee L. S-U, et al. Pulmonary function and exercise capacity in survivors of severe acute respiratory syndrome. European Respiratory Journal. 2004; 24: 436-442 This study also supported the original article; it investigated pulmonary function and exercise capacity in SARS (severe acute respiratory system) survivors. The results showed how important it is to perform CPET in critically ill patients. It was found that CPET is better than pulmonary function tests in understanding the multiple factors of an illness—such as pulmonary mechanics, cardiac and peripheral muscle factors. Summary All three articles show that the use of CPET is valid. CPET is useful pre- operatively in determining post- operative complications; it is also useful post-operatively in helping to understand the multiple factors causing a patient’s exercise limitations and to help in creating a rehabilitation treatment plan. All three studies agreed that further research needs to be conducted to further understand the benefits of CPET with this type of population. Presented by: Rebecca Porter DPT student at Bellarmine University Louisville, KY Methods and Materials N = 50 survivors Participants were all ventilated for at least 5 days Exclusion criteria: Younger than 18 years old Ventilated for less than 5 days Unable to perform CPET because of physical or mental impairments, pregnancy, terminal illness, and acute coronary syndrome within the previous thirty days The CPET intervention consisted of patients riding on a bicycle ergometer and had the following measurements taken: Anaerobic threshold (AT) Peak VO2 Ventilator equivalents for CO2 (EqCO2) Oxygen pulse Heart rate reserve (HRR) Breathing reserve at peak exercise and static spirometry The study also used the Medical Outcome Study Short Form 36 (SF-36) to assess the patient’s quality of life. Discussion During cardiopulmonary exercise testing, no adverse events occurred. Limitations: Tested only 41% of eligible discharged patients Could also have a “healthy volunteer” effect or an “unhealthy volunteer” effect Lack of accurate premorbid functional capacity and HRQL data. Conclusion The CPET is valid In helping to specify whether there are cardiac, respiratory, or musculoskeletal contributions to a patient’s exercise limitations. The study showed that the tests are safe to perform on this patient population. Clinical Significance This study was significant for physical therapy because it looked into the practicality of using CPET with ICU survivors. It assessed if CPET could help determine the causes of patients’ exercise limitations. Performing CPET on ICU survivors can help physical therapists in forming a rehabilitation program for these patients. This rehabilitation program will be able to address each of the patient’s specific impairments that are causing their exercise limitations. Results There was no significant correlation between exercise capacity and the SF- 36v2 See table for measurement results: