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Impact of Integrative Cardiopulmonary Exercise Testing (30)

Impact of Integrative Cardiopulmonary Exercise Testing (30)Second, there should be agreement on which variables should be interpreted and how much confidence can be placed on decisions made using these variables. Thus, predicted values and their limitations should be discussed. Finally, the advantages and limitations of invasive (arterial catheters and pulmonary artery catheters) studies should be contrasted with the information available from noninvasive testing (eg, gas exchange measurements and pulse oximetry). buy cheap antibiotics
Neuberg has recently raised several other important questions about the current and future use of integrative cardiopulmonary exercise testing, including the implications of results suggesting combinations of pulmonary and cardiovascular diseases, the relationship between exercise-induced symptoms and patterns of gas exchange abnormalities, and the lack of application of decision analysis to these measurements. Consistent methodology and results of prospective studies to answer these questions were suggested as necessary to expand the use of exercise testing. In Table 4, we suggest additional areas that should be addressed to establish further the utility and effectiveness of integrative cardiopulmonary exercise testing in clinical practice. It is likely that consensus conferences highlighting the current state of the art and the areas of current ambiguity in integrative cardiopulmonary exercise testing are needed.

Table 4—Standards for Integrative Cardiopulmonary Exercise Tests

Standards
What gas exchange variables should be measured?
What gas exchange variables should be calculated?
What methods are recommended for:
Ergometers and protocols
Flow/volume measurements
Expired gas analysis
Data sampling rates
Pulse oximeters
Arterial blood gases
Blood pressure
What are acceptable standards for accuracy and validation?
System performance standards
Manufacturers specifications
What are acceptable calibration and quality control standards?
What are the appropriate predicted normal values?
What should be included in the report?
Gas exchange data
Interpretation
What should be done with insufficient or inconclusive data?
What should be the standards for patient safety?
Personnel
Emergency equipment
Contraindications for exercise testing
Monitoring during exercise
What standards are needed for physicians who perform and interpret exercise tests?
What standards can be established for the training and qualifications for exercise technicians?
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