Cardiopulmonary Performance Research Articles

Abstract 11546: The Potential Beneficial Effects of Dyad Training on Medical Students’ Cardiopulmonary Resuscitation Performance

Introduction: Dyad training, which entails cooperative learning in pairs, has shown to improve student learning experiences. Cardiopulmonary resuscitation (CPR) is a team effort during which team members must cooperate to perform various tasks at the same time. Whether or not dyadic training—training two teams together—is beneficial for CPR education and simulations is still unknown. Hypothesis: Dyadic training is beneficial for CPR training. Methods: We enrolled 267 medical students (164 male and 103 female) in the study. We provided these students with a 2-hour training session on CPR for simulated cardiac arrest. Student teams were split into double groups (Dyad training groups: Groups A and B) or Single Groups. All groups received two CPR simulation rounds. CPR simulation training began with peer demonstration for Group A, and peer observation for Group B. Then the two groups switched roles. Single Groups completed CPR simulation without peer observation or demonstration. Teams were then evaluated based on leadership, teamwork, and team member skills. Results: Group B had the highest first simulation round scores overall (P= 0.004) and in teamwork (P= 0.001) and team member skills (P= 0.031). Group B also had the highest second simulation round scores overall (P< 0.001) and in leadership (P= 0.033), teamwork (P< 0.001) and team member skills (P< 0.001). In the first simulation, there were no differences between Dyad training groups with those of Single Groups in overall scores, leadership scores, teamwork scores, and team member scores. In the second simulation, Dyad training groups scored higher in overall scores (P= 0.002), leadership scores (P= 0.044), teamwork scores (P= 0.005), and team member scores (P= 0.008). Dyad training groups also displayed higher improvement in overall scores (P= 0.010) and team member scores (P= 0.022). Conclusions: Dyad training was effective for CPR training. Both peer observation and demonstration for peers in dyad training can improve student resuscitation performance.

Test-retest reliability and four-week changes in cardiopulmonary fitness in stroke patients: evaluation using a robotics-assisted tilt table.

BackgroundExercise testing devices for evaluating cardiopulmonary fitness in patients with severe disability after stroke are lacking, but we have adapted a robotics-assisted tilt table (RATT) for cardiopulmonary exercise testing (CPET). Using the RATT in a sample of patients after stroke, this study aimed to investigate test-retest reliability and repeatability of CPET and to prospectively investigate changes in cardiopulmonary outcomes over a period of four weeks.MethodsStroke patients with all degrees of disability underwent 3 separate CPET sessions: 2 tests at baseline (TB1 and TB2) and 1 test at follow up (TF). TB1 and TB2 were at least 24 h apart. TB2 and TF were 4 weeks apart. A RATT equipped with force sensors in the thigh cuffs, a work rate estimation algorithm and a real-time visual feedback system was used to guide the patients’ exercise work rate during CPET. Test-retest reliability and repeatability of CPET variables were analysed using paired t-tests, the intraclass correlation coefficient (ICC), the coefficient of variation (CoV), and Bland and Altman limits of agreement. Changes in cardiopulmonary fitness during four weeks were analysed using paired t-tests.ResultsSeventeen sub-acute and chronic stroke patients (age 62.7 ± 10.4 years [mean ± SD]; 8 females) completed the test sessions. The median time post stroke was 350 days. There were 4 severely disabled, 1 moderately disabled and 12 mildly disabled patients. For test-retest, there were no statistically significant differences between TB1 and TB2 for most CPET variables. Peak oxygen uptake, peak heart rate, peak work rate and oxygen uptake at the ventilatory anaerobic threshold (VAT) and respiratory compensation point (RCP) showed good to excellent test-retest reliability (ICC 0.65–0.94). For all CPET variables, CoV was 4.1–14.5 %. The mean difference was close to zero in most of the CPET variables. There were no significant changes in most cardiopulmonary performance parameters during the 4-week period (TB2 vs TF).ConclusionsThese findings provide the first evidence of test-retest reliability and repeatability of the principal CPET variables using the novel RATT system and testing methodology, and high success rates in identification of VAT and RCP: good to excellent test-retest reliability and repeatability were found for all submaximal and maximal CPET variables. Reliability and repeatability of the main CPET parameters in stroke patients on the RATT were comparable to previous findings in stroke patients using standard exercise testing devices. The RATT has potential to be used as an alternative exercise testing device in patients who have limitations for use of standard exercise testing devices.

Randomized clinical trial: benefits of aerobic physical activity for 24 weeks in postmenopausal women with nonalcoholic fatty liver disease.

The aim of the study was to evaluate the effectiveness of aerobic physical activity in reducing the frequency of hepatic steatosis and metabolic and cardiovascular risk in postmenopausal women with nonalcoholic fatty liver disease (NAFLD). Forty sedentary postmenopausal women (mean age 55.3 ± 8.0 y) with biopsy-proven NAFLD were randomly divided into two groups: an exercising group (19 participants) and a control group (nonexercising, 21 participants). The exercise group underwent a supervised aerobic physical activity program of 120 min/wk for 24 weeks. The anthropometric parameters; body composition; hepatic, lipid, and glycemic profiles; homeostasis model assessment of insulin resistance index; cytokines; transient elastography (FibroScan; liver stiffness/controlled attenuation parameter); and cardiopulmonary exercise test were evaluated at baseline and after 24 weeks of protocol. At baseline there were no significant differences in anthropometric, metabolic, and inflammatory parameters-stiffness and liver fat content by FibroScan between the groups. After 24 weeks, we observed a decrease of waist circumference, an increase of high-density lipoprotein cholesterol levels (P < 0.05), and improved cardiopulmonary functional capacity in the exercise group. In addition, the controlled attenuation parameter analysis showed no significant decrease of hepatic steatosis in the exercise group. With regard to the systemic inflammation, there were, however, no significant differences in the cytokines between the groups. An aerobic physical activity program of 24 weeks in NAFLD postmenopausal women showed improvement in some variables such as waist circumference, high-density lipoprotein cholesterol, and cardiopulmonary performance that may be beneficial in improving cardiovascular risk factors in this population.

Development of a diagnostic feedback device to assess neonatal cardiopulmonary resuscitation chest compression performance.

Neonatal cardiopulmonary resuscitation (NCPR) is an important intervention to save the lives of newborns who suffer from cardiac and respiratory arrest. Despite its importance there is a dearth of NCPR research and no commercially available feedback device suitable for use during NCPR. The aim of this study is to develop a diagnostic feedback device in the form of a patch placed on the infant's chest. The diagnostic feedback patch measures both the compression depth and force during NCPR, while giving audio-visual feedback according to current NCPR guidelines. The patch was systematically evaluated by conducting a series of hardware validation tests to assess the depth, force and feedback performance. The average errors in the depth and force were found to be 10.8% and 12.4%, respectively, with maximal errors below 20.7% and 24.1%. These results along with positive outcome of the feedback test suggest that the device is reliable on a hardware level and is suitable for further evaluation in a clinical setting.

Cardiopulmonary exercise performance is reduced in congenital diaphragmatic hernia survivors.

Congenital diaphragmatic hernia (CDH) is associated with lung hypoplasia. CDH survivors may have pulmonary morbidity that can decrease cardiopulmonary exercise. We aimed to examine whether cardiopulmonary exercise testing (CPET) results differ in CDH survivors versus healthy age-matched controls and whether CPET results among CDH survivors differ according to self-reported daily activity. In one medical center in Croatia, CDH survivors-patients with surgically corrected CDH who were alive at age 5 years-were invited to participate in spirometry and CPET. Values were compared with those of controls matched 2:1 by age and sex for each CDH survivor aged 7 years or older. Among 27 CDH survivors aged 5-20 years, 13 (48%) had continued symptoms or spirometric evidence of pulmonary disease. Compared with controls (n = 44), survivors (n = 22) had lower peak oxygen consumption (V˙O2 mean [SD], 35.7 [6.9] vs. 45.3 [8.2] ml/kg per min; P < 0.001). At peak exercise, V˙O2/heart rate (P < 0.001), tidal volume (P = 0.005), and minute ventilation (P < 0.001) were lower in survivors, but the maximal respiratory rate was not different (P = 0.72). Among survivors, mean (SD) V˙O2peak (ml/kg per min) differed by self-reported activity level: athletic, 40.3 (5.0); normal, 35.8 (6.5); and sedentary, 32.1 (6.8) (by ANOVA, P = 0.10 across three groups and P = 0.04 athletic vs. sedentary). More than half of CDH survivors continue to have chronic pulmonary disease. CDH survivors had lower aerobic exercise capacity than controls. Self-reporting information on daily activities may identify CDH patients with low V˙O2max who may benefit from physical training. Pediatr Pulmonol. 2016;51:1320-1329. © 2016 Wiley Periodicals, Inc.

Klinefelter syndrome, cardiovascular system, and thromboembolic disease: review of literature and clinical perspectives.

Klinefelter syndrome (KS) is the most frequently occurring sex chromosomal aberration in males, with an incidence of about 1 in 500-700 newborns. Data acquired from large registry-based studies revealed an increase in mortality rates among KS patients when compared with mortality rates among the general population. Among all causes of death, metabolic, cardiovascular, and hemostatic complication seem to play a pivotal role. KS is associated, as are other chromosomal pathologies and genetic diseases, with cardiac congenital anomalies that contribute to the increase in mortality. The aim of the current study was to systematically review the relationships between KS and the cardiovascular system and hemostatic balance. In summary, patients with KS display an increased cardiovascular risk profile, characterized by increased prevalence of metabolic abnormalities including Diabetes mellitus (DM), dyslipidemia, and alterations in biomarkers of cardiovascular disease. KS does not, however, appear to be associated with arterial hypertension. Moreover, KS patients are characterized by subclinical abnormalities in left ventricular (LV) systolic and diastolic function and endothelial function, which, when associated with chronotropic incompetence may led to reduced cardiopulmonary performance. KS patients appear to be at a higher risk for cardiovascular disease, attributing to an increased risk of thromboembolic events with a high prevalence of recurrent venous ulcers, venous insufficiency, recurrent venous and arterial thromboembolism with higher risk of deep venous thrombosis or pulmonary embolism. It appears that cardiovascular involvement in KS is mainly due to chromosomal abnormalities rather than solely on low serum testosterone levels. On the basis of evidence acquisition and authors' own experience, a flowchart addressing the management of cardiovascular function and prognosis of KS patients has been developed for clinical use.

Comparison of instructor-led versus peer-led debriefing in nursing students.

Despite its widespread support, the most effective simulation-based debriefing method has little evidence to support its efficacy. In this study, we compared the effect of peer-led and instructor-led debriefing among nursing students. The study was conducted with a non-equivalent control group using a pretest-post-test design. A convenience sample of third-year nursing students was used for the study, where 65 students enrolled in a 2-week clinical placement rotation were randomly assigned to the instructor-led group or peer-led group. The quality of cardiopulmonary resuscitation skills, satisfaction with simulation, and quality of debriefing in the peer-led group were compared to those in the instructor-led group. Group differences at each testing interval were analyzed using independent t-test. Nursing students in the instructor-led debriefing group showed better subsequent cardiopulmonary resuscitation performance, more satisfaction with simulation experience, and higher debriefing scores compared to the peer-led group. From our study, instructor-led debriefing is an effective method in improving skills performance, inducing favorable satisfaction, and providing better quality of debriefing among nursing students.

Abstract 15575: Can Rhythm Control by Catheter Ablation Improve Exercise Capacity in Asymptomatic Patients With Chronic Atrial Fibrillation?

Introduction: Radiofrequency catheter ablation (RFCA) for asymptomatic atrial fibrillation (AF) is not indicated due to limited data on it’s clinical efficacy. This study evaluated the change in oxygen kinetics and cardiopulmonary performance parameters after RFCA for asymptomatic (Canadian Cardiovascular Society-Severity of AF scores = 0) Chronic AF patients. Methods: A total of 57 patients with asymptomatic chronic AF (age 60 ± 9 year-old, 89.5% male, AF duration 51 ± 49 months) divided into 2 groups according to sinus rhythm conversion via RFCA: Group 1 (Rate control, n=32); Group 2 (Rhythm control, n=25). The patients who achieved sinus rhythm by antiarrhythmics (n=20) and cardioversion (n=4) were excluded. All underwent two times of treadmill cardiopulmonary exercise tests (modified Bruce protocol, Quark CPET®, COSMED, Italy) before and after each treatment (follow-up periods, 250 ± 181 days). Peak oxygen uptake (Peak VO2, ml/min/Kg) as aerobic capacity, O2-pulse at peak (ml/beat) for cardiovascular response, and the slope of the increase in ventilation to the increase in CO2 output (VE-VCO2 slope) for gas exchange were compared. Results: The Group 1 patients were older (62 ± 7 vs. 57 ± 10 year-old) and had longer duration of AF (63 ± 52 vs. 36 ± 39 months) than the Group 2 patients. The O2-pulse at peak were much increased in Group 2 during follow-up periods (Group 1, from 10.0 ± 3.1 to 10.6 ± 3.1, P=0.137; Group 2, 12.1 ± 3.8 to 15.4 ± 3.8, P=0.003). During exercise, maximal exercise heart rate was significantly lower in Group 2 after treatment (Group 1, 162±25 vs. Group 2, 128±29 bpm, P&lt;0.001). However, the value of Peak VO2 and VE-VCO2 slope were not different between before and after treatment, and between 2 groups. Conclusion: The results from the present study indicate that improvement of maximal aerobic capacity and exercise tolerance are negligible in asymptomatic patients with chronic AF following successful catheter ablation.

Usefulness of C-Reactive Protein Plasma Levels to Predict Exercise Intolerance in Patients With Chronic Systolic Heart Failure

Patients with heart failure (HF) have evidence of chronic systemic inflammation. Whether inflammation contributes to the exercise intolerance in patients with HF is, however, not well established. We hypothesized that the levels of C-reactive protein (CRP), an established inflammatory biomarker, predict impaired cardiopulmonary exercise performance, in patients with chronic systolic HF. We measured CRP using high-sensitivity particle-enhanced immunonephelometry in 16 patients with ischemic heart disease (previous myocardial infarction) and chronic systolic HF, defined as a left ventricular ejection fraction ≤ 50% and New York Heart Association class II-III symptoms. All subjects with CRP >2 mg/L, reflecting systemic inflammation, underwent cardiopulmonary exercise testing using a symptom-limited ramp protocol. CRP levels predicted shorter exercise times (R = -0.65, p = 0.006), lower oxygen consumption (VO2) at the anaerobic threshold (R = -0.66, p = 0.005), and lower peak VO2 (R = -0.70, p = 0.002), reflecting worse cardiovascular performance. CRP levels also significantly correlated with an elevated ventilation/carbon dioxide production slope (R = +0.64, p = 0.008), a reduced oxygen uptake efficiency slope (R = -0.55, p = 0.026), and reduced end-tidal CO2 level at rest and with exercise (R = -0.759, p = 0.001 and R = -0.739, p = 0.001, respectively), reflecting impaired gas exchange. In conclusion, the intensity of systemic inflammation, measured as CRP plasma levels, is associated with cardiopulmonary exercise performance, in patients with ischemic heart disease and chronic systolic HF. These data provide the rationale for targeted anti-inflammatory treatments in HF.

Sympathetic autonomic dysfunction and impaired cardiovascular performance in higher risk surgical patients: implications for perioperative sympatholysis

ObjectiveRecent perioperative trials have highlighted the urgent need for a better understanding of why sympatholytic drugs intended to reduce myocardial injury are paradoxically associated with harm (stroke, myocardial infarction). We...

Decreased tidal volume may limit cardiopulmonary performance during exercise in subacute stroke.

The aim of this retrospective study was to determine whether pulmonary function was reduced at submaximal and peak exercise in subacute stroke (SG) when compared with sedentary adults (CON). Ten individuals with subacute stroke and 10 sedentary, age- and gender-matched adults performed cardiopulmonary exercise testing (CPET), using a recumbent stepper. We used independent t tests to determine between-group differences at peak effort. We used repeated-measures analysis of variance with Test Minute (minutes 1-6) as the within-subject factor and Group (SG, CON) as the between-subject factor to assess cardiopulmonary submaximal performance. The SG had significantly lower values (P < .05) for oxygen uptake, minute ventilation ((Equation is included in full-text article.)E), and tidal volume (VT) than CON at peak effort of the CPET. During CPET submaximal effort, we report a significant main effect for Test Minute and Group for VT and respiratory rate but no main effect of Group for (Equation is included in full-text article.)E. To maintain adequate (Equation is included in full-text article.)E during submaximal effort and decreased VT, higher respiratory rate was observed. These results suggest that diminished VT in subacute stroke patients may limit performance during submaximal and peak effort of CPET. Rehabilitation professionals should consider methods for improving pulmonary function during stroke rehabilitation.

Muscle Metabolic Responses During Dynamic In-Magnet Exercise Testing: A Pilot Study in Children with an Idiopathic Inflammatory Myopathy

The clinical utility of supine in-magnet bicycling in combination with phosphorus magnetic resonance spectroscopy ((31)P MRS) to evaluate quadriceps muscle metabolism was examined in four children with juvenile dermatomyositis (JDM) in remission and healthy age- and gender-matched controls. Two identical maximal supine bicycling tests were performed using a magnetic resonance-compatible ergometer. During the first test, cardiopulmonary performance was established in the exercise laboratory. During the second test, quadriceps energy balance and acid/base balance during incremental exercise and phosphocreatine recovery were determined using (31)P MRS. During the first test, no significant differences were found between patients with JDM and their healthy peers regarding cardiopulmonary performance. The outcomes of the first test indicate that both groups attained maximal performance. During the second test, quadriceps phosphocreatine and pH time courses were similar in all but one patient experiencing idiopathic postexercise pain. This patient demonstrated faster phosphocreatine depletion and acidification during exercise, yet postexercise mitochondrial adenosine triphosphate synthesis rate measured by phosphocreatine recovery kinetics was approximately twofold faster than control (time constant 23 seconds vs 43 ± 7 seconds, respectively). These results highlight the utility of in-magnet cycle ergometry in combination with (31)P MRS to assess and monitor muscle energetic patterns in pediatric patients with inflammatory myopathies.

Efficacy of Feedback-Controlled Robotics-Assisted Treadmill Exercise to Improve Cardiovascular Fitness Early After Stroke: A Randomized Controlled Pilot Trial.

Cardiovascular fitness is greatly reduced after stroke. Although individuals with mild to moderate impairments benefit from conventional cardiovascular exercise interventions, there is a lack of effective approaches for persons with severely impaired physical function. This randomized controlled pilot trial investigated efficacy and feasibility of feedback-controlled robotics-assisted treadmill exercise (FC-RATE) for cardiovascular rehabilitation in persons with severe impairments early after stroke. Twenty individuals (age 61 ± 11 years; 52 ± 31 days poststroke) with severe motor limitations (Functional Ambulation Classification 0-2) were recruited for FC-RATE or conventional robotics-assisted treadmill exercise (RATE) (4 weeks, 3 × 30-minute sessions/wk). Outcome measures focused on peak cardiopulmonary performance parameters, training intensity, and feasibility, with examiners blinded to allocation. All 14 allocated participants (70% of recruited) completed the intervention (7/group, withdrawals unrelated to intervention), without serious adverse events occurring. Cardiovascular fitness increased significantly in both groups, with peak oxygen uptake increasing from 14.6 to 17.7 mL · kg · min (+17.8%) after 4 weeks (45.8%-55.7% of predicted maximal aerobic capacity; time effect P = 0.01; no group-time interaction). Training intensity (% heart rate reserve) was significantly higher for FC-RATE (40% ± 3%) than for conventional RATE (14% ± 2%) (P = 0.001). Substantive overall increases in the main cardiopulmonary performance parameters were observed, but there were no significant between-group differences when comparing FC-RATE and conventional RATE. Feedback-controlled robotics-assisted treadmill exercise significantly increased exercise intensity, but recommended intensity levels for cardiovascular training were not consistently achieved. Future research should focus on appropriate algorithms within advanced robotic systems to promote optimal cardiovascular stress.Video abstract available for more insights from the authors (Supplemental Digital Content 1, http://links.lww.com/JNPT/A107).

93 Does Intervention of Severe Valve Lesions always Improve Cardiac Function?

<h3>Introduction</h3> Severe valve lesions can result in cardiac decompensation. This study investigated the effects of surgical valvular intervention upon cardiac function assessed as peak cardiac power output (CPO_max) generation during exercise. We hypothesised that (i) cardiac function improves after valvular intervention, and (ii) those with subnormal pre-operative cardiac reserve indicative of cardiac decompensation would gain less physical and cardiac functional benefits than those with preserved pre-operative cardiac function. <h3>Methods</h3> We compared the cardiopulmonary exercise performance and non-invasive haemodynamics of 46 consecutive patients with severe valvular disease before and after valvular intervention with reference to 101 healthy male and 139 female controls without cardiovascular disease. Cardiac and physical functional reserves were measured with standard respiratory gas analyses and CO₂ rebreathing to measure peak cardiac output and quantify peak cardiac power output (CPO_max) non-invasively during treadmill exercise. Data are given as mean±SD and statistical significance accepted at <i>P &lt; 0</i>.05. <h3>Results</h3> The patient cohort showed no overall benefit from valvular intervention (pre-operative CPO_max 3.48 ± 1.27W, post-operative CPO_max 3.60 ± 0.96W, P = 0.42, <i>n = 4</i>6). However, this comprised opposing effects upon two subgroups distinguished by a pre-operative CPO_max below (LoW subgroup) or within (HiW subgroup) the normal range defined by the control population. Thus, in the LoW subgroup CPO_max<i>increased</i> with valvular intervention from 2.63 ± 0.67 to 3.42 ± 0.98W (P = 0.000014; <i>n = 2</i>6), NYHA class improved (from 2.29 ± 0.75 to 1.65 ± 0.75, P = 0.0004), peak oxygen consumption (VO_2max) increased (from 1.38 ± 0.55 to 1.56 ± 0.59 l.min^-1, P = 0.002), and peak flow- and cardiac pressure-generating capacities increased. In contrast, in the HiW subgroup, CPO_max<i>decreased</i> from 4.58 ± 0.96 to 3.84 ± 0.92W following intervention (P = 0.00026; <i>n = 2</i>0). NYHA classification remained unchanged, VO_2max decreased (from 2.29 ± 0.72 to 1.97 ± 0.75 l.min^-1, P = 0.005) and peak cardiac flow- and pressure-generating capacities significantly decreased (all P &lt; 0.05) after valve intervention. <h3>Conclusions</h3> This is the first investigation of the effects of surgical intervention upon non-invasively measured CPO_max during exercise in patients with severe valvular disease. It unexpectedly demonstrates that valvular interventions performed in routine clinical practice do not consistently improve cardiac function. Patients with subnormal pre-operative cardiac functional reserve benefited from intervention, with significantly improved cardiac and physical fitness. Patients with normal pre-operative cardiac functional reserve generally showed decreased cardiac and physical fitness.

Interaction of sodium bicarbonate and Na+/H+ exchanger inhibition in the treatment of acute metabolic acidosis in pigs.

Administration of NaHCO3 does not improve cellular function or reduce the mortality of acute lactic acidosis. This might be related to aggravation of intracellular acidosis, but it could also be due to activation of Na+/H+ exchanger with a deleterious increment in intracellular calcium ([Ca2+]i). This study examined the impact of coadministration of NaHCO3 and a selective inhibitor of Na+/H+ exchanger, sabiporide on cardiovascular function, changes in proinflammatory cytokines, and organ function in a model of acute lactic acidosis produced by hemorrhagic hypotension followed by infusion of lactic acid. Experimental, prospective study. Medical Center research laboratory. Male Yorkshire pigs. Anesthetized pigs were subjected to hypovolemia for 30 minutes and followed by DL-lactic acid infusion, and then either saline or sodium bicarbonate was infused. Hypovolemia followed by a DL-lactic acid infusion resulted in severe acidemia with a blood pH~6.8. Administration of NaHCO3 did not improve cardiovascular performance or decrease the levels of proinflammatory responses, whereas administration of sabiporide prior to acid or NaHCO3 infusion improved cardiopulmonary performance and blood oxygenation, reduced nuclear factor-κB activation, neutrophil accumulation, and proinflammatory cytokine production, and attenuated organ injury. Exposure of rat cardiac myocytes to a pH of 7.2 led to a marked increase of [Ca2+]i, and release of lactate dehydrogenase from cells which were further augmented after increase in external pH by addition of NaHCO3. Both the increase in [Ca2+]i and release of lactate dehydrogenase were attenuated in the presence of sabiporide. Coadministration of Na/H exchanger inhibitor with sodium bicarbonate improves cardiovascular performances, reduces proinflammatory responses, and attenuates organ injury. This improvement in these variables appears to be related to prevention of a rise in intracellular calcium occurring after both exposures to acid and bicarbonate.

Comparison of Clinical Characteristics of Intentional vs Accidental Drowning Patients

PurposesDrowning may happen by accident or as a method of committing suicide. The aim of this study was to determine some characteristics of drowning patients who committed intentionally. MethodsA retrospective review was performed on 462 patients who visited the emergency department complaining of drowning between January 1998 and October 2011. Of these patients, we only included the patients for whom the cause could be identified. Age, sex, cause, time of drowning, season, mechanism, cardiopulmonary resuscitation performance, body temperature, alcohol ingestion, history of previous suicide attempts, outcome, and other characteristics were collected. ResultsA total of 380 patients were included. Among them, 282 (74.2%) had drowned themselves intentionally, and they were older than those who had drowned accidentally (median age, 35.0 years [25.0-49.0 years] vs 26.5 years [19.0-35.5 years], P < .001) and showed lower body temperature (below 34°C, 32.1% vs 12.2%, P = .027). Ninety-four cases (33.3%) jumped off the river from a bridge, and 185 (65.6%) walked into the river from the riverside. In the intentional group, 59 (20.9%) had depressive disorder in their history. The rate of death showed no clinical difference (19.5% vs 16.3%, P = .487), but more males died in the accidental group (61.8% vs 93.8%, P = .015). ConclusionsIntentional drowning happened more in older subjects and presented lower initial body temperature. Walking from the riverside happened more often than jumping off a bridge. More males died of drowning regardless of intentionality.

Comparison of peak cardiopulmonary performance parameters on a robotics-assisted tilt table, a cycle and a treadmill.

Robotics-assisted tilt table (RATT) technology provides body support, cyclical stepping movement and physiological loading. This technology can potentially be used to facilitate the estimation of peak cardiopulmonary performance parameters in patients who have neurological or other problems that may preclude testing on a treadmill or cycle ergometer. The aim of the study was to compare the magnitude of peak cardiopulmonary performance parameters including peak oxygen uptake (VO2peak) and peak heart rate (HRpeak) obtained from a robotics-assisted tilt table (RATT), a cycle ergometer and a treadmill. The strength of correlations between the three devices, test-retest reliability and repeatability were also assessed. Eighteen healthy subjects performed six maximal exercise tests, with two tests on each of the three exercise modalities. Data from the second tests were used for the comparative and correlation analyses. For nine subjects, test-retest reliability and repeatability of VO2peak and HRpeak were assessed. Absolute VO2peak from the RATT, the cycle ergometer and the treadmill was (mean (SD)) 2.2 (0.56), 2.8 (0.80) and 3.2 (0.87) L/min, respectively (p < 0.001). HRpeak from the RATT, the cycle ergometer and the treadmill was 168 (9.5), 179 (7.9) and 184 (6.9) beats/min, respectively (p < 0.001). VO2peak and HRpeak from the RATT vs the cycle ergometer and the RATT vs the treadmill showed strong correlations. Test-retest reliability and repeatability were high for VO2peak and HRpeak for all devices. The results demonstrate that the RATT is a valid and reliable device for exercise testing. There is potential for the RATT to be used in severely impaired subjects who cannot use the standard modalities.

Impacts of valve intervention on the Functional REServe of the Heart: The FRESH-valve pilot study

PurposeSevere valve lesions require corrective interventions to avoid progression to heart failure (HF) and premature demise. We tested the hypothesis that despite operative risks, corrective valvular interventions will lead to significant improvements in overall cardiac pump function, especially before the onset of cardiac decompensation. MethodsWe compared the cardiopulmonary exercise performance and non-invasive haemodynamics of 46 consecutive patients with severe valvular disease before and after valvular intervention with reference to 101 healthy male and 139 female controls without cardiovascular disease. Cardiac and physical functional reserves were measured with standard respiratory gas analyses and CO2 rebreathing to measure cardiac output non-invasively during peak treadmill exercise. Data are given as mean±SD and statistical significance accepted at P<0.05. ResultsThe entire patient cohort showed no significant improvement in peak O2 consumption (V˙O2max, P=0.74) or in peak cardiac power (CPOmax, P=0.34) after valvular intervention, but we found instead a dichotomous outcome depending on preoperative cardiac function: (i) the pre-operative cardiac decompensatory subgroup (LoW, n=26) showed increased CPOmax (2.63±0.67 to 3.42±0.98W, P<0.0001) and V˙O2max (1.38±0.55 to 1.56±0.59L·min−1, P<0.01); and (ii) the pre-operative non-decompensatory subgroup (HiW) showed reduced CPOmax (4.58±0.96 to 3.84±0.92W, P<0.001) and V˙O2max (2.29±0.72 to 1.97±0.75L·min−1, P<0.01). Changes in NYHA class were found to be discrepant with these objective measurements. ConclusionThis investigation found an unexpected finding that valvular interventions performed in routine clinical practice do not consistently improve cardiac function, especially in those without pre-operative cardiac decompensation. Assessing cardiac functional gains would open up new avenues for future trials of valvular interventions.

The role of physical activity in the treatment of erectile dysfunction

ObjectiveTo compare the effect of phosphodiesterase inhibitors and physical exercise alone in patients with erectile dysfunction (ED). Materials and methodsA total of 60 patients with a satisfactory cardiopulmonary performance who consulted the outpatient clinics of Urology and Physical Therapy and Rehabilitation were included in the prospective study. In the study, 30 patients were scheduled for 6 weeks of vigorous aerobic exercise program to be carried out for 75min a day, 3 days a week. The remaining 30 patients received only an oral form of a phosphodiesterase inhibitor. All patients completed International Index of Erectile Function (IIEF) and quality of life (SF-36) forms before and after the treatment. ResultsMedian age of the patients was 55.63±12.93 years with body mass index ranging between 18.99 and 35.86kg/m2. A statistically significant increase has been observed for IIEF-5 and SF-36 scores both in the physical exercise and medical treatment groups. However, in the medical treatment group post-treatment variation in IIEF-5 and SF-36 mental scores in the medical treatment group were statistically significantly higher when compared with the physical exercise group. Increase in physical SF-36 scores in the physical exercise group was more prominent without any statistically significant difference between groups. ConclusionEmerging evidence indicates that exercise has a positive effect for improving many factors in men with erectile dysfunction including changes in body composition, physical function, risk of comorbid conditions, depression, quality of life and an increase in pelvic oxygenation and penile blood flow, and thus before or during the treatment with a phosphodiesterase inhibitor, regular physical activity should be recommend for all ED patients.

Is low [formula omitted]O2max/kg in obese heart failure patients indicative of cardiac dysfunction?

PurposeLow peak O2 consumption (V˙O2max/kg) has been widely used as an indirect indicator of poor cardiac fitness, and often guides management of patients with severe heart failure (HF). We hypothesized that it should be as good an indicator of cardiac dysfunction in obese and non-obese HF patients. MethodsWe compared the cardiopulmonary exercise performance and non-invasive hemodynamics of 152 obese (BMI>34kg.m−2) and 173 non-obese (BMI≤32) male HF patients in NYHA classes II and III, with reference to 101 healthy male controls. Their physical and cardiac functional reserves were measured during treadmill exercise testing with standard respiratory gas analyses and CO2 rebreathing to measure cardiac output non-invasively during peak exercise. Data are given as mean±SD. ResultsObese HF patients with BMI 40.9±7.5kg·m−2 (age 56.1±14.0years, NYHA 2.5±0.5) exercised to acceptable cardiopulmonary limits (peak RER=1.07±0.12), and achieved a mean V˙O2max/kg of 18.6±5.2ml·kg−1·min−1, significantly lower than in non-obese HF counterparts (19.9±5.6ml·kg−1·min−1, P=0.02, age 55.8±10.6years, BMI 26.6±3.1, NYHA 2.4±0.5, peak RER=1.07±0.09), with both lower than controls (38.5±9.7ml·kg−1·min−1, P<10−6). In contrast, the uncorrected V˙O2max was higher in obese (2.31±0.69ml·min−1) than non-obese HF patients (1.61±0.49ml·min−1, P<10−6). When cardiac dysfunction was evaluated directly, peak cardiac power was significantly greater in obese than non-obese HF patients (4.11±1.21W vs 2.73±0.82W, P<10−6), with both lower than controls (5.42±1.04W, P<10−6). ConclusionThese results demonstrate that V˙O2max/kg is not a generally reliable indicator of cardiac fitness in all patients. Instead, we found that despite having lower V˙O2max/kg, obese HF patients had stronger hearts capable of generating greater cardiac power than non-obese HF patients of equivalent clinical HF status.