ATS Pulmonary Function Laboratory Manual

chapter  19

5. Pre-heparinized (dry heparin) syringes for arterial blood gas (ABG) harvesting 6. Appropriate standard precaution (SP) attire and gloves for technicians 7. Gas analyzers (O 2 and CO 2 ) Modern CPET systems contain rapidly responding O 2 and CO 2 sensors that allow for the calculation of oxygen uptake and carbon dioxide output at rest, during exercise, and during recovery, as frequently as breath by breath. Although manufacturers’ recommendations vary considerably regarding calibration, all CPET systems should be calibrated immediately before each exercise test (22). 8. A flow measurement device (e.g., pneumotachograph, mass flow sensor, pitot tube, or turbine) are included in CPET systems to measure ventilated volume. Some systems include directional valves and tubing as well. All flow measurement devices should be validated before testing by assuring a stable zero flow signal, and by using a known-volume calibration syringe. 9. Data-acquisition computer, monitor, and keyboard 10. Resuscitation cart (20, 23) 10.1. Airway management equipment 10.2. Defibrillator 10.3. Airway suction apparatus, tubing and disposable ends 10.4. Emergency medications (e.g., epinephrine, lidocaine, and nitroglycerine) 11. Supplemental O 2 equipment and delivery systems 12. Pulse oximeter with appropriate probes 13. Chart displaying the ratings of perceived exertion (RPE) scale (24) or visual analog scale (VAS) (25) 14. Other optional tests require specific equipment 14.1. Cardiac output determination using either CO 2 equilibration or foreign gas uptake techniques 14.2. Spirometer for flow–volume curves before, during, and after exercise 15. Barometer (or other valid method to obtain barometric pressure) and accurate thermometer Loose-fitting and comfortable clothing and shoes suitable for exercise (3, 22, 23, 26) 1.2. The patient should abstain from smoking and from consuming alcohol at least 4 hours prior to test, and should not eat for 3 hours prior to test (3, 9, 10, 13, 16). 1.3. Typically, no medications are withheld prior to the CPET, however if testing is performed for the diagnosis of ischemia, some medications (beta-blockers) may be held if they attenuate heart rate and blood pressure responses to exercise. All medications taken on day of test should be recorded. 2. The patient should receive a detailed description of the exercise procedure and purpose of the test (13, 20). Protocols for maximal cardiopulmonary exercise testing generally include an initial warm-up period (no or low workload), followed by progressive graded exercise with increasing workloads, and a post exercise period at no or low workload (13). 3. Obtain informed consent (if applicable in the institution) by personnel who can accurately describe the test and potential risks, and have it witnessed (3, 20, 23). Patient Preparation (Pre-Test Instructions) 1. Patient instructions 1.1.

215