ATS Pulmonary Function Laboratory Manual

chapter  19

Resting Measurements

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Step Action 5. Blood Samples: Harvest arterial blood for analysis (e.g., blood gases and lactate) using appropriate tech- nique at rest and throughout exercise per laboratory procedure. 6. Other Assessments: Perform any additional tests (e.g., cardiac outputs) at rest per laboratory procedure.

Exercise Measurements

Step Action 1.

Start exercise using selected protocol.

2. Obtain 12-lead ECG and blood pressure at 1 to 2 minute intervals during exercise. Subjective measure- ments (e.g., RPE) are measured at rest and immediately post exercise. Perform ECG and blood pressure at the maximal work rate, if possible. 3. Encouragement may be needed with certain individuals to obtain a maximal effort. 4. Obtain arterial blood for analysis using appropriate technique throughout exercise per laboratory proce- dure. 5. Monitor and record exercise flow–volume loops with periodic inspiratory capacity maneuvers during exercise in order to properly position the exercise flow–volume loops within the resting maximal flow– volume loop. 6. At the termination of exercise ask the patient the reason for stopping the test (e.g., legs hurt, shortness of breath, or fatigue). This may assist in the determination of maximal effort and help the clinician under- stand the patient’s exercise limitations. Indications to terminate exercise are described in Patient Safety section.

Post Exercise Measurements

Step Action 1.

Cool down: Recovery should include a cool-down phase at a reduced work rate (e.g., unloaded pedal- ing) for 2 to 4 minutes, followed by 2 to 6 minutes of rest with ECG and symptom monitoring (20, 22). 2. ECG : 12-lead ECG should be monitored continuously for 10 minutes and recorded for 10 seconds every 2 minutes. This may not be necessary when the ECG is unremarkable during exercise. 3. Blood Pressure: Blood pressure should be measured every 1 to 2 minutes, as appropriate. 4. Discontinue Monitoring : Monitoring should continue for 6 to 8 minutes after exercise, or longer if the patient is symptomatic or if blood pressure, heart rate, or ST segment change have not returned to near pre-exercise values (13).

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