Sleen, B. van der (Bart-Jan) (2018) Exercise physiology in the Intensive Care Unit, breaking groundon uncharted territory: a prospective, observational study using respiratory gas analysis. thesis, Medicine.
Full text available on request.Abstract
Title: Exercise physiology in the Intensive Care Unit, breaking ground on uncharted territory; a prospective, observational, study using respiratory gas analysis. Background: Early exercise protocols are common in ICUs. However, little is known about what “early” and “exercise” entails and what the physiological response to early exercise is in critically ill patients. Different parameters from exercise physiology are already in clinical use but not in intensive care medicine. The aim of this study was to investigate the relevance of the VO2, VCO2 and VE, and their derived measures, in recovering critically ill patient during moderate exercise. Methods: Four research question were investigated. The COSMED Quark RMR was used to collect the data. Different observed, predicted and calculated measures were included. We assessed: (1a) in ventilated patients, the agreement between measured oxygen uptake efficiency slope (OUES) and predicted values, and (1b) the agreement between the OUES and calculated VO2max predictors; (2a) ventilatory efficiency and physiological dead space in patients and healthy subjects; (2b) and in ventilated patients, the agreement between ventilatory efficiency and prediction equations. Moreover, (3) in patients and healthy subjects, we assessed the agreement between the Enghoff-Bohr and a new non-invasive method for estimating physiological dead space. (4) Lastly, trends in variables over time were assessed in recovering patients. Results: (1) The agreement between all VO2 max predictors, including OUES, was poor. (2a) Ventilation was significantly less efficient in patients, compared to healthy subjects (p=0.005 and p=0.000); fractional dead space VD/VT differentiated best between the two groups (p=0.000). No agreement was found between (2b) ventilatory efficiency and predicted values and (3) between the two measures for estimating dead space ventilation. (4) No trends over time were seen. Discussion and conclusion: This study showed that the meaning of VO2, VCO2 and VE, and their derived measures, obtained from recovering ICU patients during moderate exercise, is uncharted territory. We found that ventilatory efficiency is decreased and dead space is increased in critically ill patients.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Oever, H.L.A. van den intensive care physician and Intensive Care Unit, Deventer Hospital |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:04 |
| Last Modified: | 25 Jun 2020 11:04 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2432 |
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