Intensive Care Unit, Deventer Hospital, Deventer, Netherlands.
Department of Rehabilitation, Deventer Hospital, Deventer, Netherlands.
Physiol Rep. 2022 Mar;10(5):e15213. doi: 10.14814/phy2.15213.
Nine-panel plots are standard displays of cardiopulmonary exercise data, used in cardiac and pulmonary medicine to investigate the nature of exercise limitation. We explored whether this approach could be used to analyze the data of critically ill patients on mechanical ventilation, capable of exercising actively. Patients followed an incremental exercise protocol using a bedside cycle ergometer. Respiratory gases were analyzed using indirect calorimetry, and blood gases were sampled from arterial catheters. Data of seven patients were combined into nine-panel plots. Systematic analysis clarified the nature of exercise limitation in six cases. Resting metabolic rate was increased in all patients, with a median oxygen uptake ( ) of 5.52 (IQR 4.29-6.31) ml/kg/min. Unloaded cycling increased the by 19.8% to 6.61 (IQR 5.99-7.08) ml/kg/min. Adding load to the ergometer increased the by another 20.0% to reach at a median of 7.14 (IQR 6.67-10.75) ml/kg/min, corresponding to a median extrinsic workload of 7 W. This was accompanied by increased CO production, respiratory minute volume, heart rate, and oxygen pulse. Three patients increased their to >40% of predicted , two patients passed the anaerobic threshold. Dead space ventilation was 44%, decreasing to 42% and accompanied by lower ventilatory equivalents during exercise. Exercise produced no net change in alveolo-arterial PO difference. We concluded that diagnostic ergometry in mechanically ventilated patients was feasible. Analysis of the data as nine-panel plots provided insight into individual limitations to exercise.
九面板图是心肺运动数据的标准显示方式，用于心脏和肺部医学研究运动受限的性质。我们探讨了这种方法是否可以用于分析接受机械通气的重症患者的运动数据，这些患者能够积极运动。患者使用床边功率自行车进行递增运动试验。通过间接热量测定法分析呼吸气体，从动脉导管采集血气样本。将七名患者的数据合并为九面板图。系统分析澄清了六例患者运动受限的性质。所有患者的静息代谢率均升高，中位摄氧量（ ）为 5.52（IQR 4.29-6.31）ml/kg/min。无负荷自行车运动使 增加 19.8%，达到 6.61（IQR 5.99-7.08）ml/kg/min。向功率自行车增加负荷使 再增加 20.0%，达到中位数 7.14（IQR 6.67-10.75）ml/kg/min，对应中位外做功 7 W。这伴随着 CO 生成、呼吸分钟通气量、心率和氧脉搏的增加。三名患者的 增加到>40%预测值，两名患者通过了无氧阈。死腔通气率为 44%，运动时降至 42%，并伴有较低的通气当量。运动对肺泡动脉 PO 差没有产生净变化。我们得出结论，诊断性测功在机械通气患者中是可行的。将数据作为九面板图进行分析，深入了解了运动受限的个体情况。
