Cardiopulmonary exercise testing, prehabilitation, and Enhanced Recovery After Surgery (ERAS)

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• 作者：Denny Z. H. Levett PhD (1) (2) (3)
  Michael P. W. Grocott MBBS ; MD (1) (2) (3) (4)
  
  1. Integrative Physiology and Critical Illness Group ; Clinical and Experimental Sciences ; Faculty of Medicine ; University of Southampton ; University Road ; Southampton ; UK
  2. Critical Care Research Area ; Southampton NIHR Respiratory Biomedical Research Unit ; Southampton ; UK
  3. Anaesthesia and Critical Care Research Unit ; University Hospital Southampton NHS Foundation Trust ; Southampton ; UK
  4. Professor of Anaesthesia and Critical Care Medicine ; University of Southampton ; Rm CE.93 ; Mailpoint 24 ; Southampton ; UK
  
• 刊名：Canadian Journal of Anesthesia/Journal canadien d'anesth¨|sie
• 出版年：2015
• 出版时间：February 2015
• 年：2015
• 卷：62
• 期：2
• 页码：131-142
• 全文大小：342 KB
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• 刊物主题：Anesthesiology; Pain Medicine; Intensive / Critical Care Medicine; Pneumology/Respiratory System; Cardiology; Pediatrics;
• 出版者：Springer US
• ISSN：1496-8975

文摘

Purpose This review evaluates the current and future role of cardiopulmonary exercise testing (CPET) in the context of Enhanced Recovery After Surgery (ERAS) programs. Principal findings There is substantial literature confirming the relationship between physical fitness and perioperative outcome in general. The few small studies in patients undergoing surgery within an ERAS program describe less fit individuals having a greater incidence of morbidity and mortality. There is evidence of increasing adoption of perioperative CPET, particularly in the UK. Although CPET-derived variables have been used to guide clinical decisions about choice of surgical procedure and level of perioperative care as well as to screen for uncommon comorbidities, the ability of CPET-derived variables to guide therapy and thereby improve outcome remains uncertain. Recent studies have reported a reduction in CPET-defined physical fitness following neoadjuvant therapies (chemo- and radio-therapy) prior to surgery. Preliminary data suggest that this effect may be associated with an adverse effect on clinical outcomes in less fit patients. Early reports suggest that CPET-derived variables can be used to guide the prescription of exercise training interventions and thereby improve physical fitness in patients prior to surgery (i.e., prehabilitation). The impact of such interventions on clinical outcomes remains uncertain. Conclusions Perioperative CPET is finding an increasing spectrum of roles, including risk evaluation, collaborative decision-making, personalized care, monitoring interventions, and guiding prescription of prehabilitation. These indications are potentially of importance to patients having surgery within an ERAS program, but there are currently few publications specific to CPET in the context of ERAS programs.