scholarly journals Ambulatory vital signs in the workup of pulmonary embolism using a standardized 3-minute walk test

CJEM ◽  
2015 ◽  
Vol 17 (3) ◽  
pp. 270-278
Author(s):  
Qamar Amin ◽  
Jeffrey J. Perry ◽  
Ian G. Stiell ◽  
Subhra Mohapatra ◽  
Abdulaziz Alsadoon ◽  
...  
Keyword(s):  
Heart Rate ◽  
Pulmonary Embolism ◽  
Oxygen Saturation ◽  
Tertiary Care ◽  
Heart Rate Change ◽  
Rate Change ◽  
Walk Test ◽  
Tertiary Care Centre ◽  
Absolute Decrease ◽  
Minute Walk

AbstractObjectiveDiagnosing pulmonary embolism can be difficult given its highly variable clinical presentation. Our objective was to determine whether a decrease in oxygen saturation or an increase in heart rate while ambulating could be used as an objective tool in the diagnosis of pulmonary embolism.MethodsThis was a two-site tertiary-care-centre prospective cohort study that enrolled adult emergency department or thrombosis clinic patients with suspected or newly confirmed pulmonary embolism. Patients were asked to participate in a standardized 3-minute walk test, which assessed ambulatory heart rate and ambulatory oxygen saturation. The primary outcome was pulmonary embolism.ResultsWe enrolled 114 patients, including 30 with pulmonary embolism (26.3%). A ≥2% absolute decrease in ambulatory oxygen saturation and an ambulatory change in heart rate >10 beats per minute (BPM) were significantly associated with pulmonary embolism. An ambulatory heart rate change of >10 BPM had a sensitivity of 96.6% (95% confidence interval [CI] 83.3 to 99.4) and a specificity of 31.0% (95% CI 22.1 to 45.0) for pulmonary embolism. A ≥2% absolute decrease ambulatory oxygen saturation had a sensitivity of 80.2% (95% CI 62.7 to 90.5) and a specificity of 39.3% (95% CI 29.5 to 50.0) for pulmonary embolism. The combination of both variables yielded a sensitivity of 100.0% (95% CI 87.0 to 100.0) and a specificity of 11.0% (95% CI 6.6 to 21.0).ConclusionIn summary, our study found that an ambulatory heart rate change of >10 BPM or a ≥2% absolute decrease in ambulatory oxygen saturation from baseline during a standardized 3-minute walk test are highly correlated with pulmonary embolism. Although the findings appear promising, neither of these variables can currently be recommended as a screening tool for pulmonary embolism until larger prospective studies examine their performance either alone or with pre-existing rules.

scholarly journals APLICABILIDADE DO TESTE DE CAMINHADA DE SEIS MINUTOS PARA QUANTIFICAR O DESEMPENHO CARDIOVASCULAR DO PACIENTE PÓS-INFARTO DO MIOCÁRDIO

2021 ◽  
Vol 10 (12) ◽  
pp. 1-25
Author(s):  
Jean Donizete Silveira TALIARI ◽  
Luana de Lima Fabres LEÃO ◽  
Mariana Arantes JUSTINO ◽  
Deny Silva LEÃO ◽  
Rafaela Quintino de SOUZA ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Pressure ◽  
Heart Rate ◽  
Oxygen Saturation ◽  
Vital Signs ◽  
Walk Test ◽  
Maximum Increase ◽  
Six Minute Walk Test ◽  
Cardiovascular Performance ◽  
Minute Walk

O teste de caminhada de seis minutos (TC6) foi usado como ferramenta para quantificar as alterações geradas pela reabilitação. O objetivo desta pesquisa foi estimar as respostas cardíacas após infarto do miocárdio e os benefícios da reabilitação. Utilizou-se um circuito oval, onde foram realizados três testes em dias alternados, foi estabelecida a média dos testes, em que a pressão arterial, frequência cardíaca, frequência respiratória, saturação de oxigênio, escala subjetiva de Borg e a metragem durante a distância percorrida foram verificados. Foram avaliados três participantes com, aproximadamente, 69,3±4,93 anos. O teste ocorreu em duas etapas, a primeira foi a avaliação e, a seguir, a aplicação do protocolo com cargas variando de 40 a 50% da frequência cardíaca (FC) submáxima por idade e, na segunda, ocorreu a repetição do protocolo de avaliação. Os sinais vitais apresentaram alterações fisiologicamente esperadas, a pressão arterial sistólica (PAS) evoluiu 4,54%, a pressão arterial diastólica (PAD)14,28%, após o repouso, a PAS diminuiu para -0,8%, enquanto a PAD sofreu alterações importantes. A FC teve um percentual de evolução de 19,44%, diminuindo para -3,12%. A saturação de oxigênio teve aumento máximo de 2% e -1% de declínio, a maior metragem foi de 515,11 metros e a menor 235,5 metros. O TC6 é um teste confiável para estimar o desempenho cardiovascular de indivíduos após infarto do miocárdio.   APPLICABILITY OF THE SIX-MINUTE WALK TEST TO QUANTIFY THE CARDIOVASCULAR PERFORMANCE OF PATIENTS AFTER MYOCARDIAL INFARCTION   ABSTRACT The six-minute walk test (6MWT) was used as a tool to quantify the changes generated by rehabilitation. The purpose of this research was to estimate the cardiac responses after myocardial infarction and the benefits of rehabilitation. An oval circuit was used, where three tests were performed on alternate days, the average of the tests was established, in which blood pressure, heart rate, respiratory rate, oxygen saturation, Borg's subjective scale, and the footage over the distance traveled were checked. Three participants with approximately 69.3±4.93 years old were evaluated. The test occurred in two stages, the first was the evaluation and then the application of the protocol with loads varying from 40 to 50% of submaximal heart rate (HR) by age and, in the second, there was the repetition of the evaluation protocol. The vital signs showed physiologically expected changes, the systolic blood pressure (SBP) evolved 4.54%, the diastolic blood pressure (DBP)14.28%, after resting, the SBP decreased to -0.8%, while the DBP suffered important changes. The HR had a percentage of evolution of 19.44%, decreasing to -3.12%. The oxygen saturation had a maximum increase of 2% and -1% decline, the longest distance was 515.11 meters and the shortest 235.5 meters. The 6MWT is a reliable test to estimate the cardiovascular performance of individuals after myocardial infarction.   Keywords: Six-minute Walk Test, Elder, Myocardial Infarction.

Heart-rate change as a component of the orienting response.

1966 ◽  
Vol 65 (5) ◽  
pp. 305-320 ◽  
Author(s):  
Frances K. Graham ◽  
Rachel K. Clifton
Keyword(s):  
Heart Rate ◽  
Orienting Response ◽  
Heart Rate Change ◽  
Rate Change

scholarly journals A Study on Shock Index in Early Diagnosis of Sepsis in Emergency Department of Tertiary Care Centre of Nepal

2019 ◽  
Vol 2 (2) ◽  
pp. 37-42
Author(s):  
Manish Nath Pant ◽  
Subash Dawadi ◽  
Ashish Thapa
Keyword(s):  
Emergency Department ◽  
Heart Rate ◽  
Severe Sepsis ◽  
Early Diagnosis ◽  
Blood Lactate ◽  
Lactate Level ◽  
Tertiary Care ◽  
Serum Lactate ◽  
Shock Index ◽  
Tertiary Care Centre

Introduction: Sepsis and its consequences, severe sepsis and septic shock is at menace in country like ours where infectious disease are at toll. Early diagnosis and treatment is very important to decrease the morbidity and mortality. Shock index is one of such tool that is very handy in these situations as this is just a mathematical calculation using heart rate(HR) and systolic blood pressure(SBP). The main aim of this study was to find the effectiveness of using SI as an adjunct to blood lactate in diagnosing patients in sepsis. Methods: This was an observational hospital-based study conducted at Emergency Department of TUTH, Maharajgunj on 104 patients, obtained by purposive sampling method, who had presented to the “Red Area”, aged between 18 to 65 years. These patients were screened for severe sepsis using triage vital signs, basic laboratory tests and an initial serum lactate level. Test characteristics were calculated for hyperlactatemia. I considered the following covariates in our analysis: heart rate >90 beats/min; mean arterial pressure <65 mmHg; respiratory rate > 20 breaths/min; ≥2 SIRS including white blood cell count; SI <0.6; SI 0.6 to 1; SI 1 to 1.4and SI ≥ 1.4.  Results: There was a positive correlation between shock index and blood lactate level, r=0.2, n=104, p=0.042. No relationship was found between SI>=1 and hyperlactemia, X2 (.285, N = 104) = 1, p =.594 and relationship was found between SI >=0.7 and hyperlactemia, X2 (4.1, N = 104) = 1, p =.04. sensitivity and specificity for detecting hyperlactemia of SI>=1, SI.=0.7, SIRS was 84% and 20%, 93% and 0%, 79% and 20% respectively. Conclusions: There was weak correlation between the lactate level and shock index with statistically significant correlation between the shock index grouped >=0.7 and hyperlactatemia with high sensitivity and very low specificity.

scholarly journals 6 Minute Walk Test (6-MWT) as a Tool for Predicting Post Operative Pulmonary Complications in Abdominal Surgeries

2021 ◽  
pp. 204-209
Author(s):  
K. Janani ◽  
K. Rajkumaran ◽  
S. Niranjani
Keyword(s):  
Abdominal Surgery ◽  
Pulmonary Complication ◽  
Tertiary Care ◽  
Pulmonary Complications ◽  
Uncontrolled Hypertension ◽  
Walk Test ◽  
Coronary Syndrome ◽  
Six Minute Walk Test ◽  
6 Minute Walk Test ◽  
Minute Walk

Background: Post operative pulmonary complications (PPC) contribute to increased morbidity and mortality. Thus pre operative assessment is required. Six minute walk test (6-MWT) is a simple and reliable test which is recently being included in pre operative evaluation. Objectives: The objective of this study is to determine the value of the six minute walk test as a reliable tool in detecting post operative pulmonary complications in patients undergoing abdominal surgery. Materials and Methods: It is a prospective observational study conducted in a tertiary care centre for a period of 3 months. 66 patients in the age group of 40-60 years undergoing elective abdominal surgery under general anaesthesia were included in this study based on universal sampling method. Patients with recent coronary syndrome, uncontrolled hypertension, cardiac diseases, pregnancy and conditions which impair walking (eg. Arthiritis) were excluded from the study.     6 minute walk test was performed before the surgery. The procedure was explained to the patients and consent was obtained. The test was conducted on a flat surface of 20m near our pre anaesthetic clinic and the patient was asked to walk for a period of 6 minutes in their own comfortable pace. The distance covered by the patients in the 6 minutes was noted. Vitals such a SpO2, heart rate, systolic and diastolic blood pressures were recorded before and after the test. The patients were followed up for the development of pulmonary complications in the post operative period. Results: Out of the 66 patients included in the study, 35 patients did not develop        PPC (Group 1) and 31 patients developed PPC (Group2) including one death due to respiratory failure. The six minute walk distance in the PPC group was significantly less (p=0.0001) when compared to that of the non PPC group. Patients in the PPC group also required prolonged hospital stay. Pneumonia was the most commonly developed post operative pulmonary complication. Conclusion: Six minute walk test is a useful tool in predicting post operative pulmonary complication in patients undergoing abdominal surgery.  

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