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Reliability of maximum oxygen uptake in cardiopulmonary exercise testing with continuous laryngoscopy

Mette Engan, Ida Jansrud Hammer, Marianne Bekken, Thomas Halvorsen, Zoe Louise Fretheim-Kelly, Maria Vollsæter, Lars Peder Vatshelle Bovim, Ola Drange Røksund, Hege Clemm
ERJ Open Research 2021 7: 00825-2020; DOI: 10.1183/23120541.00825-2020
Mette Engan
1Dept of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
2Dept of Clinical Science, University of Bergen, Bergen, Norway
6These authors contributed equally
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  • ORCID record for Mette Engan
  • For correspondence: metteengan@hotmail.com
Ida Jansrud Hammer
1Dept of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
6These authors contributed equally
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Marianne Bekken
2Dept of Clinical Science, University of Bergen, Bergen, Norway
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Thomas Halvorsen
1Dept of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
2Dept of Clinical Science, University of Bergen, Bergen, Norway
3Dept of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
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Zoe Louise Fretheim-Kelly
2Dept of Clinical Science, University of Bergen, Bergen, Norway
4Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Oslo, Norway
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Maria Vollsæter
1Dept of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
2Dept of Clinical Science, University of Bergen, Bergen, Norway
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Lars Peder Vatshelle Bovim
5Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Ola Drange Røksund
1Dept of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
5Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Hege Clemm
1Dept of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway
2Dept of Clinical Science, University of Bergen, Bergen, Norway
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  • FIGURE 1
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    FIGURE 1

    Illustration of the set-up for cardiopulmonary exercise test (CPET) with and without continuous video laryngoscopy. The upper left and right images demonstrate the facemask used for ordinary CPET. The middle left and right images demonstrate the modified facemask with a flexible transnasal laryngoscope positioned through a tight-fit opening. A custom-made headgear secures the body of the laryngoscope. The attached transnasal flexible laryngoscope enables video recording of the laryngeal inlet during the maximal exercise treadmill test (bottom image).

  • FIGURE 2
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    FIGURE 2

    Agreement between peak oxygen consumption (V′O2peak), respiratory exchange ratio (RER) and minute ventilation (V′E) obtained from cardiopulmonary exercise testing (CPET) and continuous laryngoscopy performed during exercise (CLE) test. The horizontal lines depict the mean difference between the variables obtained with the two methods, whereas ±1.96 sd of these differences represent 95% limits of agreement between the two methods. The 95% confidence intervals for the mean, the upper limit of agreement and the lower limit of agreement are indicated by vertical lines. The figures given below in the brackets are the mean difference and the upper and lower limits of agreement, expressed as percentages of the mean of the CPET and CLE value. a) Agreement between V′O2peak, expressed as mL·kg−1·min−1, obtained from CPET and CLE tests. The mean difference was 0.2 mL·kg−1·min−1 (0.4%), the upper limit of agreement was 4.0 mL·kg−1·min−1 (7.0%), and the lower limit of agreement was −3.5 mL·kg−1·min−1 (−6.2%). b) Agreement between RER obtained from CPET and CLE test at peak exercise. The mean difference was 0.01 units (0.7%), the upper limit of agreement was 0.11 units (9.2%), and the lower limit of agreement was −0.09 units (−7.8%). c) Agreement between V′E obtained from CPET and CLE test at peak exercise. The mean difference was 2.58 L·min−1 (2.2%), the upper limit of agreement was 26.5 L·min−1 (18.3%), and the lower limit of agreement was −21.4 L·min−1 (−13.9%).

Tables

  • Figures
  • TABLE 1

    Characteristics of the 40 subjects comparing peak oxygen consumption measured with or without continuous laryngoscopy during cardiopulmonary exercise test on a treadmill

    Female sex n (%)21 (53)
    Age years mean (range)24.8 (15.0 to 35.0)
    BMI kg·m−222.3±2.3
    Smoking n (%)0 (0)
    Exercise
     4–6 days per week n (%)19 (47.5)
     Daily n (%)21 (52.5)
    Asthma n (%)1 (3)
    FVC CPET L5.12±1.26
    FVC CLE L5.15±1.25
    FVC z-score CPET0.25±0.81
    FVC z-score CLE0.30±0.79
    FEV1 CPET L4.31±1.32
    FEV1 CLE L4.20±0.92
    FEV1 z-score CPET0.05±0.83
    FEV1 z-score CLE0.07±0.79

    Data are presented as mean±sd, unless otherwise stated. BMI: body mass index; FVC: forced vital capacity; CPET: cardiopulmonary exercise test; CLE: continuous laryngoscopy during exercise; FEV1: forced expiratory volume in 1 s.

    • TABLE 2

      Ergospirometry data for the 40 participants obtained from cardiopulmonary exercise tests performed without and with added CLE test set-up

      ParameterCPET without CLECPET with CLEDifference
      MeansdMeansdMean(95% CI)
      V′O2peak mL·min−13818873.83806883.411.4(−33.5, 56.2)
      V′O2peak mL·kg−1·min−154.96.354.76.60.22(−0.40, 0.83)
      V′CO2peak mL·min−1461810164565100653.1(−25.9, 132.0)
      VT L2.610.652.610.620.005(−0.08, 0.071)
      V′E L·min−1142.333.1139.734.22.58(−1.33, 6.49)
      HR beats·min−11868.71859.01.4(−0.8, 3.5)
      RR breaths·min−1559.35410.01.2(−1.5, 4.0)
      RER units1.210.051.200.050.01(−0.007, 0.027)
      Distance m1199219115021049(15.7, 82.0)

      CLE: continuous laryngoscopy during exercise; CPET: cardiopulmonary exercise test; V′O2peak: oxygen consumption at peak exercise; V′CO2peak: carbon dioxide production at peak exercise; VT: tidal volume; V′E: minute ventilation; HR: heart rate; RR: respiratory rate; RER: respiratory exchange rate.

      • TABLE 3

        Reliability and reproducibility of the ergospirometry data obtained for the 40 participants performing cardiopulmonary exercise test with and without CLE test set-up

        ParameterAgreementLower LoAUpper LoAICC(95% CI)WS-sdCoV %
        V′O2peak mL·min−111.4−2632860.988(0.977, 0.993)982.6
        V′O2peak mL·kg−1·min−10.2−3.54.00.957(0.920, 0.977)1.32.5
        V′CO2peak mL·min−153.1−4315370.970(0.943, 0.984)1763.8
        VT L0.0−0.470.460.933(0.876, 0.964)0.166.3
        V′E L·min−12.6−21.426.50.933(0.877, 0.964)8.76.2
        HR beats·min−11.4−11.614.30.720(0.532, 0.841)4.72.5
        RR breaths·min−1−2.5−19.915.00.614(0.375, 0.777)6.011.1
        RER units0.01−0.090.110.502(0.233, 0.700)0.043.1

        CLE: continuous laryngoscopy during exercise; LoA: limit of agreement; ICC: intraclass correlation coefficient; WS-sd: within-subject sd; CoV: coefficient of variation; V′O2peak: oxygen consumption at peak exercise; V′CO2peak: carbon dioxide production at peak exercise; VT: tidal volume; V′E: minute ventilation; HR: heart rate; RR: respiratory rate; RER: respiratory exchange rate.

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        Reliability of maximum oxygen uptake in cardiopulmonary exercise testing with continuous laryngoscopy
        Mette Engan, Ida Jansrud Hammer, Marianne Bekken, Thomas Halvorsen, Zoe Louise Fretheim-Kelly, Maria Vollsæter, Lars Peder Vatshelle Bovim, Ola Drange Røksund, Hege Clemm
        ERJ Open Research Jan 2021, 7 (1) 00825-2020; DOI: 10.1183/23120541.00825-2020

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        Reliability of maximum oxygen uptake in cardiopulmonary exercise testing with continuous laryngoscopy
        Mette Engan, Ida Jansrud Hammer, Marianne Bekken, Thomas Halvorsen, Zoe Louise Fretheim-Kelly, Maria Vollsæter, Lars Peder Vatshelle Bovim, Ola Drange Røksund, Hege Clemm
        ERJ Open Research Jan 2021, 7 (1) 00825-2020; DOI: 10.1183/23120541.00825-2020
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