|Title||Cardiopulmonary Exercise Testing|
By the end of this module the Clinical Scientist in HSST will be able to analyse, synthesise, evaluate and apply their knowledge to perform assessment of exercise tolerance utilising full cardio-pulmonary exercise testing (CPET) in multiple patient groups and for multiple specific outcomes. Clinical Scientists in HSST will be competent in; the interpretation and full reporting of CPET, able to outline the performance, consider the effects of co- morbidities, advise appropriately on further investigations and decide on therapeutic interventions required to manage patient with a broad range of respiratory disorders within scope of practice of Consultant Clinical Scientist.
Knowledge and understanding
By the end of this module the Clinical Scientist in HSST will analyse, synthesise, evaluate and critically apply their expert knowledge with respect to the:
- normal respiratory, cardiovascular and metabolic physiological responses to exercise.
- physiological and pathophysiological causes of impaired exercise tolerance.
- potential reasons for presenting symptoms, e.g. cause of breathlessness on exertion.
- absolute and relative contra-indications to CPET.
- reasons for early termination of testing including:
- equipment malfunction;
- artefactual physiological data presentation;
- patient concerns;
- abnormal response patterns to exercise that may have safety implications such as onset of ischaemia.
Technical and clinical skills
By the end of this module the Clinical Scientist in HSST, with respect to cardio-pulmonary exercise testing, will be able to demonstrate a critical understanding of current research and its application to the performance and mastery of the following technical including:
- meeting the health and safety criteria to perform full-cardio-pulmonary exercise testing.
- verifying equipment has as suitable for use based on established quality control and quality assurance procedures including:
- performance of calibration procedures
- quality assurance testing
- biological control assessment
- use of referral information and desired test outcomes to select the appropriate exercise modality and workload protocol including:
- cycle ergometer / treadmill
- Bruce / Balke / Ramped Protocols
- calculated work rate increments
- steady state exercise
- assessment of critical power
- where appropriate, performance of additional tests such as venous blood samples, measurement of inspiratory capacity, determination of perceived exertion
- appropriately analysing exercise data based on outcomes required including:
- the determination of peak variables
- the determination of onset of anaerobic metabolism
- the assessment of fitness based on peak or anaerobic threshold variables
- Iso-time concept
- monitoring the 12-lead ECG trace throughout exercise to ensure the exercise is safe to begin and monitor for any cardiac changes that may require early termination of the exercise test for health and safety reasonsdetermine the appropriateness of test termination.
- continually monitoring all cardio-respiratory traces (including 9-panel plot or similar) to ensure values continue to be physiologically plausible, i.e. no hardware artefact, and look for signs when the exercise test may be close to termination based on desired outcome variables.
- determining the appropriate time during testing for venous/arterial/capillary blood sampling where required.By the end of this module the Clinical Scientist in HSST will be expected to critically reflect and apply in practice a range of clinical and communication skills to advise and communicate effectively with patients, relevant clinicians, patients and the public and other healthcare professionals and will:
- analyse the physiological data collected during the CPET.
- provide detailed physiological interpretation of CPETs based on published guidance and algorithms for fitness to undergo major surgery, e.g. multi- visceral transplant, thoracic/cardiac surgery.
- develop test reports based on the requirements of the referring clinician and previously published evidence including the provision of suspected:
- suitability and risk to undergo major surgery.
- peri- and post-operative care requirements.
- feedback to multi-disciplinary teams with regard to differential diagnoses, fitness for surgery.
- provide clinical opinion with regard to potential additional diagnostics that may be of value, e.g. D-Dimer or Computed Tomography Pulmonary Angiogram (CTPA) for suspected pulmonary emboli.
- reflect on the challenges of applying research to practice in relation to these areas of practice and suggest improvements, building on a critique of available evidence.
Attitudes and behaviours
By the end of this module the Clinical Scientist in HSST will be expected to evaluate their own response to both normal and complex situations demonstrating the professional attributes and insights required of a Consultant Clinical Scientist working within the limits of professional competence referring as appropriate to senior staff and will:
- communicate the complex results to medical colleagues in an appropriate and understandable manner.
- explain in written and verbal reports the overall findings of CPET testing and make recommendations for diagnosis, treatment and further investigations.
- explain the methods and results of the tests and their implications to patients, carers and if required to the public.