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Cardiopulmonary Exercise Testing — A Survey of Current Use in England

Cardiopulmonary exercise testing (CPET) is an objective method of evaluating integrated cardiopulmonary function. Increasingly, it is being used for perioperative risk assessment. This survey was performed between October and December 2008 to identify where and how CPET is being used for perioperative risk assessment in England. Direct telephone contact was made with the Department of Anaesthesia in 154/173 (89%) of NHS Trusts in England in order to ascertain the availability of a CPET service. One hundred and fifteen (66%) Trusts confirmed whether or not they have a CPET service −30 (17%) Trusts have a CPET service and 12 (7%) are in the process of setting one up. These Trusts were sent a nine-question survey, which was completed by 15 Trusts. Criteria for selecting patients for CPET testing included type of surgery, age and co-morbidities. All trusts use anaerobic threshold (AT) values to identify patients at risk of adverse outcome, though many also used additional variables including peak oxygen consumption, ventilatory equivalents for carbon dioxide, ventilatory equivalents for oxygen, oxygen pulse, oxygen consumption/power slope and breathing reserve. Different numerical threshold values were used in different centres. Patients identified as high risk were managed in a variety of ways, including referral for specialist advice, modifying or cancelling surgery, modified perioperative care and augmented postoperative care (in a level 2 or 3 environment). This survey clearly highlights significant inconsistency in the use of CPET for perioperative risk assessment and suggests that some standardisation of practice may be of value.