Resting Metabolic Rate Test
Metabolism Metabolism can be understood as the conversion by the human body between food and accumulated fat into energy. The energy is used by the body to maintain constant temperature , to move and to make all the organ function. Measure of metabolism is: calories (cal). Total Metabolic Rate The total metabolic rate are the total calories that the human body needs in order to actuate the daily functional activities.
Recommendations Resting metabolic rate test using the face mask 1. 2. Since the ventilation is very low (normally <10 litres/min), the turbine calibration has to be performed with very slow manoeuvres (each complete manoeuvre in about 10-15 seconds), to obtain the best accuracy. Use the following correction for the dead space (VD): - 50 ml for the small mask - 60 ml for the medium mask - 70 ml for the large mask Resting metabolic rate test using the canopy option 1. 2.
Performing a test using the face mask Calibrations Before the test, it is necessary to perform an ergo calibration (see Calibration chapter) and it is advisable to perform also a turbine calibration (see Recommendations in this chapter). How to prepare a patient The patient interfaces with the equipment by means of a face mask, like in the stress exercise. The mask has to be tight to the face, in order to avoid any air leakage. Start the test 1. 2. 3.
Viewing the test At the rend of the test, it will be opened automatically a window with the test results. At the end of the test, or if it is selected View/RMR, the main results are shown: sss Nota: The percentage of used Proteins (PRO%) is calculated assuming 12 grams of Ureic Nitrogen in 24 hours.
How to modify the average interval If the average interval (automatically identified by the software) is not satisfying, for example because the patient was speaking in the first minutes, it is possible to modify the interval of the average. Right-click and select Edit RMR…. It is possible to move the start and the end lines. To move the start line, left-click on the exact time in which you want to start the calculations, for the end line, right-click.
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Performing a test using the canopy option The principle of a ventilated bubblehood system is that a stream of air is forced to pass across the face of a subject and mixes with the air which is collected by a transparent hood, placed over the subject’s head. A measurement system, knowing the flow rate, calulates the oxygen consumption and the CO2 production and, starting from these values, the energy expenditure.
How to prepare the patient 1. 2. 3. 4. Switch on the Canopy unit. If there are no problems, the red led on the front panel of the unit flashes for few seconds and the alarm beeps. If the led does not flash and/or the alarm does not beep, the test cannot be performed, because the backup battery is exhausted or there is no backup battery. When the green led turns on, the test can start.
7. When the FeCO2 remains within the acceptability range, press F2 to start the data acquisition. Verify, also during the test, that the measured FeCO2 is within the 0.5%-0.8% range. Otherwise, adjust it by means of the Flow adjustment handle. Warning: If the green led turns off during the test, the red led flashes and the alarm beeps, abort the test, because the pump does not work or the mains does not power the system. In the last case, the pump works only because of the backup battery.
Sub-maximal Exercise Testing
Introduction Several physiological responses to exercise are used to evaluate cardiorespiratory fitness, including oxygen consumption, heart rate, and blood pressure. Measuring these variables during exercise, particularly maximum exercise, increase the chance of detecting any coronary artery disease or pulmonary disease.
Sub-maximal exercise testing Heart rate varies linearly with VO2 to the point of maximum exertion; thus, VO2max may be estimated using the relation between heart rate and VO2 without subjecting the individual to maximum levels of physical stress. During sub-maximal exercise testing, predetermined workloads are used to elicit a steady state of exertion (plateau of heart rate and VO2).
Staffing Staff members should be able to do the following: 1. Establish rapport with the subject and make him or her feel comfortable. 2. Recognize normal acute and chronic responses to exercise. 3. Recognize abnormal signs and symptoms during exercise. 4. Provide basic life support measures competently. 5. Adhere to established procedures and protocols. 6. Clearly explain test results to the individual.
Considerations for accuracy The ability to obtain valid and reproducible results is essential to ensure that any differences between pre-treatment and post-treatment test results are due to exercise training rather than variations in testing procedures. Some inconsistencies that are inherent may increase variability: • Sub-maximal heart rate is influenced by time of day, eating, smoking, and familiarization with test procedures.
Performing the test In this chapter it is supposed that the user is able to: • perform an exercise test • create exercise protocols • view, edit and print tests If this is not the case, please read the Exercise testing chapter. To perform a sub-maximal test, follow these instructions: 1.
Spirometry
Setting spirometry options The software allows to configure some options selecting Configure from the Option menu. Spirometry Automatic Interpretation K4 b2 has the function of interpreting each test performed by a patient visualising an automatic diagnosis. The algorithm has been calculated basing on “Lung Function Testing: selection of reference values and interpretative strategies, A.R.R.D. 144/ 1991:1202-1218”.
Parameters manager The program allows to calculate a huge number of parameters; it is advisable, in order to simplify the analysis of the results, to view, to print and to sort the desired parameters only. Select the menu item Options/Parameters... View Move the parameters to view into the Selected parameters list. Print Move the parameters to print into the Selected parameters list. Sort Drag the parameter up or down with the mouse. Customise Add, modify and delete custom parameters.
Name: identifies the set and cannot be duplicated; Description: free field; Age: the adult predicteds start since this age. To enter a new set of predicteds click on the New button. The field Name must be filled and must be unique. To stop without saving click on the Cancel button. To save the set, click on the Save button. To delete a set of predicteds click on the Delete button. If a set is deleted, also the associated formulae are deleted.
• calculated according to the predicteds in the list Use the predicteds formulae; • customised by the user with the option ...or the customised formulae. The Delete button deletes the selected parameter. The Copy button stores the selected parameter in memory. The Paste button inserts a new parameter from the one copied. If the name is not unique, the user is asked whether to specify a new name or to replace the existing parameter. Page set-up Select Page Setup... from the File menu.
Spirometry tests sss Note: Read carefully the contraindications in Chapter 1. Once completed the phases of the introduction of the patient’s data and the visit data, it is possible to carry out the spirometric tests. K4 b2 allows to perform the following tests: Key Test FVC pre Forced Vital Capacity FVC post Forced Vital Capacity after bronchial stimulation SVC Slow Vital Capacity MVV Maximum Voluntary Ventilation Before performing any test make sure that: 1.
Forced Vital Capacity (pre) FVC is a reference test to verify obstructive (airflow limitations) and restrictive disorders (lung volume limitations).
Perform the FVC test with the encouragement 1. 2. 2 118 - K4 b User Manual Select Encouragement from View menu. Perform the test as explained in the previous paragraph.
Slow Vital Capacity Important test for assessing COPD (chronic obstructive pulmonary disease) patients affected by this disease might present a the Slow Vital Capacity could be higher than the Forced one (FVC).
Maximum Voluntary Ventilation Test for assessing the maximum ventilatory capacity. In the past, it was commonly performed during routine PF tests, however its clinical use declined over the years. Today MVV test is most commonly performed as part of the exercise tolerance tests, where it is used as an index of maximum ventilatory capacity. Test consists in breathing in and out deeply and rapidly for 12, 15 seconds.
Bronchial Provocation Test Bronchodilator test sss Note: Read carefully the contraindications in Chapter 1. Bronchodilators are administered routinely in the b2 laboratory to determine whether airflow obstruction is reversible. Bronchodilators increase airway calibre by relaxing airway smooth muscle. The test consists of comparing results between the reference FVC (FVC PRE) and the FVC POST performed after the administration of the drug.
Perform the test (During 1st step only) select Protocol... from the Test menu and choose the name of the bronchoprovocation protocol that you are going to use (manual protocol if you want to type the information about the agent before any manoeuvre) 1. Select FVC post from the Test menu. 2. Select an existing protocol or click on “manual protocol”, and wait the green leds turned on. 3. Press F2, or the button by side, to start the test. 4. Press F3, or the button by side, to achieve the test. 5.
Viewing results All the visualisation functions refer to the test carried out by the Current Patient, whose name is indicated on the left-side of the status bar. To view tests results: 1. Select the Patients from the File menu 2. Select the patient corresponding to the test you want to view. 3. Select in the list box of the tests up to 5 tests of the kind (FVC, VC/IVC, or MVV) and press OK.
Printing results You can print out in three different ways: • printing the Report • printing the Active Window • printing a series of reports Printing Reports To print a report of the current visit, select Print report… from File menu. The software will choose automatically the best performed test. The standard Report is composed by 1, 2 or 3 pages depending if you wish to printout the FVC data and the graphs together on the first page or if you wish to printout the bronchoprovocation response.
Export data With this function you can export the test data in 4 different formats: • *.txt (ASCII) • *.xls (Microsoft Excel) • *.wk1 (Lotus 123) • *.xpo (Cosmed) Export a test 1. 2. 3. 4. Select Export tests from the File menu. Select the test to export from the list box and press OK. Type the name and the format of the file in the dialog Save as. If the ASCII format is selected, the Text button in the dialog box Save as allows you to configure the separators for character based files.
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External devices
GPS GPS initialisation The GPS operates on information gathered from satellites.To gather this information, take your GPS on outside and find large, open area that has a clear view of the sky (a nearby park would work fine). The GPS needs to receive at least three strong satellite signals to find your location.
Operating sequence Test with GPS module can be carried out with K4 b2 system in Holter Data Record or Telemetry Data Transmission mode only. In addition to the Operating sequence of this mode you must carry out the following operation. Run a test with GPS 1. Connect the receiver antenna to the Portable Unit plugging phone jack into the RS232 port at the bottom of the PU. 2. 3. Select Settings then External device and press Enter.
Monitoring GPS parameters in real time To monitor in real time GPS parameters during Telemetry Mode Transmission or as soon as test has been stored or downloaded, go to the PC software and select Parameters to view/Test execution… (real time) or Parameters to view/Test visualization… (after download) from the Options menu. Select the following parameters: Velocity GPS Vel (m/sec) Distance GPS Dist (meters, incremented during exercise phases only) Latitude Lat (DD°MM.MMM’ N/S) Longitude Long (DD° MM.
Pulse Oximeter (option) The oximeter option is useful to monitor SpO2 value during the test. Test with this option can be carried out with K4b2 system in Holter Data Record or Telemetry Data Transmission mode only. In addition to the Operating sequence of this mode you must carry out the following operation: Operating Sequence 1. Connect the Oximeter module to the Portable Unit plugging phone jack into the RS232 port at the bottom of the PU 2.
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System maintenance
System maintenance All service operations which are not specified in this user manual should be performed by qualified personnel in accordance with the service handbook (to be required to the manufacturer). Rubber mouthpieces, face masks, breathing valve and the other parts are not shipped sterile. They should be disinfected before using according to the following instructions. All materials used in the construction of the K4 b2 are non toxic and pose no safety risk to the patient or operator.
sss Warning: Do not use alcoholic solutions for the turbine, otherwise there can be damages to the plastic material. Cleaning the turbine flowmeter It is necessary to disinfect periodically the turbine for sanitary measures or/and for the correct device function. The disinfecting procedure is easy and may be effected every time the user needs, keeping attention to some precautions: 1. 2. 3. 4. 5. 6. Take out the turbine. Dip it in a disinfectant solution (non alcoholic based) for about 20 minutes.
Disinfecting the mask It’s possible disinfecting the mask following these procedures: • Standard autoclaving method Rapid cycles of autoclave lasting 10 minutes at 132°C (270°F) Heavy cycles of autoclave lasting 30 minutes at 121°C (250°F) Pre vacuum cycles of autoclave lasting 30 minutes at 121°C (250°F) • Hetilene oxide method (ETO) The hetilene oxide doesn’t deteriorate the face masks.
3. Replace the damaged fuse(s).
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Appendix
Service - Warranty Warranty and limitation of liability COSMED provides a one (1) year limited warranty from the date of the original sale of COSMED products. All COSMED products are guaranteed to be free from defect upon shipment. COSMED’s liability for products covered by this warranty is limited exclusively to replacement, repair, or issuance of a credit for the cost of a defective product, at the sole discretion of COSMED.
Repair Service Policy Goods returned to seller for Non-Warranty repair will be subject to conditions 1, 2, 3, 4. The returned goods need to re-enter COSMED together with the customs documents (Pro-forma Invoice and Customs Paper) as requested by the Italian law. • The shipment has to be qualified as a Temporary Export. • All the goods returned to COSMED without the customs papers will not be accepted.
Privacy Information Dear Customer, we inform you that your personal data are gathered and will be used by Cosmed Srl in conformity with the requirements of the Italian privacy law (Decreto Legislativo 196/2003). We believe it is important for you to know how we treat your personal data. Personal data treatment and purposes We request and process your personal data: a.
Converting factors configuration You can edit the parameters shown in Control Panel by selecting Control Panel from the Calibration menu in the calibration program, then pressing the button by side. You might configure the following options: Name: identify the parameter Unit of meas.: unit of measurement Base line and Gain: factors used to convert the acquired raw data (mV) into the final format according to Y=(mV-BL)*Gain. The value entered for gain must be multiplied by 1000 (for Gain=1, enter 1000).
Calculations references VO2 and VCO2 "Energy Expenditure and Fuel Selection in Biological Systems: The Theory and Practice of Calculations Based on Indirect Calorimetry and Tracer Methods": M. Elia, G. Livesey, World Rev. Nutr. Diet. Basel, Karger, 1992, vol 70, pp 68-131. "Nutritional Assessment in Critical Care, A Training Handbook": Donald C.
ATS 94 recommendations Reference: “Standardization of Spirometry: 1994 Update” “American J. Respiratory Critical Care Medicine”, Vol. 152, 1107-1136; 1995. ATS recommendations Volume range: 8l (BTPS) Flow range: ±14 l/sec Volume accuracy: ±3% or < 50ml Flow accuracy: ±5% or < 200ml/sec Flowmeter resistance: <1.5 cmH2O da 0 a 14 l/sec Reproducibility: the 2 largest of 3 acceptable FEV1 and FVC values should be within 5% or 150 ml.
Predicted values ERS93 Standardized Lung Function Testing: Official Statement of the European Respiratory Society, The European Respiratory Journal Volume 6, Supplement 16, March 1993. Compilation of reference values for lung function measurements in children: Ph. H. Quanjer, J. Stocks, G.Polgar, M. Wise, J. Karlberg, G. Borsboom; ERJ 1989, 2, Supp.4,184s-261s. KNUDSON 83 Changes in the Normal Maximal Expiratory Flow-Volume Curve with Growth and Anging: J. Knudson, D. Lebowitz, J. Holdberg, B.
Compilation of reference values for lung function measurements in children: Ph. H. Quanjer, J. Stocks, G.Polgar, M. Wise, J. Karlberg, G. Borsboom; ERJ 1989, 2, Supp.4,184s-261s. Reference Values for Residual Volume, Functional Residual Capacity and Total Lung Capacity - ATS workshop on Lung Volume measurements, official statement of the European Respiratory Society; J. Stocks, Ph. H.
Blow out more air Blow out harder Take a deeper breath Blow out faster That was a good test FVC reproducible FEV1 reproducible PEF reproducible MVV time too short 2 148 - K4 b User Manual flow >0.2l/s within 20 ml of FVC dPEF<10% dFVC<200ml and 5% best FVC dFEV1<200ml and 5% FEV1 No errors diff. 2 max FVC within 0.2 l diff. 2 max FEV1 within 0.2 l diff.
References Gas Exchange References [“On line computer analysis and breath by breath graphical display of exercise function tests.
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