Anders Schmidt

Effect of physical training on peak oxygen consumption rate and exercise-induced asthma in adult asthmatics

Sixteen adults with perennial asthma were trained for 2 months using heavy exercise. Eleven comparable subjects performing light exercise with the same frequency and duration served as controls. After the training the peak oxygen consumption rate (Vo2max) was increased by 10% (P = 0.02) in the heavily trained group, whereas no significant change was observed in the control group. The difference in Vo2max between males and females averaged 20% and is thus of the same magnitude as found in healthy subjects. An exercise-induced asthma (EIA) test comprising 6 min of free running was carried out in all participants in both training groups before and after the training period. The post-exercise decrease in pulmonary function assessed by peak expiratory flow (PEF) was 36 + 4% (mean +/- SEM) before heavy training and 33 +/- 2% after two months of training (paired t-test: P = 0.18); for the control group the decrease was 40 +/- 6% and 40 +/- 7% (P = 0.22), respectively, at the pre- and post-training investigation. It is concluded that physical training may increase the Vo2max in asthmatic patients by the same amount as in normal subjects, whereas no influence on the degree of EIA could be detected.

SHORT-TERM PHYSICAL TRAINING IN BRONCHIAL ASTHMA

The effect of two types of physical training on patients with perennial asthma were compared in a blind, controlled, randomized study. Eleven of 27 adults with asthma performed a physical training programme which did not change their oxygen consumption (control group). The remaining 16 asthmatics performed a physical training programme which improved their maximal oxygen consumption (training group). Both of the training programmes were performed for 1 hour, twice a week during a period of 2 months. No complications were reported during the performance of the training programmes. The doses of all medicines apart from beta 2-agonist aerosol were unchanged during the training period. The patients inhaled beta 2-agonist aerosol if their peak expiratory flow (PEF) was less than 60% of their maximal PEF. The training group decreased their use of aerosol from an average of 4.94 puffs per day to 3.41 puffs per day (P less than 0.05). The control group did not change their use of beta 2-agonist aerosol significantly. It is concluded that physical exercise which improves the maximal oxygen consumption decreases the use of beta 2-agonist spray and that heavy exercise is well tolerated by asthmatics.

Exercise-induced asthma after walking, running and cycling

Bronchial response to 6 min exercise performed as treadmill-walking, treadmill-running, ergometer bicycling and free running were compared in 11 subjects with exercise-induced asthma (EIA). The study was performed under control of air temperature and relative humidity. The three different types of exercise were performed on consecutive days, and the ventilation was monitored using pneumotachography and rating of perceived exertion (RPE). The decrease in peak expiratory flow after treadmill-running was 25.5 +/- 4.5% (mean +/- SEM), after bicycle ergometer exercise 26.0 +/- 3.0%, after treadmill-walking 26.0 +/- 3.0% and after free running 27.0 +/- 3.5%. No statistical difference in bronchial response was demonstrated between the four types of exercise. The total ventilation for the 6 min period of exercise was 421, 411 and 427 litres for treadmill-walking, treadmill-running and bicycle ergometer exercise, respectively. It is concluded that the type of work is of little importance in EIA.

Organisation of in-hospital cardiac arrest teams - A nationwide study

BACKGROUND In-hospital cardiac arrests are treated by a team of health care providers. Improving team performance may increase survival. Currently, no international standards for cardiac arrest teams exist in terms of member composition and allocation of tasks. AIM To describe the composition of in-hospital cardiac arrest teams and review pre-arrest allocation of tasks. METHODS A nationwide cross-sectional study was performed. Data on cardiac arrest teams and pre-arrest allocation of tasks were collected from protocols on resuscitation required for hospital accreditation in Denmark. Additional data were collected through telephone interviews and email correspondence. Psychiatric hospitals and hospitals serving outpatients only were excluded. RESULTS Data on the cardiac arrest team were available from 44 of 47 hospitals. The median team size was 5 (25th percentile; 75th percentile: 4; 6) members. Teams included a nurse anaesthetist (100%), a medical house officer (82%), an orderly (73%), an anaesthesiology house officer (64%) and a medical assistant (20%). Less likely to participate was a cardiology house officer (23%) or a cardiology specialist registrar (5%). Overall, a specialist registrar was represented on 20% of teams and 20% of cardiac arrest teams had a different team composition during nights and weekends. In total, 41% of teams did not define a team leader pre-arrest, and the majority of the teams did not define the tasks of the remaining team members. CONCLUSION In Denmark, there are major differences among cardiac arrest teams. This includes team size, profession of team members, medical specialty and seniority of the physicians. Nearly half of the hospitals do not define a cardiac arrest team leader and the majority do not define the tasks of the remaining team members.

Cardioversion Efficacy Using Pulsed Biphasic or Biphasic Truncated Exponential Waveforms: A Randomized Clinical Trial

Background Several different defibrillators are currently used for cardioversion and defibrillation of cardiac arrhythmias. The efficacy of a novel pulsed biphasic (PB) waveform has not been compared to other biphasic waveforms. Accordingly, this study aims to compare the efficacy and safety of PB shocks with biphasic truncated exponential (BTE) shocks in patients undergoing cardioversion of atrial fibrillation or ‐flutter. Methods and Results This prospective, randomized study included patients admitted for elective direct current cardioversion. Patients were randomized to receive cardioversion using either PB or BTE shocks. We used escalating shocks until sinus rhythm was obtained or to a maximum of 4 shocks. Patients randomized to PB shocks received 90, 120, 150, and 200 J and patients randomized to BTE shocks received 100, 150, 200, and 250 J, as recommended by the manufacturers. In total, 69 patients (51%) received PB shocks and 65 patients (49%) BTE shocks. Successful cardioversion, defined as sinus rhythm 4 hours after cardioversion, was achieved in 43 patients (62%) using PB shocks and in 56 patients (86%) using BTE shocks; ratio 1.4 (95% CI 1.1–1.7) (P=0.002). There was no difference in safety (ie, myocardial injury judged by changes in high‐sensitive troponin I levels; ratio 1.1) (95% CI 1.0–1.3), P=0.15. The study was terminated prematurely because of an adverse event. Conclusions Cardioversion using a BTE waveform was more effective when compared with a PB waveform. There was no difference in safety between the 2 waveforms, as judged by changes in troponin I levels. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02317029.

Comparison of isocapnic hyperventilation and treadmill exercise in children with exercise-induced asthma

The degree of post-exercise airway obstruction (Exercise-Induced Asthma (EIA] in 14 children was compared to the degree of airway obstruction following isocapnic hyperventilation. EIA was provoked by 6 min of treadmill running. Isocapnic hyperventilation was performed sitting during 6 min. The total ventilation (Vtot) during the two provocations was identical. The temperature of the inspired air was also identical during the two provocations, and the relative humidity was 40% during treadmill-running and 15% during hyperventilation. The decrease in peak expiratory flow after treadmill-running was 29%. After hyperventilation a fall on 19% was seen. These figures are statistically different. It is concluded that although there is a significant difference in airway obstruction after the two provocations the ventilation is greater importance for EIA than is the work load.

Elevated calprotectin in patients with atrial fibrillation with and without heart failure

Abstract Calprotectin is an inflammatory marker, which has been found elevated in patients suffering from cardiac conditions, e.g. myocardial infarction, unstable angina and chronic heart failure. Inflammation has further been linked to atrial fibrillation (AF). However, the association between calprotectin and AF is unknown. We aimed to compare calprotectin levels in patients suffering from AF with healthy adults. In addition, AF patients with and without heart failure were compared. Calprotectin was measured in patients undergoing elective direct current cardioversion for AF. Calprotectin was determined before, 4 hours and 3 months after cardioversion. Healthy blood donors were used to verify the reference interval for calprotectin. In total, 104 prospectively enrolled patients were included. The median serum calprotectin level for AF patients was 1.6 μg/mL before cardioversion. Calprotectin levels increased significantly 4 h (1.9 μg/mL) and 3 months (2.2 μg/mL) after cardioversion. Blood donors’ median serum calprotectin (1.3 μg/mL) was significantly lower than AF patients. AF patients with heart failure had significantly higher calprotectin at baseline compared with AF patients without a history of heart failure (2.0 μg/mL vs. 1.5 μg/mL). The difference was not significant at 4 h (2.0 μg/mL vs. 1.7 μg/mL) or 3 months (2.5 μg/mL vs. 2.2 μg/mL). In conclusion, the calprotectin levels in patients with AF were significantly higher than healthy blood donors and were further increased after cardioversion. AF patients with heart failure had significantly higher levels of calprotectin than AF patients without heart failure.

Hospital implementation of resuscitation guidelines and review of CPR training programmes: a nationwide study.

This study aimed to investigate cardiopulmonary resuscitation (CPR) guideline implementation and CPR training in hospitals. This nationwide study included mandatory resuscitation protocols from each Danish hospital. Protocols were systematically reviewed for adherence to the European Resuscitation Council (ERC) 2010 guidelines and CPR training in each hospital. Data were included from 45 of 47 hospitals. Adherence to the ERC basic life support (BLS) algorithm was 49%, whereas 63 and 58% of hospitals adhered to the recommended chest compression depth and rate. Adherence to the ERC advanced life support (ALS) algorithm was 81%. Hospital BLS course duration was [median (interquartile range)] 2.3 (1.5–2.5) h, whereas ALS course duration was 4.0 (2.5–8.0) h. Implementation of ERC 2010 guidelines on BLS is limited in Danish hospitals 2 years after guideline publication, whereas the majority of hospitals adhere to the ALS algorithm. CPR training differs among hospitals.

Clinical experience and skills of physicians in hospital cardiac arrest teams in Denmark: a nationwide study

Background The quality of in-hospital resuscitation is poor and may be affected by the clinical experience and cardiopulmonary resuscitation (CPR) training. This study aimed to investigate the clinical experience, self-perceived skills, CPR training and knowledge of the guidelines on when to abandon resuscitation among physicians of cardiac arrest teams. Methods We performed a nationwide cross-sectional study in Denmark. Telephone interviews were conducted with physicians in the cardiac arrest teams in public somatic hospitals using a structured questionnaire. Results In total, 93 physicians (53% male) from 45 hospitals participated in the study. Median age was 34 (interquartile range: 30–39) years. Respondents were medical students working as locum physicians (5%), physicians in training (79%) and consultants (16%), and the median postgraduate clinical experience was 48 (19–87) months. Most respondents (92%) felt confident in treating a cardiac arrest, while fewer respondents felt confident in performing intubation (41%) and focused cardiac ultrasound (39%) during cardiac arrest. Median time since last CPR training was 4 (2–10) months, and 48% had attended a European Resuscitation Council (ERC) Advanced Life Support course. The majority (84%) felt confident in terminating resuscitation; however, only 9% were able to state the ERC guidelines on when to abandon resuscitation. Conclusion Physicians of Danish cardiac arrest teams are often inexperienced and do not feel competent performing important clinical skills during resuscitation. Less than half have attended an ERC Advanced Life Support course, and only very few physicians know the ERC guidelines on when to abandon resuscitation.

BIPHASIC TRUNCATED EXPONENTIAL WAVEFORM IS SUPERIOR COMPARED TO PULSED BIPHASIC WAVEFORM IN CARDIOVERTING ATRIAL FIBRILLATION AND ATRIAL FLUTTER: A RANDOMIZED CONTROLLED TRIAL

Several different biphasic waveforms are currently in clinical use, but few studies have compared their efficiency. The aim of this study was to compare the efficiency of a biphasic truncated exponential (BTE) waveform with a pulsed biphasic waveform (PBW) in patients undergoing elective