Exercise Stress Testing for the Pediatric Patient with Burns: A Preliminary Report

McElroy, Kimberly; Mi, Alvarado; Pg, Hayward; Mh, Desai; Dn, Herndon; Mc, Robson

doi:10.1097/00004630-199203000-00011

Cited by 13 publications

(3 citation statements)

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“…If this is the case, then rehabilitation exercise medicine may need specific guidelines for burned populations, especially if HR- or oxygen uptake-based training (i.e., percent HR/oxygen uptake max) is used as a guide for exercise prescription. Some have reported that burns do not affect children's exercise tolerance during a graded exercise stress test(20), while others have reported limited endurance exercise due to abnormal lung function at 2 to 3 years post burn (7, 21). …”

Section: Introductionmentioning

confidence: 99%

Children with Burn Injury Have Impaired Cardiac Output during Submaximal Exercise

Rivas

Herndon

Beck³

et al. 2017

Medicine &Amp; Science in Sports &Amp; Exercise

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Introduction Burn trauma damages resting cardiac function; however, it is currently unknown if the cardiovascular response to exercise is likewise impaired. We tested the hypothesis that, in children, burn injury lowers cardiac output (Q) and stroke volume (SV) during submaximal exercise. Methods Five children with 49±4% total body surface area (BSA) burned (2 female, 11.7±1 y, 40.4±18 kg, 141.1±9 cm) and eight similar non-burned controls (5 female, 12.5±2 y, 58.0±17 kg, 147.3±12 cm) with comparable exercise capacity (peak oxygen consumption [peak VO2]: 31.9±11 vs. 36.8±8 ml O2·kg·min-1, P=0.39) participated. The exercise protocol entailed a pre-exercise (pre-EX) rest period followed by 3-minute exercise stages at 20 W and 50 W. VO2, heart rate (HR), Q (via non-rebreathing), SV (Q/HR), and arteriovenous O2 difference ([a-v] O2 dif, Q/VO2) were the primary outcome variables. Results Using a 2-way factorial ANOVA (group [G] × exercise [EX]), we found that Q was ∼27% lower in the burned than the non-burned group at 20 W of exercise (burned 5.7±1.0 vs. nonburned: 7.9±1.8 L·min-1) and 50 W of exercise (burned 6.9±1.6 vs. nonburned 9.2 ±3.2 L·min-1) (G × EX interaction, P=0.012). SV did not change from rest to exercise in burned children but increased by ∼24% in the non-burned group (main effect for EX, P=0.046). Neither [a-v] O2 dif nor VO2 differed between groups at rest or exercise, but HR response to exercise was reduced in the burn group (G × EX interaction, P=0.004). When normalized to BSA, SV (index) was similar between groups; however, Q (index) remained attenuated in the burned group (G × EX interaction, P<0.008). Conclusions Burned children have an attenuated cardiovascular response to submaximal exercise. Further investigation of hemodynamic function during exercise will provide insights important for cardiovascular rehabilitation in burned children.

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Section: Introductionmentioning

confidence: 99%

Children with Burn Injury Have Impaired Cardiac Output during Submaximal Exercise

Rivas

Herndon

Beck³

et al. 2017

Medicine &Amp; Science in Sports &Amp; Exercise

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“…In children with cystic fibrosis, the ET was used to assess the tolerance to effort and the response to the treatment with aerobic and resisted physical training program (38,39) . In the ET performance in 59 patients with average age of 11.4 years after extensive burns and inhalation lesions, no differences on the functional capacity were observed (40) . The ET performance in obese children and adolescents showed lower functional capacity in the presence of hyperinsulinemia (41) and in the metabolic syndrome (42) .…”

Section: Class IIImentioning

confidence: 83%

Indicações do teste ergométrico em crianças e adolescentes

Silva¹,

Saraiva²

2004

Rev Bras Med Esporte

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The exercise test (ET) is a low-risk procedure that presents extremely rare complications, especially among pediatric age populations. In this reviewing, the main ET indications in children and adolescents (age up to 19 years) are presented as a method of diagnostic, prognostic and functional evaluation in several situations: evaluation of the physical capacity, evaluation of symptoms related to exercise, evaluation of clinical and surgical treatments in patients with cardiomyopathies, congenital and valvar cardiopathies, asthmatic patients and pre-participation in physical activities programs, among others.Adult patients have as most frequent indication of ET the search for diagnostic information, when intermediate probability of significant coronary arterial disease occurs in the absence of significant alterations of the ECG in rest (1) . The ischemic disease is rare among young populations, what shows a significant difference in indication and interpretation and results in low risk in the ET routine in the pediatric age population. The complications are extremely rare even when ET is performed in children with congenital cardiopathies and arrhythmias. The ET applications in young individuals are mainly related to the measure of the physical capacity, evaluation of known cardiac abnormalities and evaluation of symptoms related to exercise (2) .

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“…After seeing some of the paediatric burn survivors with major physical deformities or amputations, one wonders whether it is worthwhile to save these individuals. McElroy et al [52] found that paediatric patients with a mean 46%TBSA studied 5 years later had the appropriate 8 Table 2 Functional impairment classi®cations…”

Section: Is It Worth It?mentioning

confidence: 99%