Perioperative cardiopulmonary exercise testing (CPET): consensus clinical guidelines on indications, organization, conduct, and physiological interpretation.

Levett DZH, Jack S, Swart M, Carlisle J, Wilson J, Snowden C,
Riley M, Danjoux G, Ward SA, Older P, Grocott MPW; Perioperative
Exercise Testing and Training Society (POETTS).

Br J Anaesth. 2018 Mar;120(3):484-500. doi: 10.1016/j.bja.2017.10.020. Epub 2017
Nov 24.

The use of perioperative cardiopulmonary exercise testing (CPET) to evaluate the
risk of adverse perioperative events and inform the perioperative management of
patients undergoing surgery has increased over the last decade. CPET provides an
objective assessment of exercise capacity preoperatively and identifies the
causes of exercise limitation. This information may be used to assist clinicians
and patients in decisions about the most appropriate surgical and non-surgical
management during the perioperative period. Information gained from CPET can be
used to estimate the likelihood of perioperative morbidity and mortality, to
inform the processes of multidisciplinary collaborative decision making and
consent, to triage patients for perioperative care (ward vs critical care), to
direct preoperative interventions and optimization, to identify new
comorbidities, to evaluate the effects of neoadjuvant cancer therapies, to guide
prehabilitation and rehabilitation, and to guide intraoperative anaesthetic
practice. With the rapid uptake of CPET, standardization is key to ensure valid,
reproducible results that can inform clinical decision making. Recently, an
international Perioperative Exercise Testing and Training Society has been
established (POETTS promoting the highest standards of care for
patients undergoing exercise testing, training, or both in the perioperative
setting. These clinical cardiopulmonary exercise testing guidelines have been
developed by consensus by the Perioperative Exercise Testing and Training Society
after systematic literature review. The guidelines have been endorsed by the
Association of Respiratory Technology and Physiology (ARTP).