title: Cardiopulmonary fitness and respirator clearance: an update.
abstract: This review addresses five key questions regarding respirator clearance: What is the efficacy of different methods of respirator clearance? Which diagnostic test is most predictive of cardiac event during respirator use? Is spirometry accurate in predicting respiratory distress/insufficiency during respirator use? Is exercise tolerance testing accurate in predicting cardiac injury during respirator use? Which periodicity of clearance evaluations is most protective against cardiac event during respirator use? The medical literature was searched using PubMed, the Cochrane Library, and Web of Science. Relevant articles were reviewed to assess current recommendations and practices in respirator clearance. Between the years 1970 and 2011, 144 articles were identified, and 21 were included in this review. Current recommendations for respirator clearance are based on consensus rather than outcome studies, and opinions differed between expert sources. Many authors observed the need for cost-effective respirator clearance, but none proposed evidence-based strategies. Prospective studies on respirator clearance that evaluate cardiac and pulmonary outcomes are necessary to establish an evidence base for improving the validity, efficiency, and consistency of respirator clearance testing.
authors.affiliation: University of California, Davis, School of Medicine , Department of Public Health Sciences , Davis , California, USA. srbelafsky@ucdavis.edu.
authors.forename: Sheri
authors.initials: S
authors.lastname: Belafsky
authors.forename: Justin
authors.initials: J
authors.lastname: Vlach
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McCurdy
mesh_terms: D017079:Exercise Tolerance; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000517:prevention & control; D016273:Occupational Exposure / Q000517:prevention & control*; D010809:Physical Fitness; D012131:Respiratory Insufficiency / Q000175:diagnosis*; D012134:Respiratory Protective Devices / Q000009:adverse effects*; D012307:Risk Factors; D013147:Spirometry; D013997:Time Factors; D014481:United States; D014489:United States Occupational Safety and Health Administration