218 | Chapter 9 Figure 1. The 3D-printed connector A: The inside of the connector, the arrow shows where the HME is placed. A and C: This part is connected to the patient’s stoma by placing it into the adhesive baseplate. B and D: This part is connected to the computer for breathing gas-analysis. As visible in C and D: the two parts can by connected by sliding and locking it. Study design Participants were randomized into two groups (1:1) using opaque envelopes, which determined the order of the HMEs to be used during CPET-testing. During the test, patients were blinded to the HME in use, which was installed in the 3D-printed connector (Figure 1) by the researcher administering the test (Anne Heirman). Exercise Testing Protocol CPETs were conducted on two separate visits, with two weeks in between. The tests were performed using an electronically braked cycle ergometer (Lode Corival, ProCare, Groningen, The Netherlands). Throughout testing, the subject’s heart rate was continuously monitored with a 12-lead Electrocardiogram (ECG). Breathing-gasanalysis was carried out with a calibrated ergospirometry system (Jaeger Masterscreen CPX, Houten, The Netherlands). Directly after finishing the test, participants were asked to rate their perceived level of exertion and dyspnea, on a Borg scale ranging from 6-20, with 20 indicating maximal exertion24. Prior to testing, there was a five-minute period of slow pedaling so subjects could familiarize themselves with the bicycle. The test started with three minutes of unloaded cycling followed by an increase in load every minute until subjects could no longer maintain the desired cadence (between 60 and 80 RPM). The load was increased by 15 or 20 watts per minute, based on the
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