Significant exercise-induced hypoxaemia with equivocal desaturation in patients with chronic obstructive pulmonary disease

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Abstract:

Abstract Background:

The wide 95% confidence interval for SaO2 measured by pulse oximetry (SPO2) and the inherent characteristics of the oxyhaemoglobin dissociation curve can lead to modest but significant decreases in PaO2PaO2 ≥ 5 mmHg) that may be under-appreciated. Aim:

To avoid missing potentially significant ΔPaO2 by using SPO2, this study establishes a threshold of ΔSPO2 to detect ΔPaO2 by examining the correlation between ΔSPO2 and ΔPaO2. Methods:

We enrolled 29 elderly patients with moderate to severe chronic obstructive pulmonary disease as assessed by lung function testing. Arterial blood gases and SPO2 measurements were carried out during maximal exercise testing. The patients were assigned to groups based on PaO2 measurements: group 1 had PaO2 at peak exercise (PaO2peak) ≥60 mmHg without a ΔPaO2; group 2 had PaO2peak ≥ 60 mmHg with a ΔPaO2; group 3 had PaO2peak < 60 mmHg without a ΔPaO2; and group 4 had PaO2peak < 60 mmHg with a ΔPaO2. Results:

The study population was evenly distributed between groups 1, 2 and 4. However, group 3 did not have any patients enrolled in this study that met group 3 criteria. The sensitivity of pulse oximetry required to detect SaO2 below 90% was 19%. ΔSPO2 of 3% may increase the low sensitivity of SPO2 and was shown by a 92% positive predictive value for ΔPaO2 ≥ 5 mmHg. Conclusion:

This study suggests that important changes in oxygenation may be avoided if using ΔSPO2 rather than absolute values of SPO2 in patients with chronic obstructive pulmonary disease undergoing exercise testing to detect exercise-induced hypoxaemia.

Keywords: blood gas analysis; carboxyhaemoglobin; cycle ergometer; pulse oximetry; validation

Document Type: Research Article

DOI: http://dx.doi.org/10.1111/j.1445-5994.2006.01069.x

Affiliations: 1: Division of Respiratory and Critical Care Physiology and Medicine, Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA 2: Division of Pulmonary and Critical Care Medicine, En-Tzu-Gong Memorial Hospital, Sanshiah, Taipei, 3: Department of Pathology, Chang-Gung Memorial Hospital, Taoyuan, Taiwan 4: Division of Pulmonary and Critical Care Medicine, Buddhist Taipei Tzu Chi General Hospital, Xindian City,

Publication date: May 1, 2006

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