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McDonald CF, Serginson J, AlShareef S, Buchan C, Davies H, Miller BR, Munsif M, Smallwood N, Troy L, Khor YH. Thoracic Society of Australia and New Zealand clinical practice guideline on adult home oxygen therapy. Respirology 2024. [PMID: 39009413 DOI: 10.1111/resp.14793] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 06/27/2024] [Indexed: 07/17/2024]
Abstract
This Thoracic Society of Australia and New Zealand Guideline on the provision of home oxygen therapy in adults updates a previous Guideline from 2015. The Guideline is based upon a systematic review and meta-analysis of literature to September 2022 and the strength of recommendations is based on GRADE methodology. Long-term oxygen therapy (LTOT) is recommended for its mortality benefit for patients with COPD and other chronic respiratory diseases who have consistent evidence of significant hypoxaemia at rest (PaO2 ≤ 55 mm Hg or PaO2 ≤59 mm Hg in the presence of hypoxaemic sequalae) while in a stable state. Evidence does not support the use of LTOT for patients with COPD who have moderate hypoxaemia or isolated nocturnal hypoxaemia. In the absence of hypoxaemia, there is no evidence that oxygen provides greater palliation of breathlessness than air. Evidence does not support the use of supplemental oxygen therapy during pulmonary rehabilitation in those with COPD and exertional desaturation but normal resting arterial blood gases. Both positive and negative effects of LTOT have been described, including on quality of life. Education about how and when to use oxygen therapy in order to maximize its benefits, including the use of different delivery devices, expectations and limitations of therapy and information about hazards and risks associated with its use are key when embarking upon this treatment.
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Affiliation(s)
- Christine F McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - John Serginson
- Department of Respiratory Medicine, Sunshine Coast Health, Birtinya, Queensland, Australia
- School of Nursing, Midwifery & Social Work, University of Queensland, St Lucia, Queensland, Australia
| | - Saad AlShareef
- Department of Medicine, College of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Saudi Arabia
| | - Catherine Buchan
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Huw Davies
- Respiratory and Sleep Services, Flinders Medical Centre, Southern Adelaide Local Health Network, South Australia, Australia
| | - Belinda R Miller
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Maitri Munsif
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| | - Natasha Smallwood
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Lauren Troy
- Department of Respiratory and Sleep Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Institute for Academic Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Yet Hong Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia
- Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
- Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Respiratory Research@Alfred, Central Clinical School, Monash University, Melbourne, Victoria, Australia
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Nardini S, Corbanese U, Visconti A, Mule JD, Sanguinetti CM, De Benedetto F. Improving the management of patients with chronic cardiac and respiratory diseases by extending pulse-oximeter uses: the dynamic pulse-oximetry. Multidiscip Respir Med 2023; 18:922. [PMID: 38322131 PMCID: PMC10772858 DOI: 10.4081/mrm.2023.922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/21/2023] [Indexed: 02/08/2024] Open
Abstract
Respiratory and cardio-vascular chronic diseases are among the most common noncommunicable diseases (NCDs) worldwide, accounting for a large portion of health-care costs in terms of mortality and disability. Their prevalence is expected to rise further in the coming years as the population ages. The current model of care for diagnosing and monitoring NCDs is out of date because it results in late medical interventions and/or an unfavourable cost-effectiveness balance based on reported symptoms and subsequent inpatient tests and treatments. Health projects and programs are being implemented in an attempt to move the time of an NCD's diagnosis, as well as its monitoring and follow up, out of hospital settings and as close to real life as possible, with the goal of benefiting both patients' quality of life and health system budgets. Following the SARS-CoV-2 pandemic, this implementation received additional impetus. Pulseoximeters (POs) are currently used in a variety of clinical settings, but they can also aid in the telemonitoring of certain patients. POs that can measure activities as well as pulse rate and oxygen saturation as proxies of cardio-vascular and respiratory function are now being introduced to the market. To obtain these data, the devices must be absolutely reliable, that is, accurate and precise, and capable of recording for a long enough period of time to allow for diagnosis. This paper is a review of current pulse-oximetry (POy) use, with the goal of investigating how its current use can be expanded to manage not only cardio-respiratory NCDs, but also acute emergencies with telemonitoring when hospitalization is not required but the patients' situation is debatable. Newly designed devices, both "consumer" and "professional," will be scrutinized, particularly those capable of continuously recording vital parameters on a 24-hour basis and coupling them with daily activities, a practice known as dynamic pulse-oximetry.
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Affiliation(s)
- Stefano Nardini
- Scientific Committee, Italian Multidisciplinary Respiratory Society (SIPI), Milan
| | - Ulisse Corbanese
- Retired - Chief of Department of Anaesthesia and Intensive Care, Hospital of Vittorio Veneto (TV)
| | - Alberto Visconti
- ICT Engineer and Consultant, Italian Multidisciplinary Respiratory Society (SIPI), Milan
| | | | - Claudio M. Sanguinetti
- Chief Editor of Multidisciplinary Respiratory Medicine journal; Member of Steering Committee of Italian Multidisciplinary Respiratory Society (SIPI), Milan
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Jiandani M, Kulsange N. Timed up and go test: An underutilized tool in patients with chronic respiratory disease. INDIAN JOURNAL OF RESPIRATORY CARE 2022. [DOI: 10.4103/ijrc.ijrc_110_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Pipek LZ, Nascimento RFV, Acencio MMP, Teixeira LR. Comparison of SpO 2 and heart rate values on Apple Watch and conventional commercial oximeters devices in patients with lung disease. Sci Rep 2021; 11:18901. [PMID: 34556765 PMCID: PMC8460792 DOI: 10.1038/s41598-021-98453-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 09/06/2021] [Indexed: 11/09/2022] Open
Abstract
Lung diseases have high mortality and morbidity, with an important impact on quality of life. Hypoxemic patients are advised to use oxygen therapy to prolong their survival, but high oxygen saturation (SpO2) levels can also have negative effects. Pulse oximeters are the most common way to assess oxygen levels and guide medical treatment. This study aims to assess whether wearable devices can provide precise SpO2 measurements when compared to commercial pulse oximeters. This is a cross-section study with 100 patients with chronic obstructive pulmonary disease and interstitial lung disease from an outpatient pneumology clinic. SpO2 and heart rate data were collected with an Apple Watch Series 6 (Apple) and compared to two commercial pulse oximeters. The Bland-Altman method and interclass correlation coefficient were used to compare their values. We observed strong positive correlations between the Apple Watch device and commercial oximeters when evaluating heart rate measurements (r = 0.995, p < 0.001) and oximetry measurements (r = 0.81, p < 0.001). There was no statistical difference in the evaluation of skin color, wrist circumference, presence of wrist hair, and enamel nail for SpO2 and heart rate measurements in Apple Watch or commercial oximeter devices (p > 0.05). Apple Watch 6 is a reliable way to obtain heart rate and SpO2 in patients with lung diseases in a controlled environment.
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Affiliation(s)
| | | | - Milena Marques Pagliarelli Acencio
- Laboratorio de Pneumologia/LIM09-Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Lisete Ribeiro Teixeira
- Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, São Paulo, Brazil
- Laboratorio de Pneumologia/LIM09-Divisao de Pneumologia, Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
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van Gastel M, Wang W, Verkruysse W. Reducing the effects of parallax in camera-based pulse-oximetry. BIOMEDICAL OPTICS EXPRESS 2021; 12:2813-2824. [PMID: 34168904 PMCID: PMC8194625 DOI: 10.1364/boe.419199] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 06/13/2023]
Abstract
Camera-based pulse-oximetry enables contactless estimation of peripheral oxygen saturation (SpO2). Because of the lack of readily available and affordable single-optics multi-spectral cameras, custom-made multi-camera setups with different optical filters are currently mostly used. The introduced parallax by these cameras could however jeopardise the SpO2 algorithm assumptions, especially during subject movement. In this paper we investigate the effect of parallax quantitatively by creating a large dataset consisting of 150 videos with three different parallax settings and with realistic and challenging motion scenarios. We estimate oxygen saturation values with a previously used global frame registration method and with a newly proposed adaptive local registration method to further reduce the parallax-induced image misalignment. We found that the amount of parallax has an important effect on the accuracy of the SpO2 measurement during movement and that the proposed local image registration reduces the error by more than a factor of 2 for the most common motion scenarios during screening. Extrapolation of the results suggests that the error during the most challenging motion scenario can be reduced to approximately 2 percent when using a parallax-free single-optics camera. This study provides important insights on the possible applications and use cases of remote pulse-oximetry with current affordable and readily available cameras.
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Affiliation(s)
- Mark van Gastel
- Philips Research, High Tech Campus 34, 5656AE, Eindhoven, Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, 5600MB, Eindhoven, Netherlands
| | - Wenjin Wang
- Philips Research, High Tech Campus 34, 5656AE, Eindhoven, Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, 5600MB, Eindhoven, Netherlands
| | - Wim Verkruysse
- Philips Research, High Tech Campus 34, 5656AE, Eindhoven, Netherlands
- Department of Electrical Engineering, Eindhoven University of Technology, 5600MB, Eindhoven, Netherlands
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Portable Oxygen Therapy: Is the 6-Minute Walking Test Overestimating the Actual Oxygen Needs? J Clin Med 2020; 9:jcm9124007. [PMID: 33322352 PMCID: PMC7764027 DOI: 10.3390/jcm9124007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/05/2020] [Accepted: 12/09/2020] [Indexed: 01/07/2023] Open
Abstract
The appropriate titration for the personalized oxygen needs of patients with chronic obstructive pulmonary disease (COPD) and severe hypoxemia is a determining factor in the success of long-term oxygen therapy. There are no standardized procedures to assist in determining the patient’s needs during the physical activities of daily life. Despite that effort tests are a wide broad approach, further research concerning the development of protocols to titrate O2 therapy is needed. The main objective of this study was to assess whether the level of oxygen titrated through the 6-minute walking test (6MWT) for patients with COPD and exertional hypoxemia is adequate to meet the patients’ demand during their activities of daily living. Physiological and subjective variables were estimated for a study population during two walking tests: a 6MWT and a 20-minute walking circuit (20MWC), designed ad-hoc to reproduce daily physical activities more truthfully. The results indicate that in a significant proportion of patients, the 6MWT might not accurately predict their oxygen needs at a domiciliary environment. Therefore, the titration of the portable O2 therapy could not be optimal in these cases, with the detrimental impact on the patient’s health (hyperoxia episodes), the autonomy of the oxygen device, and the decrease of time out of the home.
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Mayoralas-Alises S, Carratalá JM, Díaz-Lobato S. New Perspectives in Oxygen Therapy Titration: Is Automatic Titration the Future? Arch Bronconeumol 2018; 55:319-327. [PMID: 30414709 DOI: 10.1016/j.arbres.2018.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 08/24/2018] [Accepted: 09/05/2018] [Indexed: 10/27/2022]
Abstract
Oxygen therapy, like all technology-based treatments, is continuously evolving. There are no doubts as to its effectiveness in the treatment of acute and respiratory failure in different clinical scenarios. However, the dosing guidelines for oxygen therapy are not as strict as for other treatments. The use of higher than necessary flows over excessively long periods, derived from the clinician's perception of it as a 'life-saving treatment with few side effects', has led to a rather liberal use of this intervention, despite evidence that overuse and suboptimal adjustment can be harmful. The titration of oxygen therapy, which is traditionally performed manually, has been shown to be beneficial. Recently, new devices have been developed that automatically adjust oxygen flow rates to the needs of each patient, in order to maintain stable oxygen saturation levels. These closed-loop oxygen supply systems can potentially reduce medical error, improve morbidity and mortality, and reduce care costs. Familiarizing the medical community with these technological advances will improve awareness of the risks of the inappropriate use of oxygen therapy. The aim of this paper is to provide an update of recent developments in oxygen therapy titration.
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Affiliation(s)
| | - José Manuel Carratalá
- Unidad de Corta Estancia, Servicio de Urgencias, Hospital General de Alicante, Alicante, España
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Association between decreased respiratory function and increased blood pressure variability. Blood Press Monit 2017; 23:79-84. [PMID: 29266017 DOI: 10.1097/mbp.0000000000000310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The respiratory system is an important component in the control of the autonomic nervous system, and is a possible factor of blood pressure variability (BPV). We examined whether decreased respiratory function is associated with exaggerated BPV in hypertensives. PATIENTS AND METHODS This is a substudy of the Japan Morning Surge-Home Blood Pressure Study and patients who underwent both spirometry and ambulatory blood pressure monitoring (ABPM) in the Japan Morning Surge-Home Blood Pressure study were analyzed. In 95 hypertensives without known clinical respiratory diseases, we performed ABPM and the respiratory function test. RESULTS Percent vital capacity (%VC), but not forced expiratory volume in 1 s as a percentage of forced vital capacity, was associated with the SD (r=-0.23, P<0.05) and coefficient of variation (r=-0.25, P<0.05) of daytime systolic blood pressure (SBP). Lower %VC was associated with higher SD of daytime SBP (P=0.049 for trend). After adjusting for covariates, %VC tended to be associated with SD of daytime SBP (β=-0.22, P=0.08) and was associated with coefficient of variation of daytime SBP (β=-0.26, P=0.04). CONCLUSION Decreased respiratory function was associated with exaggerated ambulatory BPV, especially in the daytime in hypertensives without respiratory diseases. This is the first study to show an association between respiratory function and increased BPV as assessed by ABPM. The results of our study indicate that low respiratory function could exaggerate BPV, and thus may be one of the mechanisms underlying the elevated cardiovascular risk in patients with decreased respiratory function.
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Sant'Anna T, Donária L, Hernandes NA, Furlanetto KC, Barbosa DS, Gosselink R, Pitta F. Oxygen Desaturation in Daily Life and During a Laboratory-Based Protocol of Activities of Daily Living in COPD: Is There Relationship? Lung 2017; 196:19-26. [PMID: 29134264 DOI: 10.1007/s00408-017-0068-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To analyze the relationship between oxygen desaturation episodes during a laboratory-based ADL protocol and in real-life routine in patients with stable chronic obstructive pulmonary disease (COPD). METHODS Twenty patients with stable COPD (12 men, 70 ± 7 years, FEV1% 54 ± 15 predicted) with no indication for long-term oxygen therapy (LTOT) were submitted to assessments including ADL performance by the Londrina ADL Protocol (LAP) and level of physical activity in daily life, both while submitted to simultaneous activity and pulse oximeter monitoring. RESULTS Episodes of desaturation ≥ 4% (ED ≥ 4%) during the LAP were correlated both with ED ≥ 4% in daily life (r = 0.45) and number of episodes of SpO2 under 88% (ED < 88%) in daily life (r = 0.59). ED < 88% during the LAP was also correlated with ED < 88% in daily life (r = 0.51), explaining 43% of its variance. CONCLUSION In stable patients with COPD and no indication of LTOT, episodes of desaturation during a lab-based ADL protocol are moderately related to episodes of desaturation in daily (real) life, especially those episodes under 88%.
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Affiliation(s)
- Thaís Sant'Anna
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Av. Robert Koch, 60 - Vila Operária, Londrina, Parana, 86038-350, Brazil
| | - Leila Donária
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Av. Robert Koch, 60 - Vila Operária, Londrina, Parana, 86038-350, Brazil
| | - Nidia A Hernandes
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Av. Robert Koch, 60 - Vila Operária, Londrina, Parana, 86038-350, Brazil
| | - Karina C Furlanetto
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Av. Robert Koch, 60 - Vila Operária, Londrina, Parana, 86038-350, Brazil
| | - Décio S Barbosa
- Health Sciences Graduate Program, Health Sciences Center, State University of Londrina, Av. Robert Koch, 60 - Vila Operária, Londrina, Parana, 86038-350, Brazil
| | - Rik Gosselink
- Respiratory Division and Pulmonary Rehabilitation, University Hospitals, Katholieke Universiteit Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Fabio Pitta
- Laboratory of Research in Respiratory Physiotherapy, Department of Physiotherapy, State University of Londrina, Av. Robert Koch, 60 - Vila Operária, Londrina, Parana, 86038-350, Brazil.
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Imaizumi Y, Kario K, Eguchi K, Taketomi A. Daytime blood pressure surges following hypoxic episodes in a case of pneumoconiosis with lacunar stroke recurrences. Blood Press Monit 2017; 22:175-177. [PMID: 28263202 DOI: 10.1097/mbp.0000000000000237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Yuki Imaizumi
- aKotake Hospital bIizuka Municipal Hospital, Fukuoka cDepartment of Medicine, School of Medicine, Division of Cardiovascular Medicine, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Hardinge M, Annandale J, Bourne S, Cooper B, Evans A, Freeman D, Green A, Hippolyte S, Knowles V, MacNee W, McDonnell L, Pye K, Suntharalingam J, Vora V, Wilkinson T. British Thoracic Society guidelines for home oxygen use in adults: accredited by NICE. Thorax 2015; 70 Suppl 1:i1-43. [DOI: 10.1136/thoraxjnl-2015-206865] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mohktar MS, Sukor JA, Redmond SJ, Basilakis J, Lovell NH. Effect of Home Telehealth Data Quality on Decision Support System Performance. PROCEDIA COMPUTER SCIENCE 2015; 64:352-359. [DOI: 10.1016/j.procs.2015.08.499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Stolz D, Boersma W, Blasi F, Louis R, Milenkovic B, Kostikas K, Aerts JG, Rohde G, Lacoma A, Rakic J, Boeck L, Castellotti P, Scherr A, Marin A, Hertel S, Giersdorf S, Torres A, Welte T, Tamm M. Exertional hypoxemia in stable COPD is common and predicted by circulating proadrenomedullin. Chest 2014; 146:328-338. [PMID: 24722847 DOI: 10.1378/chest.13-1967] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The prevalence of exertional hypoxemia in unselected patients with COPD is unknown. Intermittent hypoxia leads to adrenomedullin (ADM) upregulation through the hypoxia-inducible factor-1 pathway. We aimed to assess the prevalence and the annual probability to develop exertional hypoxemia in stable COPD. We also hypothesized that increased ADM might be associated with exertional hypoxemia and envisioned that adding ADM to clinical variables might improve its prediction in COPD. METHODS A total of 1,233 6-min walk tests and circulating proadrenomedullin (proADM) levels from 574 patients with clinically stable, moderate to very severe COPD enrolled in a multinational cohort study and followed up for 2 years were concomitantly analyzed. RESULTS The prevalence of exertional hypoxemia was 29.1%. In a matrix derived from a fitted-multistate model, the annual probability to develop exertional hypoxemia was 21.6%. Exertional hypoxemia was associated with greater deterioration of specific domains of health-related quality of life, higher severe exacerbation, and death annual rates. In the logistic linear and conditional Cox regression multivariable analyses, both FEV1% predicted and proADM proved independent predictors of exertional hypoxemia (P < .001 for both). Adjustment for comorbidities, including cardiovascular disorders, and exacerbation rate did not influence results. Relative to using FEV1% predicted alone, adding proADM resulted in a significant improvement of the predictive properties (P = .018). Based on the suggested nonlinear nomogram, patients with moderate COPD (FEV1% predicted = 50%) but high proADM levels (> 2 nmol/L) presented increased risk (> 30%) for exertional desaturation. CONCLUSIONS Exertional desaturation is common and associated with poorer clinical outcomes in COPD. ADM improves prediction of exertional desaturation as compared with the use of FEV1% predicted alone. TRIAL REGISTRY ISRCTN Register; No.: ISRCTN99586989; URL: www.controlled-trials.com.
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Affiliation(s)
- Daiana Stolz
- Department of Pneumology, University Hospital, Basel, Switzerland.
| | - Wim Boersma
- Department of Pneumology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands
| | - Francesco Blasi
- Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy
| | - Renaud Louis
- Department of Pneumology, University of Liege, Liege, Belgium
| | - Branislava Milenkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Clinic for Pulmonary Diseases, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Joachim G Aerts
- Erasmus MC, Rotterdam and Amphia Hospital Breda, Breda, The Netherlands
| | - Gernot Rohde
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Alicia Lacoma
- Department of Microbiology, Hospital Universitari Germans Trais i Pujol, Badalona, Spain
| | - Janko Rakic
- Department of Pneumology, University Hospital, Basel, Switzerland
| | - Lucas Boeck
- Department of Pneumology, University Hospital, Basel, Switzerland
| | - Paola Castellotti
- Department of Pathophysiology and Transplantation, University of Milan, IRCCS Fondazione Cà Granda, Milan, Italy
| | - Andreas Scherr
- Department of Pneumology, University Hospital, Basel, Switzerland
| | - Alicia Marin
- Department of Microbiology, Hospital Universitari Germans Trais i Pujol, Badalona, Spain
| | - Sabine Hertel
- Clinical Diagnostics Division, Thermo Scientific Biomarkers, BRAHMS GmbH, Hennigsdorf, Germany
| | - Sven Giersdorf
- Clinical Diagnostics Division, Thermo Scientific Biomarkers, BRAHMS GmbH, Hennigsdorf, Germany
| | - Antoni Torres
- Pneumology Department, Hospital Clinic, University of Barcelona, IDIBAPS and CIBERES, Barcelona, Spain
| | - Tobias Welte
- Department of Pneumology, Medizinische Hochschule, Hannover, Germany
| | - Michael Tamm
- Department of Pneumology, University Hospital, Basel, Switzerland
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Faria I, Gaspar C, Zamith M, Matias I, das Neves RC, Rodrigues F, Bárbara C. TELEMOLD project: oximetry and exercise telemonitoring to improve long-term oxygen therapy. Telemed J E Health 2014; 20:626-32. [PMID: 24796364 DOI: 10.1089/tmj.2013.0248] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Standard assessment of long-term oxygen therapy (LTOT) prescription involves hospital-based clinical tests. However, there is some evidence suggesting that oxygen demand during daily activities may not be correctly estimated by such tests, when compared with continuous ambulatory oximetry. The authors describe the results of a study aiming to evaluate the clinical relevance of a home telemonitoring system in LTOT optimization. SUBJECTS AND METHODS Thirty-five chronic respiratory failure patients were monitored in real time with an oximeter sensor and an accelerometer. Signals were sent via Bluetooth(®) (Bluetooth SIG, Kirkland, WA) to a mobile phone and then via 3G or general packet radio service to a server. Continuous and secure access to data was established through an Internet site. RESULTS Each patient was monitored an average of 7.6 ± 4.5 days (total, 83 ± 67 h). Valid records were on average 65 ± 24%. Records of rest, activity, and sleep time per patient were, on average, 28 ± 21%, 7 ± 6%, and 59 ± 25%, respectively. Significant desaturation during rest, activity, and sleep was found in 2, 26, and 9 patients, respectively. Patients' ratings of the user-friendliness of the equipments, assessed by questionnaire, were fairly good (76% reported it as easy/very easy). CONCLUSIONS Our study suggests that a telemonitoring system combining oximetry and physical activity evaluation might contribute to a more adequate oxygen prescription, mainly during daily activities.
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Affiliation(s)
- Inês Faria
- 1 Service of Pneumology, EPE North Lisbon Hospital Center , Pulido Valente Hospital, Lisbon, Portugal
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Cutaia M, Brehm R, Cohen M. The relationship of the BODE index to oxygen saturation during daily activities in patients with chronic obstructive pulmonary disease. Lung 2011; 189:269-77. [PMID: 21701832 DOI: 10.1007/s00408-011-9308-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2010] [Accepted: 05/29/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND The frequency of oxygen desaturation during daily activities in chronic obstructive pulmonary disease (COPD) is poorly defined. The BODE index predicts survival in COPD. The purpose of this study was to determine the relationship between BODE scores and oxygen saturation during daily activities. METHODS Seventy-eight patients with COPD (FEV(1) = 37%) underwent ambulatory oximetry and activity monitoring. We defined four activity categories: Walking, Slow-Intermittent-Walking (SIW), Active-Not-Walking (ANW), and Rest. We quantified oxygen desaturation during activity using a desaturation index (DSI = % time oxygen saturation <90%). BODE scores were categorized into three groups: group I (0-3), II (4-6), and III (7-10). RESULTS The percentage of patients demonstrating oxygen desaturation (DSI ≥ 10%) during each activity was 55% for Walking, 35% for SIW, 15% for ANW, and 28% for Rest. There was a strong association between BODE score and desaturation for Walking and SIW. During Walking, 21, 44, and 86% of patients in BODE groups I, II, and III, respectively, demonstrated desaturation. The DSI for Walking and SIW was increased in patients in BODE groups II and III compared to group I (P < 0.006, P < 0.007, respectively). BODE score was also linked to long-term oxygen therapy (LTOT) usage; the majority of patients not on LTOT (89%) had a BODE score <7. The majority of patients on LTOT (84%) demonstrated desaturation during Walking, but 42% of patients not on LTOT also demonstrated desaturation. In this subgroup of patients not on LTOT, all patients with a BODE score ≥ 7 demonstrated desaturation during Walking. CONCLUSIONS The link between the BODE index and oxygen desaturation during daily activities suggests that desaturation is linked to disease severity. Our data suggest that patients with a BODE score ≥ 7 should be evaluated for desaturation during daily activities. Use of the BODE index to screen for exertional desaturation may have value as a tool that can lead to the earlier identification of patients who may be candidates for LTOT.
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Affiliation(s)
- Michael Cutaia
- Pulmonary and Critical Care Section, Department of Medicine, Veteran's Administration Medical Center, SUNY/Downstate Health Sciences Center, 800 Poly Place, Brooklyn, NY 11209, USA.
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Kochar R, Tanikella R, Fallon MB. Serial pulse oximetry in hepatopulmonary syndrome. Dig Dis Sci 2011; 56:1862-8. [PMID: 21327708 DOI: 10.1007/s10620-011-1600-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 01/27/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND/AIM The natural history of hepatopulmonary syndrome (HPS) is poorly characterized and how hypoxemia develops and progresses over time is unclear. We evaluated oxygenation over time in advanced liver disease patients with and without HPS using serial pulse oximetry. METHODS Data from a prospective cohort of patients evaluated for liver transplantation were analyzed. All patients with significant cardiopulmonary disease were excluded and patients with and without HPS were compared. Arterial oxygen saturation measurements with pulse oximetry (SpO(2)) were recorded serially from initial evaluation until transplantation or last clinic visit on record. Patients with SpO(2) measurements at ≥ 2 visits were included. RESULTS A total of 22 HPS patients were compared to 32 non-HPS patients (18 with intrapulmonary vasodilation on contrast echocardiography, CE) over a mean duration of 20 months and 4 SpO(2) measurements. HPS patients had lower SpO(2) at baseline (96.8 vs. 98.4%, P = 0.02) and at end of follow-up (95.8 vs. 98.2%, P = 0.02), and were more likely to have a ≥ 2% reduction (P = 0.04) and faster decline in SpO(2) as compared to non-HPS patients (F = 2.2, P = 0.04). HPS patients with lower SpO(2) and/or PO(2) at baseline appeared more likely to worsen over time. There was no difference in SpO(2) over time between the 2 non-HPS subgroups (- or +CE). CONCLUSIONS HPS patients have a significant decline in SpO(2) over time compared to non-HPS patients, and therefore, pulse oximetry may be useful for monitoring cirrhotics for development or worsening of HPS. Presence of intrapulmonary vasodilation in the absence of hypoxemia does not appear to affect SpO(2) over time.
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Affiliation(s)
- Rajan Kochar
- Division of Gastroenterology, Hepatology and Nutrition, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.234, Houston, TX 77030, USA.
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Park JH, Jegal Y, Shim TS, Lim CM, Lee SD, Koh Y, Kim WS, Kim WD, du Bois R, Do KH, Kim DS. Hypoxemia and arrhythmia during daily activities and six-minute walk test in fibrotic interstitial lung diseases. J Korean Med Sci 2011; 26:372-8. [PMID: 21394305 PMCID: PMC3051084 DOI: 10.3346/jkms.2011.26.3.372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 01/21/2011] [Indexed: 11/20/2022] Open
Abstract
We performed 24-hr monitoring of pulse oximetric saturation (SpO(2)) with ECG and six-minute walk test (6MWT) in 19 patients with fibrotic interstitial lung diseases (ILD) to investigate; 1) The frequency and severity of hypoxemia and dysrhythmia during daily activities and 6MWT, 2) safety of 6MWT, and 3) the parameters of 6MWT which can replace 24-hr continuous monitoring of SpO(2) to predict hypoxemia during daily activities. All patients experienced waking hour hypoxemia, and eight of nineteen patients spent > 10% of waking hours in hypoxemic state. Most patients experienced frequent arrhythmia, mostly atrial premature contractions (APCs) and ventricular premature contractions (VPCs). There were significant correlation between the variables of 6MWT and hypoxemia during daily activities. All of the patients who desaturated below 80% before 300 meters spent more than 10% of waking hour in hypoxemia (P = 0.018). In contrast to waking hour hypoxemia, SpO(2) did not drop significantly during sleep except in the patients whose daytime resting SpO(2) was already low. In conclusion, patients with fibrotic ILD showed significant period of hypoxemia during daily activities and frequent VPCs and APCs. Six-minute walk test is a useful surrogate marker of waking hour hypoxemia and seems to be safe without continuous monitoring of SpO(2).
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Affiliation(s)
- Jeong Hyun Park
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Yangjin Jegal
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Tae Sun Shim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Chae-Man Lim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Sang Do Lee
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Younsuck Koh
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Woo Sung Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Won Dong Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Roland du Bois
- National Jewish Hospital, University of Colorado, Denver, USA
| | - Kyung-Hyun Do
- Department of Radiology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
| | - Dong Soon Kim
- Division of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea
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Panos RJ, Eschenbacher W. Exertional desaturation in patients with chronic obstructive pulmonary disease. COPD 2010; 6:478-87. [PMID: 19938972 DOI: 10.3109/15412550903341497] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Although the Centers for Medicare and Medicaid Services oxygen prescription guidelines utilize a threshold arterial oxygen tension <or=55 mmHg or an oxygen saturation <or=88%, a range of oxygen levels and relative declines have been used in investigations of exertional desaturation in patients with chronic obstructive pulmonary disease (COPD). There is no uniform definition of exertional hypoxemia or standardized exercise protocol to elicit decreases in oxygen levels in individuals with COPD. The causes for exertional desaturation in patients with COPD are multifactorial with ventilation-perfusion mismatching, diffusion-type limitation, shunting and reduced oxygen content of mixed venous blood all contributing to some degree. Neither resting oxygen saturation nor pulmonary function studies can reliably predict which patients with COPD will develop exertional desaturation. However, preserved pulmonary function, especially diffusing capacity, reliably predicts which patients with COPD will sustain oxygenation during exercise. Although exertional desaturation in patients with COPD appears to portend a poor prognosis, there is no evidence that maintenance of normoxemia during exercise improves the survival of these patients. Studies of the effect of supplemental oxygen on exercise performance in individuals with COPD who desaturate with exertion have yielded conflicting results. The use of short-term or "burst" oxygen either prior to or after exertion may not have significant clinical benefit. Differences in the definition of desaturation, mode of exercise, and characteristics of the patient population make it difficult to compare studies of exertional desaturation and its treatment and to determine their applicability to clinical practice.
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Affiliation(s)
- Ralph J Panos
- Pulmonary, Critical Care, and Sleep Division, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio 45220, USA.
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Kishimoto A, Tochikubo O, Ohshige K. Relation between Nocturnal Arterial Oxygen Desaturation and Morning Blood Pressure. Clin Exp Hypertens 2009; 29:51-60. [PMID: 17190731 DOI: 10.1080/10641960601096786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Arterial oxygen saturation (SpO2) in volunteers had been previously investigated, and the possibility that a decrease in SpO2 leads to an increase in blood pressure (BP) in airline passengers experiencing oxygen desaturation at high altitudes was reported. It was also shown that mean nocturnal SpO2 was lower in subjects with high-normal BP or mild hypertension than in those with normal BP. The present study investigated nocturnal SpO2, evening BP, and morning BP of volunteers during daily life and examined the relation between nocturnal SpO2 and change in BP (morning BP minus evening BP) to determine the influence of SpO2 on BP. METHODS Sixty-two volunteers (31 men and 31 women) aged 40-87 years (mean: 55.9 +/- 12 [SD] years) underwent measurement of SpO2 and heart rate with a ring-shaped pulse oximeter during sleep at home. Evening BP and morning BP were measured by automatic BP recorder. Subjects that were classified as having high SpO2 (mean nocturnal SpO2 >or= 95%; n = 23, 10 men and 13 women; mean age: 53.2 +/- 12 years) or low SpO2 (mean nocturnal SpO2 < 94%; n = 21, 12 men and 9 women; mean age: 58.7 +/- 13 years) were compared. The relation between mean nocturnal SpO2 and morning BP and the relation between mean nocturnal SpO2 and change in BP were investigated. RESULTS There was a significant negative correlation between mean nocturnal SpO2 and morning systolic BP (SBP; r = -0.50, p < 0.01) and between mean nocturnal SpO2 and morning diastolic BP (DBP; r = -0.37, p < 0.01). A significant negative correlation between mean nocturnal SpO2 and change in SBP was observed (r = -0.57, p < 0.01). Morning BP was significantly higher in the low nocturnal SpO2 group than in the high nocturnal SpO2 group (p < 0.001). CONCLUSION The increase in morning BP from evening BP was significantly greater in subjects with a low nocturnal SpO2. The decrease in SpO2 during sleep may affect morning BP rise.
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Affiliation(s)
- Aya Kishimoto
- Department of Public Health, Yokohama City University School of Medicine, Yokohama, Japan
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García-Talavera I, García CH, Macario CC, de Torres JP, Celli BR, Aguirre-Jaime A. Time to desaturation in the 6-min walking distance test predicts 24-hour oximetry in COPD patients with a PO2 between 60 and 70mmHg. Respir Med 2008; 102:1026-32. [DOI: 10.1016/j.rmed.2008.02.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 01/17/2008] [Accepted: 02/02/2008] [Indexed: 10/22/2022]
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Marrone O, Salvaggio A, Insalaco G. Respiratory disorders during sleep in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2008; 1:363-72. [PMID: 18044093 PMCID: PMC2707801 DOI: 10.2147/copd.2006.1.4.363] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Patients with COPD may show slow, progressive deteriorations in arterial blood gases during the night, particularly during rapid eye movement (REM) sleep. This is mainly due to hypoventilation, while a deterioration of ventilation/perfusion mismatch plays a minor role. The severity of gas exchanges alterations is proportional to the degree of impairment of diurnal pulmonary function tests, particularly of partial pressure of oxygen (PaO2) and of carbon dioxide (PaCO2) in arterial blood, but correlations between diurnal and nocturnal blood gas levels are rather loose. Subjects with diurnal PaO2 of 60–70 mmHg are distinguished in “desaturators” and “nondesaturators” according to nocturnal oxyhemoglobin saturation behavior. The role of nocturnal hypoxemia as a determinant of alterations in sleep structure observed in COPD is dubious. Effects of the “desaturator” condition on pulmonary hemodynamics, evolution of diurnal blood gases, and life expectancy are also controversial. Conversely, it is generally accepted that occurrence of sleep apneas in COPD is associated with a worse evolution of the disease. Nocturnal polysomnographic monitoring in COPD is usually performed when coexistence of sleep apnea (“overlap syndrome”) is suspected, while in most other cases nocturnal oximetry may be enough. Nocturnal oxygen attenuates sleep desaturations among stable patients, without increases in PaCO2 of clinical concern. Nocturnal treatment with positive pressure ventilators may give benefit to some stable hypercapnic subjects and patients with the overlap syndrome.
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Affiliation(s)
- Oreste Marrone
- Istituto di Biomedicina e Immunologia Molecolare, Consiglio Nazionale delle Ricerche, Palermo, Italy.
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22
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Nonoyama ML, Brooks D, Guyatt GH, Goldstein RS. Effect of Oxygen on Health Quality of Life in Patients with Chronic Obstructive Pulmonary Disease with Transient Exertional Hypoxemia. Am J Respir Crit Care Med 2007; 176:343-9. [PMID: 17446339 DOI: 10.1164/rccm.200702-308oc] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Ambulatory oxygen improves acute exercise performance in people with chronic obstructive pulmonary disease (COPD). This improvement may not translate into symptomatic benefit for patients during activities of daily living. OBJECTIVES We undertook a series of individual randomized controlled trials (N-of-1 RCTs) to measure the effect of oxygen in patients with COPD who do not meet criteria for mortality reduction with long-term oxygen therapy. METHODS Twenty-seven patients completed blinded N-of-1 RCTs, each comprising three pairs of 2-week home treatment periods, with oxygen provided during one period of each pair and a placebo mixture during the other. MEASUREMENTS AND MAIN RESULTS Patients completed the Chronic Respiratory Questionnaire (CRQ), the St. George's Respiratory Questionnaire, and a home five-minute-walk test at the end of each period. We defined a positive response as a CRQ dyspnea score greater (less dyspnea) on oxygen than placebo during all three pairs of treatment periods, with a difference >or= 0.5 inches for at least two treatment pairs. Oxygen significantly increased the five-minute-walk test (427 vs. 412 steps, p = 0.04). Two of 27 patients met the responder criteria. Among the whole group, neither the CRQ nor the St. George's Respiratory Questionnaire showed any statistical or clinical differences between oxygen and placebo. CONCLUSIONS This study does not support the general application of long-term ambulatory oxygen therapy for patients with COPD who do not meet criteria for mortality reduction with long-term oxygen therapy. N-of-1 RCTs can identify patients who may benefit.
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Affiliation(s)
- Mika L Nonoyama
- West Park Healthcare Centre, 82 Buttonwood Avenue, Toronto, ON, M6M 2J5 Canada
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23
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Iobbi MG, Simonds AK, Dickinson RJ. Oximetry feedback flow control simulation for oxygen therapy. J Clin Monit Comput 2007; 21:115-23. [PMID: 17205376 DOI: 10.1007/s10877-006-9064-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2006] [Accepted: 11/26/2006] [Indexed: 11/28/2022]
Abstract
OBJECTIVES For many with Chronic Obstructive Pulmonary Disease (COPD), arterial oxygen saturation while receiving Long-Term Oxygen Therapy (LTOT) falls below an acceptable threshold (SpO(2) < 90%) for extended periods during routine daily activities. Using a closed-loop controller, we have evaluated a simulated method to automatically regulate the oxygen flow-rate in response to the measured oxygen demand. METHODS The closed-loop control scheme was implemented in a computer simulation on Simulink. Feedback from a pulse oximeter was used to maintain a target SpO(2) of 91% by changing the oxygen flow-rate to the patient. The controller was evaluated using a model to approximate the patient's arterial oxygen saturation response, including hypoxic events from artificial disturbances as well as recorded patient oximetry data. RESULTS The simulated controller produced improvement in arterial oxygen saturation throughout a wide range of disturbance frequencies. It suppressed disturbances with periods greater than a couple of minutes by more than -10 dB. When evaluated with patient oximetry recordings, the controller on average reduced the time spent with arterial blood saturation below threshold by 76%. Given the same volume of oxygen, the closed-loop controller also produced a 63% improvement compared to fixed flow-rate LTOT. CONCLUSIONS The simulation findings indicate an optimized matching between oxygen supply and demand, maintaining SpO(2) above threshold to improve therapeutic efficacy compared to standard LTOT.
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Affiliation(s)
- Mario G Iobbi
- Department of Bioengineering, South Kensington Campus, Imperial College London, London, SW7 2AZ, UK
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Zhu Z, Barnette RK, Fussell KM, Michael Rodriguez R, Canonico A, Light RW. Continuous oxygen monitoring--a better way to prescribe long-term oxygen therapy. Respir Med 2006; 99:1386-92. [PMID: 15878655 DOI: 10.1016/j.rmed.2005.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2004] [Accepted: 03/09/2005] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE The purpose of this study was to determine if an oxygen prescription based on continuous oximetry monitoring, would result in an increased percentage of time spent within an SpO2 level between 88% and 92%. METHODS We conducted a prospective, cohort study in an outpatient, pulmonary setting in a tertiary care referral center, on 17 patients with stable chronic obstructive pulmonary disease (COPD) who had previously been prescribed long-term oxygen therapy. The patients were monitored for approximately 24h with a portable oximeter that recorded SpO2 and EKG readings. During the initial 24h of monitoring, the patients were on their previous oxygen prescription. Their oxygen prescription was then altered based on a predetermined protocol described below. The patients were then monitored for an additional 24h. RESULTS Sixteen patients completed the study. Based on the initial continuous oximetry, the median oxygen prescription was reduced from 2.5 to 1.2 L/min (P < 0.001). The oxygen prescription during exercise, rest, and sleep decreased from 3.0 +/- 0.9 to 1.8 +/- 1.3 L/min (P < 0.001), 2.2+/-0.4 to 0.8 +/- 0.7 L/min (P < 0.001), and 2.2 +/- 0.4 to 0.9 +/- 0.8 L/min (P < 0.001) respectively. After the oxygen prescription was adjusted, the percentage of the time that the SpO2 was between 88 and 92% increased from 24.8 +/- 21.7% to 52.8 +/- 25.0% (P = 0.001), but the percentage of time that the SpO2 was below 88% did not change significantly (2.8 +/- 6.1% to 4.3 +/- 8.1%). CONCLUSIONS This study demonstrates that an oxygen prescription based on continuous oximetry monitoring results in (1) a significant increase in the percentage of time that the SpO2 is between 88% and 92%, (2) a significant decrease in the amount of oxygen prescribed, (3) a slight increase in the amount of time that the SpO2 is below 88% that was not statistically significant.
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Affiliation(s)
- Zhiwen Zhu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, PR China
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Neri M, Melani AS, Miorelli AM, Zanchetta D, Bertocco E, Cinti C, Canessa PA, Sestini P. Long-term oxygen therapy in chronic respiratory failure: A Multicenter Italian Study on Oxygen Therapy Adherence (MISOTA). Respir Med 2006; 100:795-806. [PMID: 16242926 DOI: 10.1016/j.rmed.2005.09.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 09/08/2005] [Accepted: 09/11/2005] [Indexed: 11/24/2022]
Abstract
BACKGROUND The adherence to the prescribed oxygen therapy is difficult to obtain for patients on long-term oxygen therapy (LTOT). There is little information on the modalities of oxygen utilisation for patients on LTOT who are using liquid oxygen in real life. STUDY OBJECTIVE Evaluation of the behaviour and the knowledge regarding LTOT in a large group of patients mainly using liquid oxygen. DESIGN AND SETTING Questionnaire administered to consecutive outpatients on domiciliary LTOT for at least 6 months referring to one of 20 clinics throughout Italy. Blinded to this result, the physician who cared for the patient completed another questionnaire. RESULTS We evaluated 1504 patients (mean age 71.6 years; males 64%; 74% suffering from COPD). Most respondents (93%) used liquid oxygen with mobile device. Fifteen per cent of patients had a prescribed length of oxygen therapy less than 15 h/day; 21% reported to practice oxygen for less than 15 h/day. Patients reported using oxygen for less hours than had been prescribed during the day at rest (P=0.02, k=0.80) during exercise (P=0.002, k=0.72) and at night (P=0.0036, k=0.77). There was no difference between the flow prescribed by the physician and that known and practised by the patient at rest or during sleep; during exercise the flow reported by patients was lower than that prescribed by the physician. Patients used in the night but not at rest or during exercise, a lower level of oxygen flow than what they knew had been prescribed. Fifty-five per cent of patients received indications to modify the oxygen flow in the various situations of life. Liquid oxygen was almost always useful to decrease breathlessness. Most (84%) patients possessed a mobile device, but only 40% declared they used it daily, 'shame' being indicated as the principal barrier. On the physicians' side, we found that the criteria used in prescribing did not always correspond to evidence-based recommendations. CONCLUSION The widespread use of liquid oxygen did not automatically assure optimal adherence to the prescribed treatment as regards times and modality of oxygen use. A better education of patients, relatives, and the general public, as well as increased self-assessment on the part of health caregivers would improve the practice of LTOT in Italy.
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Affiliation(s)
- Margherita Neri
- Pneumologia, Fondazione S Maugeri I.C.C.R.S Istituto Scientifico di Tradate VA, Italy
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Morante F, Güell R, Mayos M. Eficacia de la prueba de los 6 minutos de marcha en la valoración de la oxigenoterapia de deambulación. Arch Bronconeumol 2005. [DOI: 10.1157/13081247] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Morante F, Güell R, Mayos M. Efficacy of the 6-Minute Walk Test in Evaluating Ambulatory Oxygen Therapy. ACTA ACUST UNITED AC 2005; 41:596-600. [PMID: 16324597 DOI: 10.1016/s1579-2129(06)60292-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare oxyhemoglobin saturation (SpO2) observed during the 6-minute walk test with that of pulse oximetry carried out during activities of daily living (ADLs). The efficacy of the 6-minute walk test for determining adequate oxygen flow to prevent arterial desaturation during ADLs was also analyzed. PATIENTS AND METHODS We studied 37 patients diagnosed with chronic obstructive pulmonary disease (COPD)--mean (SD) forced expiratory volume in 1 second, 26% (9%) of predicted--and compared SpO2 values obtained in the 6-minute walk test with those obtained with ambulatory pulse oximetry during ADLs. Eleven of the 20 patients with exercise-induced desaturation agreed to use portable liquid oxygen and were randomized to ambulatory pulse oximetry on 2 consecutive days, both with and without the administration of oxygen. Oxygen flow was adjusted on successive 6-minute walk tests until a mean SpO2 greater than 85% was reached. RESULTS The mean SpO2 for all patients was 84% (7%) during the 6-minute walk test and 89% (4%) during ADLs (P<.001). Cumulative percentages of time with SpO2 less than 90%, 88%, and 85% were higher during the 6-minute walk test than during ADLs (P<.001). During the walk test, desaturation was detected in 27% of patients, but was not confirmed by ambulatory pulse oximetry during ADLs. In the subgroup of 11 patients using portable liquid oxygen no significant differences were found between SpO2 values recorded during the walk test and during ADLs with the appropriate oxygen flow. CONCLUSION The 6-minute walk test is an effective method for detecting desaturation during ADLs and for establishing the oxygen flow needed to correct exercise-induced desaturation.
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Affiliation(s)
- F Morante
- Departament de Pneumologia, Hospital de la Santa Creu i de Sant Pau, Barcelona, Spain.
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Status of Research on Selected Cardiopulmonary Tests and Measures Utilized in the Rehabilitation of Geriatric Patients. TOPICS IN GERIATRIC REHABILITATION 2005. [DOI: 10.1097/00013614-200507000-00008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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The Integration of the Guide to Physical Therapy Practice in the Management of a Geriatric Patient With Chronic Obstructive Pulmonary Disease. TOPICS IN GERIATRIC REHABILITATION 2005. [DOI: 10.1097/00013614-200504000-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
The Department of Veterans Affairs (VA) Health Care System is the largest integrated single-payer system in the United States. Its primary mission is to provide primary care, specialized care, and related medical and social support services to veterans. Much time and resources are expended on chronic obstructive pulmonary disease, known as COPD, at VA hospitals and clinics, thereby justifying the development of multifaceted strategies to address this problem. This article discusses the special problems of COPD in veterans who use VA facilities. The article also highlights the contributions of the VA to the research, training, and development of clinical practice guidelines for the management of this pervasive disease and presents the challenges that threaten its role in this area.
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Affiliation(s)
- Jesse Roman
- Division of Pulmonary, Allergy and Critical Care Medicine, Atlanta VA Medical Center, Emory University School of Medicine, Atlanta, Georgia, USA
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Ambulatory Monitoring of Oxygen Saturation in Chronic Lung Disease: Optimizing Long-Term Oxygen Therapy. ACTA ACUST UNITED AC 2002. [DOI: 10.1097/00045413-200211000-00001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Eaton T, Rudkin S, Garrett JE. The clinical utility of arterialized earlobe capillary blood in the assessment of patients for long-term oxygen therapy. Respir Med 2001; 95:655-60. [PMID: 11530953 DOI: 10.1053/rmed.2001.1118] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The prescription of long-term oxygen (LTOT) is underpinned by the measurement of arterial PO2, generally obtained by radial artery puncture. This test is commonly associated with patient discomfort and a test that is reliable, well-tolerated and non-invasive would be advantageous. Cutaneous oximetry has not proved sufficiently accurate. Arterialized earlobe capillary sampling has been proposed, with some authors stating that it is under-utilized. However, to date studies have yielded conflicting results and the clinical utility remains uncertain. Our regional oxygen service based at a specialist respiratory hospital undertook a prospective study of consecutive patients with chronic respiratory disease undergoing assessment for LTOT. Simultaneous radial artery and arterialized earlobe sampling was performed. Rigorous steps were taken to ensure optimal arterialization of the earlobe samples. Agreement between arterial and arterialized PO2 and PCO2 was compared using the Bland-Altman method. One hundred patients were studied. Procedural difficulties (insufficient sample or air in sample) were similar for both procedures, however clotting occurred more frequently in arterialized earlobe samples. Sixty-four sample pairs were available for comparison. The bias and limits of agreement between arterialized and arterial PO2 were wide, mean (+/- 2 SD), -048 (-2.05-1.09) kPa. The bias and limits of agreement for PCO2 were smaller. Using the absolute criterion (arterial PO2 < 7.3 kPa), 9/55 (16%) patients would receive oxygen inappropriately based on the arterialized earlobe sample. Conversely, no patients would have been denied LTOT. Radial artery puncture gave rise to significantly greater discomfort (P < 0.0001) and level of concern (P < 0.0001). Patient preference strongly favoured arterialized earlobe sampling. However, despite rigorous attention to arterialization earlobe sampling was insufficiently accurate to replace radial artery puncture in the prescription of LTOT.
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Affiliation(s)
- T Eaton
- Department of Respiratory Medicine and Clinical Physiology, Green Lane Hospital, Auckland, New Zealand.
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Guyatt GH, McKim DA, Weaver B, Austin PA, Bryan RE, Walter SD, Nonoyama ML, Ferreira IM, Goldstein RS. Development and testing of formal protocols for oxygen prescribing. Am J Respir Crit Care Med 2001; 163:942-6. [PMID: 11282770 DOI: 10.1164/ajrccm.163.4.2002135] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The absence of standardized assessment protocols with well- defined measurement properties limits comparison of outcomes among those receiving long-term oxygen therapy (LTOT). We describe simple protocols for a hospital test, a simulated home test, and an actual home test, their reliability and relationship to each other. Stable patients with exercise hypoxemia participated. In 74 patients who completed four exercise tests, correlations between tests ranged from 0.85 to 0.78. Of these 27.0% had the same prescription from all four tests. In 46% prescriptions were within 1 L/ min and in 27% within 2 L/min. During exercise the hospital tests suggested slightly higher oxygen prescriptions than did the simulated home tests (2.5 L/min versus 2.0 L/min, p < 0.001). In 23 patients who participated in actual home assessments, the correlations between the home test, the hospital, and the simulated home tests were 0.22 (95% CI -0.24 to 0.67) and 0.27 (95% CI -0.18 to 0.72). In conclusion, standardizing tests for the assessment of LTOT is important. We describe simple hospital and simulated home tests that are reproducible, easy to carry out, and correlate well with each other.
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Affiliation(s)
- G H Guyatt
- Department of Clinical Epidemiology and Biostatistics and Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Cutaia M. New insights into the temporal pattern of hypoxemia in COPD. Chest 2000; 118:1521-2. [PMID: 11115431 DOI: 10.1378/chest.118.6.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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