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Inability of single resting arterial blood gas to predict significant hypoxaemia in chronic obstructive pulmonary disease.
MedLine Citation:
PMID:  21118412     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Background:  While point measurement of resting arterial partial pressure of oxygen (P(a) O(2) ) is the traditional gold-standard for assessment of oxygenation in chronic obstructive pulmonary disease (COPD), 24-h oximetry may identify further patients with clinically significant hypoxaemia. We aimed to describe the relationship between these two parameters and identify other correlated variables. Methods:  All patients registered with the Barwon Health Hospital Admission Risk Program from 1 March to 31 October 2008 for the diagnosis of COPD were identified. The main inclusion criteria were obstructive spirometry, clinical stability and moderate resting hypoxaemia (P(a) O(2) 56-70 mmHg). All patients underwent 24-h oximetry, arterial blood gas, spirometry, anthropometry and telephone questionnaire, and 23 patients also completed polysomnography. Results:  Inclusion criteria were met in 35 of 287 patients. Mean recording time was 23.5 h, representing 97% of intended oximetry time. Nineteen patients (54%) spent greater than 30% of recorded oximetry time below 90%. There was a moderate inverse correlation between time below 90% saturations and P(a) O(2) (r=-0.40, P= 0.02), with body mass index (BMI) the only other independent predictor of the primary outcome identified (r= 0.39, P= 0.02). Correlations were similar for waking hours considered separately. However, for sleeping oximetry, BMI and age were the only independent predictors of time below 90%. Polysomnography demonstrated a high prevalence of rapid eye movement-related hypoventilation and obstructive sleep apnoea syndrome. Conclusions:  Many patients with moderate hypoxaemia on resting P(a) O(2) desaturate significantly on ambulatory oximetry. The correlation between P(a) O(2) and proportion of saturations below 90% is moderate and similar to BMI, but this pattern does not hold during sleeping hours.
Authors:
J M Trauer; C Gielen; T Trauer; C L Steinfort
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Internal medicine journal     Volume:  42     ISSN:  1445-5994     ISO Abbreviation:  Intern Med J     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-04-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101092952     Medline TA:  Intern Med J     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  387-94     Citation Subset:  IM    
Copyright Information:
© 2010 The Authors. Internal Medicine Journal © 2010 Royal Australasian College of Physicians.
Affiliation:
Department of Respiratory Medicine Hospital Admission Risk Program, Barwon Health Department of Psychiatry, The University of Melbourne School of Psychology and Psychiatry Monash University St Vincent's Hospital Mental Health Service, Melbourne, Victoria Centre for Disease Control, Northern Territory Department of Health and Families, Darwin, Northern Territory, Australia.
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