| Routine pulse oximetry during methacholine challenges is unnecessary for safety. | |
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MedLine Citation:
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PMID: 11083689 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Methacholine-induced bronchoconstriction is associated with significant hypoxemia, which can be assessed noninvasively by transcutaneous oxygen tension and pulse oximetry. OBJECTIVES: To assess the value of the monitoring of finger pulse oximetry during routine methacholine challenges in a clinical pulmonary function laboratory with regard to both safety and the possibility that a significant fall in oxygen saturation as measured by pulse oximetry (SpO(2)) might be a useful surrogate for determining the response to methacholine. METHODS: Two hundred consecutive patients undergoing diagnostic methacholine challenges in the pulmonary function laboratory of a tertiary-care, university-based referral hospital were studied. Methacholine challenges were performed by the standardized 2-min tidal breathing technique, and the DeltaFEV(1) was calculated from the lowest postsaline solution inhalation to the lowest postmethacholine inhalation value. SpO(2) was measured immediately prior to each spirogram, and the DeltaSpO(2) was measured from the lowest postsaline solution inhalation value to the lowest postmethacholine inhalation value. We examined the data for safety (ie, any SpO(2) value < 90). Based on previous reports, we used a DeltaSpO(2) of > or = 3 as significant and looked at the sensitivity, specificity, and positive and negative predictive values for DeltaSpO(2) > or = 3 vis-à-vis a fall in FEV(1) of > or = 15%. RESULTS: There were 119 nonresponders (DeltaFEV(1), < 15%) and 81 responders. The baseline FEV(1) percent predicted was slightly but significantly lower in the responders (responders [+/- SD], 91.6 +/- 15%; nonresponders, 96.4 +/- 14%; p < 0.05). DeltaSpO(2) was 3.1 +/- 1.6 in the responders and 1.6 +/- 1.8 in the nonresponders (p < 0. 001). There was a single recording in one patient of SpO(2) < 90 (88). A DeltaSpO(2) > or = 3 had a sensitivity of 68%, a specificity of 73%, a positive predictive value of 63%, and negative predictive value of 77% for a fall in FEV(1) > or = 15%. CONCLUSIONS: Pulse oximetry is not routinely useful for safety monitoring during methacholine challenge. DeltaSpO(2) is not helpful in predicting a positive spirometric response to methacholine. However, the negative predictive value is adequate to allow the DeltaSpO(2) to be used as an adjunct in assessing a negative result of a methacholine test in patients who have difficulty performing spirometry. |
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Authors:
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D W Cockcroft; T S Hurst; D D Marciniuk; D J Cotton; K F Laframboise; A K Nagpal; R P Skomro |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Chest Volume: 118 ISSN: 0012-3692 ISO Abbreviation: Chest Publication Date: 2000 Nov |
Date Detail:
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Created Date: 2000-11-29 Completed Date: 2000-12-14 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0231335 Medline TA: Chest Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 1378-81 Citation Subset: AIM; IM |
Affiliation:
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Department of Medicine, Division of Respiratory Medicine, Royal University Hospital, University of Saskatchewan, Saskatoon, Canada. cockcroft@sask.usask.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Anoxia / blood, chemically induced Blood Gas Monitoring, Transcutaneous Bronchial Provocation Tests / methods* Bronchoconstrictor Agents / diagnostic use* Female Forced Expiratory Volume / drug effects Humans Male Methacholine Chloride / diagnostic use* Middle Aged Monitoring, Physiologic Oximetry* Oxygen / blood Predictive Value of Tests Prospective Studies Safety Sensitivity and Specificity Sodium Chloride Spirometry |
| Chemical | |
Reg. No./Substance:
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0/Bronchoconstrictor Agents; 62-51-1/Methacholine Chloride; 7647-14-5/Sodium Chloride; 7782-44-7/Oxygen |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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