Chest
Volume 106, Issue 2, August 1994, Pages 361-365
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Clinical Investigations: Exercise
The Effects of Exercise Testing on the Prescription of Oxygen Therapy

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This study reviews the effects of using oxygen saturation measurements during exercise and the effects of the method of exercise testing on the prescription of oxygen therapy. Using cutaneous oximetry (designated A and B models) and co-oximetry, 25 of 41 patients (model A), 30 of 39 patients (model B), and 28 of 42 patients (co-oximetry) had an oxygen saturation measurement greater than 85 percent at maximal incremental exercise despite an arterial oxygen tension less than 55 mm Hg. Also, in a group of patients who underwent incremental followed by constant work rate testing, 9 of 28 exhibited a fall in arterial oxygen tension to 55 mm Hg or below only during the constant work rate testing. Oxygen saturation measurements cannot reliably be used as a substitute for arterial oxygen tension measurements for the prescription of oxygen therapy. The type of exercise study performed may influence the outcome of such oxygen prescription.

Section snippets

Patient Selection

We examined test results from all patients referred to our pulmonary function laboratory from November 1985 to September 1987 who had arterial blood gas (ABG) measurements obtained during rest and exercise. All patients (N=413) who underwent exercise testing while breathing room air were included. If a patient had more than one study conducted during this period, only results from the first study were selected.

Blood Gas and Cutaneous Oximetry Measurements

All ABG samples were obtained from a radial artery catheter placed percutaneously.

Results

Data from 413 patients were analyzed in two groups. Group 1 included 295 patients who underwent incremental exercise testing with one or both of the cutaneous oximeters. Data from the remaining 118 patients were not included in this analysis because they were obtained from different oximeters. The number of patients studied with these other oximeters was insufficient for inclusion. Group 2 included 142 patients who underwent incremental exercise followed by constant work rate testing.

Discussion

The results of this study show that using oximetry measurements alone as the basis to prescribe oxygen during exercise (using previous Medicare guidelines of an oxygen saturation of 85 percent or less) would result in denying appropriate oxygen therapy to many patients who would otherwise qualify for such therapy based on PaO2 measurements. These results are similar to those observed in the resting state.5 While using the current Medicare criteria, an oxygen saturation of 88 percent or less,

Acknowledgments

The authors thank Lela Prewitt for the data analysis, and Jeffery Johnson and Carlos Lopez for the performance of the exercise testing.

References (15)

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Supported in part by National Institutes of Health grant RR00827 from the Division of Research Resources for the Clinical Research Center. Revision accepted January 26, 1994

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