Transcutaneous Oxygen Saturation and Carbon Dioxide Tension during Meals in Patients with Chronic Obstructive Pulmonary Disease

doi:10.1378/chest.100.5.1287

Chest

Volume 100, Issue 5, November 1991, Pages 1287-1292

https://doi.org/10.1378/chest.100.5.1287 Get rights and content

The effect on transcutaneous SaO₂ and transcutaneous carbon dixoide tension (PtCO₂) of eating was assessed in 44 patients with severe COPD (FEV₁<50 percent) The SaO₂, PtCO₂, and heart rate (HR) were measured every minute before, during, and until 30 minutes after a standardized meal (445 kcal) was consumed. All patients were measured twice on the same day, while eating a meal with high (80 percent) and low (28 percent) carbohydrate content, respectively. The mean meal desaturation (ΔSaO₂) was less than 1 percent in normoxemic patients but was –3.2 ± 0.7 percent (p<0.001) in hypoxemic (PaO₂<7.3 kPa) patients. Significant differences between hypoxemic patients with a ΔSaO₂ greater than 4 percent and less than or equal to 4 percent, respectively, were found in FEV₁ (16 ± 3 percent and 29 ± 8 percent; p<0.001), respiratory muscle strength (3.9 ± 1.2 kPa and 5.9 ± 1.2 kPa; p<0.01), HR (112 ± 12 beats per minute and 90 ± 18 beats per minute; p<0.001), body weight (54.9 ± 7.5 kg and 74.7 ± 10.4 kg; p<0.001), and fat-free mass (42.0 ± 6.6 kg and 52.6 ± 5.8 kg; p<0.005) but not in baseline SaO₂ and PtCO₂. The decrease in SaO₂ and the increase in HR were less during the carbohydrate-rich meal. No significant fluctuations in PtCO₂ were found after either meal. Meal-related oxygen desaturation cannot explain weight loss in normoxemic patients with COPD but may contribute to a limited dietary intake in a subgroup of hypoxemic patients exhibiting marked oxygen desaturation during meals. A single carbohydrate-rich meal does not have an immediate impact on PtCO₂ in stable COPD.

Section snippets

Patients

Forty-four patients with severe airflow obstruction (FEV₁ <50 percent of predicted) were admitted to a pulmonary rehabilitation center for physical training and participated in the study. All patients were in stable clinical condition and were not suffering from a lower respiratory tract infection.

Methods

Body height was measured standing barefoot and was determined to the nearest 0.5 cm. Body weight was measured with a beam scale without shoes in light clothing to the nearest 0.1 kg (SECA). Body

Results

A description of the study group is given in Table 2. The weight-stable and weight-losing groups with a resting PaO₂ of 7.3 kPa or more were significantly different in age and pulmonary function. Even more compromised values for IVC, FEV₁, and Pimax were found in the hypoxemic patients. Mean values of baseline SaO₂, meal SaO₂, and after-meal SaO₂ of meal 1 for the three groups are graphically displayed in Figure 1. Baseline SaO₂ was significantly lower in the hypoxemic relative to the

Discussion

Nutritional management of COPD is difficult and controversial. Several factors have been suggested in the literature that may interfere with dietary intake in COPD, such as gastrointestinal disorders, psychosocial factors, and meal-related oxygen desaturation.² In this study, we addressed the immediate effect of eating on SaO₂. Furthermore, we were interested in the effect of the carbohydrate content of a meal on PaCO₂ because it has been suggested to patients with COPD to shift from

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Undernutrition state in patients with chronic obstructive pulmonary disease. A critical appraisal on diagnostics and treatment
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Citation Excerpt :
High doses of dietary supplements can lead to side effects such as bloating or gas and diarrhoea [44]. Patients with COPD may run a risk of desaturation and arterial hypoxia in connection with meals, which can hamper nutritional treatment [61,62]. Low compliance: Compliance with nutritional supplement prescriptions is poor in outpatient care [31,43].
‘Undernutrition state’ (UNS) is an ominous condition, in particular when associated with chronic obstructive pulmonary disease (COPD). In this review we discuss pathophysiological mechanisms and how UNS is defined and diagnosed. It seems unlikely that COPD-patients with established UNS have similar potential of reversibility (treatability) upon nutrition interventions as patients at a risk of developing such a condition, i.e. patients with low energy/nutrient intake, since pathophysiological, biochemical and metabolic conditions may differ substantially.
We summarize the results of 7 of 17 published randomized controlled trials of nutritional supplementation in COPD-patients with defined UNS in the latest Cochrane review (2012). We thus excluded 10 of 17 trials included in review (2012), mostly because those studies also included patients with ’risk of’ UNS.
The seven included trials exhibit extensive heterogeneity for all studied variables. Most studies did not show beneficial effects of nutritional supplementation, although some reported minor increase in body weight and physical function of unclear clinical relevance.
In contrast to the Cochrane review we conclude that it is difficult to draw firm conclusions regarding the effect of nutritional supplements in patients with COPD and UNS. Improved knowledge in this area is of utmost importance and some factors which should be considered in future studies are suggested.
Continuous oxygen monitoring - A better way to prescribe long-term oxygen therapy
2005, Respiratory Medicine
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%.
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 ∼24 h with a portable oximeter that recorded SpO₂ and EKG readings. During the initial 24 h 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 24 h.
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%).
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.
Pathophysiology and treatment of denutrition in chronic respiratory insufficiency
2005, Reanimation
La dénutrition est fréquente au cours de l'insuffisance respiratoire chronique (IRC) évoluée. Elle est corrélée à un mauvais pronostic de survie. Sa physiopathologie repose sur une inégalité entre des besoins en énergie accrus et des apports alimentaires insuffisants. Trois types d'IRC sont abordés dans cette mise au point : la bronchopneumopathie chronique obstructive (BPCO), l'insuffisance respiratoire secondaire à la sclérose latérale amyotrophique (SLA), et celle liée à la mucoviscidose. Dans la BPCO, il est noté une augmentation des besoins énergétiques en raison de l'augmentation du travail respiratoire et des phénomènes inflammatoires sous la dépendance de cytokines pro-inflammatoires. Les compléments oraux et parfois la nutrition entérale peuvent être efficaces. Cependant les patients ne sont pas tous répondeurs, car la cachexie peut-être considérée comme une adaptation métabolique à l'hypoxie chronique. Dans la SLA, la dénutrition répond essentiellement à une insuffisance alimentaire en raison des troubles de déglutition. La nutrition entérale par sonde de gastrostomie est un traitement logique et doit être envisagée avec le patient. Dans la mucoviscidose, il existe très précocement des troubles de l'absorption digestive en rapport avec l'atteinte pancréatique. Le suivi nutritionnel s'impose dès le diagnostic, des suppléments en vitamines liposolubles et en extraits pancréatiques sont prescrits pour prévenir les carences. S'il est noté un arrêt de croissance chez l'enfant ou une perte de poids malgré les cures d'antibiotiques, la nutrition entérale après pose d'une gastrostomie percutanée est un traitement efficace.
Denutrition is common in end-stage respiratory insufficiency. It is correlated with a poor prognosis. It is due to an unbalance between increased energy demand and decreased oral supply. Pathophysiology of denutrition differs according to aetiology of chronic respiratory insufficiency. In patients with chronic obstructive pulmonary disease, it is well accepted that the high cost of work of breathing is the main explanation of the increased energy expenditure. In such situations, these patients do not eat enough nutrients and hence, may be considered for oral supplementation or enteral nutrition. However, some of them do not respond to this treatment, because cachexia may be the expression of the metabolic adaptation to chronic hypoxia. In other diseases, such as neurological disorders where difficulties of swallowing are involved, enteral nutrition via a gastrostomy is recommended. This support is also efficient in cystic fibrosis in which the intestinal absorption is impaired, mostly as a consequence of pancreatic insufficiency.
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Weight loss is a frequent complication in patients with chronic obstructive pulmonary disease (COPD) and is a determining factor of functional capacity, health status, and mortality. Weight loss in COPD is a consequence of increased energy requirements unbalanced by dietary intake. Both metabolic and mechanical inefficiency contribute to the elevated energy expenditure during physical activity, while systemic inflammation is a determinant of hypermetabolism at rest. A disbalance between protein synthesis and protein breakdown may cause a disproportionate depletion of fat-free mass in some patients. Nutritional support is indicated for depleted patients with COPD because it provides not only supportive care, but direct intervention through improvement in respiratory and peripheral skeletal muscle function and in exercise performance. A combination of oral nutritional supplements and exercise or anabolic stimulus appears to be the best treatment approach to obtaining significant functional improvement. Patients responding to this treatment even demonstrated a decreased mortality. Poor response was related to the effects of systemic inflammation on dietary intake and catabolism. The effectiveness of anticatabolic modulation requires further investigation.
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Chest

Clinical InvestigationsTranscutaneous Oxygen Saturation and Carbon Dioxide Tension during Meals in Patients with Chronic Obstructive Pulmonary Disease

Section snippets

Patients

Methods

Results

Discussion

Chest

Chest

Clin Nutr

Am J Clin Nutr

Chest

Lancet

Chest

Chest

Inventory of nutritional status in chronic obstructive pulmonary disease.

Chest

Nutrition in chronic lung disease.

Am Rev Respir Dis

Energy expenditure and rib cage-abdominal motion in chronic obstructive pulmonary disease.

Eur Respir J

Oxygen consumption of the respiratory muscles in normal and in malnourished patients with chronic obstructive pulmonary disease.

Am Rev Respir Dis

Weight loss in chronic obstructive pulmonary disease (abstract).

Clin Nutr

Arterial oxygen saturation during meals in patients with severe chronic obstructive pulmonary disease.

South Med J

Clinical Investigations
Transcutaneous Oxygen Saturation and Carbon Dioxide Tension during Meals in Patients with Chronic Obstructive Pulmonary Disease