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Acute hyperoxic challenge improves haemodynamics & Pulmonary vascular stiffness in interstitial lung disease-associated pulmonary hypertension

Peter George, Tristan Huie, Jeff Swigris, Kern Buckner, Kevin Brown, Brett Fenster
European Respiratory Journal 2016 48: PA4889; DOI: 10.1183/13993003.congress-2016.PA4889
Peter George
1Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom
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Tristan Huie
2Interstitial Lung Disease Unit, National Jewish Health, Denver, COUnited States
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Jeff Swigris
2Interstitial Lung Disease Unit, National Jewish Health, Denver, COUnited States
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Kern Buckner
3Pulmonary Hypertension Unit, National Jewish Health, Denver, COUnited States
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Kevin Brown
2Interstitial Lung Disease Unit, National Jewish Health, Denver, COUnited States
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Brett Fenster
3Pulmonary Hypertension Unit, National Jewish Health, Denver, COUnited States
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Abstract

Introduction: Pulmonary hypertension (PH) is a potentially severe complication of interstitial lung disease (ILD) that results from multiple mechanisms, including hypoxic pulmonary vasoconstriction. Because hyperoxia may have vasodilatory effects, we tested whether acute hyperoxia improved hemodynamics and pulmonary vascular stiffness in an ILD-PH cohort.

Methods: Patients with ILD and suspected PH underwent right heart catheterization (RHC). Patients with low peripheral oxygen saturation (SpO2) were administered supplemental O2 to achieve an SpO2 ≥ 90% and then haemodynamic data were collected. Hemodynamics were repeated after 100% FiO2 for 5 minutes.

Results: The cohort comprised 23 patients with ILD and RHC-proven PH (mean pulmonary artery pressure (mPAP) 33±7.34 mmHg, pulmonary artery occlusion pressure 12±2.5 mmHg, pulmonary vascular resistance (PVR) 4.9±2.8 Wood's Units (WU), and capacitance 2.07±0.89 mL/mmHg. 11 patients required supplemental oxygen to achieve an SpO2>90% The baseline mean SpO2 was 94.4%; 3 patients were hypoxic (PaO2<8kPa). 100% FiO2 improved SpO2 (+4.1%), reduced mPAP (-2.7±4.3 mmHg, p=0.002), PVR (-0.78±1.24 WU, p=0.0007), and pulmonary vascular stiffness (increased capacitance) (+0.39±0.48 mmHg/mL, p<0.0001).

Discussion: Hyperoxia acutely improves hemodynamics and vascular stiffness even in the absence of hypoxaemia, suggesting oxygen supplementation may be beneficial in normoxic ILD PH. Because proximal pulmonary arterial remodeling contributes significantly to overall vascular stiffness, these acute changes in stiffness with hyperoxia suggest previously undescribed improvements in proximal arterial mechanics.

  • Interstitial lung disease
  • Pulmonary hypertension
  • Copyright ©the authors 2016
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Acute hyperoxic challenge improves haemodynamics & Pulmonary vascular stiffness in interstitial lung disease-associated pulmonary hypertension
Peter George, Tristan Huie, Jeff Swigris, Kern Buckner, Kevin Brown, Brett Fenster
European Respiratory Journal Sep 2016, 48 (suppl 60) PA4889; DOI: 10.1183/13993003.congress-2016.PA4889

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Acute hyperoxic challenge improves haemodynamics & Pulmonary vascular stiffness in interstitial lung disease-associated pulmonary hypertension
Peter George, Tristan Huie, Jeff Swigris, Kern Buckner, Kevin Brown, Brett Fenster
European Respiratory Journal Sep 2016, 48 (suppl 60) PA4889; DOI: 10.1183/13993003.congress-2016.PA4889
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