Hypoxemia in patients with idiopathic or heritable pulmonary arterial hypertension

Khirfan, Ghaleb; Naal, Tawfeq; Abuhalimeh, Batool; Newman, Jennie; Heresi, Gustavo A.; Dweik, Raed A.; Tonelli, Adriano R.

doi:10.1371/journal.pone.0191869

Cited by 18 publications

(17 citation statements)

References 19 publications

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“…The association between PA O 2 Hb and survival was expected given previous research [41, 42]. The association between PAW blood O 2 Hb and survival is novel and consistent with our prior study showing that hypoxemia (determined by pulse oximetry) in patients with idiopathic and heritable PAH is associated with worse survival [43].…”

Section: Discussionsupporting

confidence: 88%

Gasometric gradients between blood obtained from the pulmonary artery wedge and pulmonary artery positions in pulmonary arterial hypertension

et al. 2019

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IntroductionLittle is known on the pulmonary gradients of oxyhemoglobin, carboxyhemoglobin and methemoglobin in pulmonary arterial hypertension (PAH). We sought to determine these gradients in group 1 PAH and assess their association with disease severity and survival.MethodsDuring right heart catheterization (RHC) we obtained blood from pulmonary artery (PA) and pulmonary artery wedge (PAW) positions and used co-oximetry to test their gasometric differences.ResultsWe included a total of 130 patients, 65 had group 1 PAH, 40 had pulmonary hypertension (PH) from groups 2–5 and 25 had no PH during RHC. In all groups, PAW blood had higher pH, carboxyhemoglobin and lactate as well as lower pCO2 than PA blood. In group 1 PAH (age 58 ± 15 years, 72% females), methemoglobin in the PAW was lower than in the PA blood (0.83% ± 0.43 vs 0.95% ± 0.50, p = 0.03) and was directly associated with the degree of change in pulmonary vascular resistance (R = 0.35, p = 0.02) during inhaled nitric oxide test. Oxyhemoglobin in PA (HR (95%CI): 0.90 (0.82–0.99), p = 0.04) and PAW (HR (95%CI): 0.91 (0.84–0.98), p = 0.003) blood was associated with adjusted survival in PAH.ConclusionsMarked differences were observed in the gasometric determinations between PAW and PA blood. The pulmonary gradient of methemoglobin was lower in PAH patients compared to controls and a higher PAW blood methemoglobin was associated with a more pronounced pulmonary vascular response to inhaled nitric oxide. Pulmonary artery and PAW oxyhemoglobin tracked with disease severity and survival in PAH.

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Section: Discussionsupporting

confidence: 88%

Gasometric gradients between blood obtained from the pulmonary artery wedge and pulmonary artery positions in pulmonary arterial hypertension

et al. 2019

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“…Hypoxia in PH results in worsened pulmonary vasoconstriction with subsequent detrimental effects on RV function [ 21 , 23 ]. Hypoxaemia at rest or during exercise has been shown to be predictive of lower survival duration in stable PAH patients [ 24 ]. Our data suggests that this observation can be extended to the critical care population, where lower S pO 2 / F iO 2 ratios at critical care admission indicated higher hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

Critical care outcomes in patients with pre-existing pulmonary hypertension: insights from the ASPIRE registry

et al. 2021

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Pulmonary Hypertension (PH) is a life-shortening condition characterised by episodes of decompensation precipitated by factors such as disease progression, arrhythmias and sepsis. Surgery and pregnancy also place additional strain on the right ventricle. Data on critical care management in patients with pre-existing PH are scarce.We conducted a retrospective observational study of a large cohort of patients admitted to the critical care unit of a national referral centre between 2000–17 to establish acute mortality, evaluate predictors of in-hospital mortality and establish longer-term outcomes in survivors to hospital discharge.242 critical care admissions involving 206 patients were identified. Hospital survival was 59.3%, 94% and 92% for patients admitted for medical, surgical or obstetric reasons. Medical patients had more severe physiological and laboratory perturbations than patients admitted following surgical or obstetric interventions. Higher APACHE II score, age and lactate, and lower SpO2/FiO2, platelet count and sodium level were identified as independent predictors of hospital mortality. An exploratory risk score, OPALS (Oxygen (SpO2:FiO2), ≤185; Platelets, ≤196×109·L−1; Age, ≥37.5 years; Lactate, ≥2.45 mmol·L−1; Sodium, ≤130.5 mmol·L−1), identified medical patients at increasing risk of hospital mortality. One of nine patients (11%) who were invasively ventilated for medical decompensation and 50% of patients receiving renal replacement therapy left hospital alive. There was no significant difference in exercise capacity or functional class between follow-up and pre-admission in patients who survived to discharge.These data have clinical utility in guiding critical care management of patients with known PH. The exploratory OPALS score requires validation.

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“…The criterion for an HR upper limit of 120 bpm has commonly been used as an indication for termination, and it was also recommended as a target HR for inpatient cardiac patients (22). Hypoxemia may contribute to a sensation of dyspnea by predisposing the respiratory muscles to fatigue (39). Portable pulse oximetry is commonly used to measure oxygen saturation during exercise.…”

Section: Termination Criteriamentioning

confidence: 99%

Optimal aerobic exercise intensity and its influence on the effectiveness of exercise therapy in patients with pulmonary arterial hypertension: a systematic review

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Park

et al. 2021

J Thorac Dis

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Background: Exercise intensity in exercise training programs is an important determinant of program efficacy, such as improvement in exercise capacity and quality of life (QOL). It is not well known whether differently applied exercise intensities are efficacious when used in exercise-based cardiac rehabilitation programs for patients with pulmonary arterial hypertension (PAH).Methods: Three databases (PubMed, EMBASE, and CINAHL) were searched with the following inclusion criteria: comparative study of exercise interventions for patients with pulmonary arterial hypertension. Three clinical specialists (a physician, nurse, and exercise physiologist) selected the included articles using the process of systematic review. Included articles were grouped according to aerobic exercise intensity: low, moderate-tovigorous, and vigorous. The level of evidence for each study was rated using Sackett's levels of evidence.Results: Of 1,452 studies reviewed, 8 were included according to the inclusion criteria (3 randomized controlled trials (RCTs), 3 prospective studies, and 2 case series). Exercise capacity for a six-minute walk distance (mean: 57.7 m) and QOL improved in the above moderate intensity group, while the low intensity group did not show improvement after intervention. For termination criteria, data obtained from the reviewed articles were not sufficient to suggest any exercise intensity recommendations for patients with pulmonary arterial hypertension. Conclusions:The findings in this study suggest that at least moderate aerobic exercise intensity is needed to significantly improve six-minute walk distance and QOL in individuals diagnosed with World Health Organization Group 1 of pulmonary arterial hypertension. There is a need for prospective RCTs comparing different exercise intensities in this patient population.

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Hypoxemia in patients with idiopathic or heritable pulmonary arterial hypertension

Cited by 18 publications

References 19 publications

Gasometric gradients between blood obtained from the pulmonary artery wedge and pulmonary artery positions in pulmonary arterial hypertension

Gasometric gradients between blood obtained from the pulmonary artery wedge and pulmonary artery positions in pulmonary arterial hypertension

Critical care outcomes in patients with pre-existing pulmonary hypertension: insights from the ASPIRE registry

Optimal aerobic exercise intensity and its influence on the effectiveness of exercise therapy in patients with pulmonary arterial hypertension: a systematic review

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