Effect of supplementary oxygen in obese subjects with hypercapnia at an altitude of 2660 meters above the sea level
AuthorsPontificia Universidad Javeriana. Facultad de Medicina. Departamento de Medicina Interna. Grupo de Investigación de Enfermedades Crónicas del Adulto
Bastidas, Alirio R.
Giraldo, Luis F.
1073-449X / 1535-4970 (Electrónico)
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Introduction The administration of high fraction of inspired oxygen (FiO2) in patients with obesity and hypercapnia at sea level worsens hypercapnia. However, the effect pf this intervention is not know on residents at altitudes higher than 2500 m above the sea level, where small studies have shown that PaCO2 values grater than 35mmHg are abnormal. The objective of this trial was to describe the eddect of hyperoxia in the PaCO2 levels in patients with Obesity and Hypercapnia at Bogota and its surroundings (altitude of 2660 m above the sea level). Methods We performed a randomized, controlled, cross.over, trial, administering oxygen at FiO2 of 28% and 50% for 30 minutes to 33 patients in different days. The inclusion criteria were: Body Mass Index > 30 Kh/m2 and PaCO2 > 35 mmHg. An increase of more than 4 mmHg in PaCO2 levels was considered as clinically significant. Arterial blood gases were measured before and after the intervention and compared by the Wilcoxon signed rank and Friedman tests. Results Compared with the basal values (FiO2:21%), the administration of FiO2 at 28% produced a reduction in the PaCO2 of 1.7 mmHg (p=0.02) and the FiO2 at 50% produced a reduction in the PaCO2 of 0.1mmHg (p=0.66). There were no differences between the FiO2 at 28% and 50%. In the subgroup of patients with PaCO2 > 37 mmHg, the results were similar to the global group. However, in 2 patients with basal PaCO2 > 40 mmHg we observed a hypercapnic response to hyperoxia. Conclusions Using the traditionally accepted cutoff for hypercapnia at high altitudes the responde to hyperoxia in obese hypercapnic patients was similar to what have been found in healthy subjects at sea level (hyperventilation). Our findings suggest that the criteria of the PaCO2 to define obesity - associated hypoventilation at high altitudes should be redefined by a new study including an appropriate sample of subjects with PaCO2 > 40 mmHg.
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Link to the resourcehttps://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2014.189.1_MeetingAbstracts.A3518
SourceAmerican Journal of Respiratory and Critical Care Medicine; Vol. 189 (2014)
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