Sechs-Minuten-Gehtest mit und ohne Sauerstoff bei Patienten mit COPD: Vergleich von Gehstrecke und Sauerstoffsättigung bei unterschiedlichen Applikationsformen

Zusammenfassung

Hintergrund: Patienten mit COPD und respiratorischer Insuffizienz erfahren unter Belastung meist einen Abfall der Sauerstoffsättigung (SaO₂). Fragestellung unserer Untersuchung war, wie sich im Sechs-Minuten-Gehtest (6MWT) Gehstrecke und SaO₂ unter Sauerstoff (O₂) 2 l/min kontinuierlichem Fluss (CF), Demand (D) und Raumluft (RL) ändern und wie sich die 10 Patienten mit kürzester (Gruppe I) gegenüber den 10 Patienten mit längster (Gruppe II) Gehstrecke im Ausgangs-6MWT (unter CF) unterscheiden. Methode und Patienten: Bei 27 Patienten wurde an 3 folgenden Tagen ein 6MWT mit CF, D und RL durchgeführt. Über 6 Min vor (Phase 1), während (Phase 2) und nach (Phase 3) dem 6MWT wurden O₂ CF (Tag 1) bzw. D (Tag 2) bzw. RL (Tag 3) verabfolgt, die durchschnittliche SaO₂ jeder Phase gemessen und ihre Änderung (ΔSaO₂) im und nach dem 6MWT errechnet. Zudem wurde die ΔSaO₂ zwischen Beginn und Mitte sowie zwischen Mitte und Ende jeder Phase gemessen. Zeitnah zu den Untersuchungen wurden FEV₁ und pO₂ bestimmt. Ergebnisse: Im Gesamtkollektiv änderte sich die Gehstrecke unter den 3 Applikationsformen nicht signifikant. Unter allen Applikationsformen trat ein hoch signifikanter Abfall der SaO₂ ein. Die Abnahme unter den beiden Formen der O₂-Applikation unterschied sich nicht signifikant. Der Abfall der SaO₂ unter Belastung und der nachfolgende Wiederanstieg in Ruhe traten in den ersten 3 Minuten der jeweiligen Phase auf. Patienten der Gruppe II konnten die Gehstrecke unter RL häufig weiter steigern, bei den Patienten der Gruppe I nahm jedoch die Gehstrecke weiter ab. In Gruppe II war das FEV₁ abs. signifikant höher, FEV₁ % Soll und pO₂ hingegen waren zwischen beiden Gruppen nicht signifikant different. Schlussfolgerung: Patienten mit langer Gehstrecke zeigen selbst unter RL einen deutlichen Lerneffekt, haben ein höheres FEV₁, nicht jedoch einen höheren pO₂. Die Phase der Wiederaufsättigung nach Belastungsende ist kurz. Sauerstoffzufuhr über ein Demand-Ventil ist bei einer Flussrate von 2 l/min einem kontinuierlichen Fluss nicht unterlegen. In mehr als der Hälfte der Patienten fällt bei beiden O₂-Applikationsformen jedoch die SaO₂ auf Werte unter 90 % ab, so dass in diesen Fällen die Flussrate zu erhöhen ist.

Abstract

Background: Patients afflicted with COPD and respiratory Failure often experience a decrease of oxygen saturation (SaO₂) under physical strain. The aim of our study was to find out which changes occur in walking distance and SaO₂ under the application of Oxygen (O₂) 2 l/min continous flow, under demand (D) and under normal air (RL) when performing the Six-Minute-Walking-Test (6MWT) and further, in which way do the 10 patients of the shortest walking distance group (group I) differ from the eo patients with the longest walking distance (group II) concerning the starter 6 MWT (under CF). Method and Patients: 27 patients undertook a 6MWT three days in a row with CF, D and (RL), 6 minutes before (phase I), during (phase II) and after (phase III) the 6MWT oxygen was applied in CF (day I), D (day II) and RL (day III), the mean oxygen saturation in each phase was measured and the change (ΔSaO₂) during and after the 6MWT was calculated. Additionally we measured the ΔSaO₂ between start and middle, as well as between middle and end of each phase. In close proximity to the tests FEV₁ and pO₂ was determined. Results: In the total of all test persons there was no significant difference in the walking distance tetween the 3 forms of application. There was, however, a highly significant decrease of the oxygen saturation. The decrease in the two forms of oxygen application did not differ significantly. The decrease of SaO₂ under strain and the consecutive rise under rest occurred within the first 3 minutes of each phase. Patients of group II were often able to increase their walking distance under RL, whereas patients of group I decreased their walking distance further. In group II FEV₁ abs. was significantly higher, but FEV₁ % debit and pO₂ did not differ significantly between both groups. Conclusions: Patients with a long walking distance showed a marked learning effect even under RL, they presented a higher FEV₁, but not an increased pO₂. The phase of resaturation after the end of strain is short. Oxygen application through a demand valve with a flow rate of 2 l/min is not inferior to a continuous flow. In more than half of all patients the SaO₂ fell below 90 % under both forms of oxygen application, in conclusion the flow rate should be increased in these cases.

Literatur

• 1 McSweeny A J, Grant I, Heaton R K. et al . Life quality of patients with chronic obstructive pulmonary disease.  Arch Intern Med. 1982;  142 473-478
• 2 Okubadejo A A, Paul E A, Jones P W. et al . Quality of life in patients with chronic obstructive pulmonary disease and severe hypoxemia.  Thorax. 1996;  51 44-47
• 3 Burrows D, Earle R H. Course and prognosis of chronic obstructive lung disease: a prospective study in 200 patients.  N Engl J Med. 1969;  280 397-404
• 4 Nocturnal Oxygen Therapy Trial Group . Continuous or nocturnal oxygen therapy in hypoxic chronic obstructive lung disease.  Ann Intern Med. 1980;  93 391-398
• 5 Medical Research Council Working Party . Long term domiciliary oxygen therapy in chronic hypoxic cor pulmonale complicating chronic bronchitis and emphysema.  Lancet. 1981;  1 681-686
• 6 Deutsche Gesellschaft für Pneumologie . Wissenschaftliche Sektion: Klinische Pneumologie. Leitlinien zur Langzeit-Sauerstofftherapie.  Pneumologie. 2001;  55 454-464
• 7 Ries A L, Farrow J T, Clausen J L. Pulmonary function tests cannot predict exercise-induced hypoxemia in chronic obstructive pulmonary disease.  Chest. 1988;  93 454-459
• 8 Freitag A P, Summers E, Hamilton A L. et al . Behavior of arterial oxygen saturation during exercise in normal subjects and patients with pulmonary and cardiac impairment.  Chest. 1995;  108 140S-000
• 9 Eaton T, Garrett J E, Young P. et al . Ambulatory oxygen improves quality of life of COPD patients: a randomised controlled study.  Eur Respir J. 2002;  20 306-312
• 10 Woodcock A A, Gross E R, Geddes D M. Oxygen relieves breathlessness in “pink puffers”.  Lancet. 1981;  1 907-909
• 11 Jolly E C, Di Boscio V, Aguirre L. et al . Effects off supplemental oxygen during activity in patients with advanced COPD without severe resting hypoxemia.  Chest. 2001;  120 437-443
• 12 Dean N C, Brown J K, Himelman R B. et al . Oxygen may improve dyspnoea and endurance in patients with chronic obstructive pulmonary disease and only mild hypoxemia.  Am Rev Respir Dis. 1992;  146 941-945
• 13 Bradley B L, Garner A E, Billiu D. et al . Oxygen-assisted exercise in chronic obstructive lung disease: the effect on exercise capacity and arterial blood gas tensions.  Am Rev Respir Dis. 1978;  118 239-243
• 14 Emtner M, Porszasz J, Burns M. et al . Benefits of supplemental oxygen in exercise training in nonhypoxemic chronic obstructive pulmonary disease patients.  Am J Respir Crit Care Med. 2003;  168 1034-1042
• 15 Rooyackers J M, Dekhuijzen P N, Herwaarden C L Van. et al . Training with supplemental oxygen in patients with COPD and hypoxaemia at peak exercise.  Eur Respir J. 1997;  10 1278-1284
• 16 Dewan N A, Bell W. Effect of low flow and high flow oxygen delivery on exercise tolerance and sensation of dyspnea.  Chest. 1994;  105 1061-1065
• 17 O'Donnell D E, Bain D J, Webb K A. Factors contributing to relief of exertional breathlessness during hyperoxia in chronic airflow limitation.  Am J Respir Crit Care Med. 1997;  155 530-535
• 18 Chatila W, Nugent T, Vance G. et al . The effects of high-flow vs. low-flow oxygen on exercise in advanced obstructive airways disease.  Chest. 2004;  126 1108-1115
• 19 Somfay A, Porszasz J, Lee S M. et al . Dose-response effect of oxygen on hyperinflation and exercise endurance in nonhypoxaemic COPD patients.  Eur Respir J. 2001;  18 77-84
• 20 Solway S, Brooks D, Lacasse Y. et al . A qualitative systematic overview of the measurement properties of functional walks used in the cardiorespiratory domain.  Chest. 2001;  119 256-270
• 21 Guyatt G H, Prugsley S O, Sullivan M J. et al . Effect of encouragement on walking test performance.  Thorax. 1984;  39 818-822
• 22 Hien P, Morr H. 6-Minuten-Gehtest in der pneumologischen und kardiologischen Diagnostik.  Pneumologie. 2002;  56 558-566
• 23 Enright P L, McBurnie M A, Bittner V. et al . The 6-min walk test.  Chest. 2003;  123 387-398
• 24 Bowen J B, Vott J J, Thrall R S. et al . Functional status and survival following pulmonary rehabilitation.  Chest. 2000;  118 697-703
• 25 Enright P L, Sherrill D L. Reference equations for the six-minute walk in healthy adults.  Am J Respir Crit Care Med. 1998;  158 1384-1387
• 26 Troosters T, Gosselink R, Decramer M. Six minute walking distance in healthy elderly subjects.  Eur Respir J. 1999;  14 270-274
• 27 Gerardi D A, Lovett L, Benoit-Connors M L. et al . Variables related to increased mortality following out-patient pulmonary rehabilitation.  Eur Respir J. 1996;  9 431-435
• 28 Pinto-Plata V M, Cote C, Cabral H. et al . The 6-min walk distance: change over time and value as a predictor of survival in severe COPD.  Eur Respir J. 2004;  23 28-33
• 29 Borg G A. Psychophysical bases of perceived exertion.  Med Sci Sports Exerc. 1982;  14 377-381
• 30 McGavin C R, Artvinli M, Naoe H. et al . Dyspnoea, disability, and distance walked: comparison of estimates of exercise performance in respiratory rates.  Br Med J. 1978;  2 241-243
• 31 Bower J S, Brook C J, Zimmer K. et al . Performance of a demand oxygen saver system during rest, exercise, and sleep in hypoxemic patients.  Chest. 1988;  94 77-80
• 32 Tiep B L, Carter R, Brooke N. et al . Demand oxygen delivery during exercise.  Chest. 1987;  91 15-20
• 33 American Thoracic Society Statement . Guidelines for the six-minute walk test.  Am J Respir Crit Care Med. 2002;  166 111-117
• 34 Weiss R A. et al .Six minute walk test in severe COPD: reliability and effect of walking course layout and length. San Francisco: Paper presented at ACCP Conference September 2002
• 35 Sciurba F, Criner G J, Lee S M. et al . Six minute walk distance in chronic obstructive pulmonary disease. Reproducibility and effect of walking course layout and length.  Am J Respir Crit Care Med. 2003;  167 1522-1527
• 36 Gibbons W J, Fruchter N, Sloan S. et al . Reference values for a multiple repetition 6-minute walk test in healthy adults older than 20 years.  J Cardiopulm Rehabil. 2001;  21 87-93
• 37 Knox A J, Morrison J F, Muers M F. Reproducibility of walking test results in chronic obstructive pulmonary disease.  Thorax. 1988;  43 388-392
• 38 Leach R M, Davidson A C, Chinn S. et al . Portable liquid oxygen and exercise ability in severe respiratory disability.  Thorax. 1992;  47 781-789
• 39 O'Donnell D E, Lam M, Webb K A. Measurement of symptoms, lung hyperinflation and endurance during exercise in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1998;  158 1557-1565
• 40 Marin J M, Carrizo S J, Gascon M. et al . Inspiratory capacity, dynamic hyperinflation, breathlessness and exercise performance during the 6-minute-walk test in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2001;  163 1395-1399
• 41 Nandi K, Smith A A, Crawford A. et al . Oxygen supplementation before or after submaximal exercise in patients with chronic obstructive pulmonary disease.  Thorax. 2003;  58 670-673
• 42 Stevenson N J, Calverley P M. Effect of oxygen on recovery from maximal exercise in patients with chronic obstructive pulmonary disease.  Thorax. 2004;  59 668-672
• 43 Senn S, Wanger J, Fernandez E. et al . Efficacy of a pulsed oxygen delivery device during exercise in patients with chronic respiratory disease.  Chest. 1989;  96 467-472
• 44 Roberts C M, Bell J, Wedzicha J A. Comparison of the efficacy of a demand oxygen delivery system with continuous low flow oxygen in subjects with stable COPD and severe oxygen desaturation on walking.  Thorax. 1996;  51 831-834
• 45 Hagarty E M, Morton S, Skorodin M S. et al . Comparison of three oxygen delivery systems during exercise in hypoxemic patients with chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 1997;  155 893-898
• 46 Kawakami Y, Terai T, Yamamoto H. et al . Exercise and oxygen inhalation in relation to prognosis of chronic obstructive pulmonary disease.  Chest. 1982;  81 182-188
• 47 Keller C A, Shepard J W, Chun D S. et al . Pulmonary hypertension in chronic obstructive pulmonary disease: multivariate analysis.  Chest. 1986;  90 185-192
• 48 Celli B R, Hoskere G, Mehta J B. et al . Hemodynamic changes to exercise in patients with COPD and normal controls.  Chest. 2004;  126 922S (Poster presentation)