Hi.
My name's William Levack. I'm a respiratory physiotherapist from New
Zealand. I'm also new to this list so forgive me if this letter is a
bit long. Recently I've been trying to document protocol for the use of
supplemental oxygen with exercise therapy. One gray area that has
appeared however is in the rehabilitation of people with chronic
respiratory disease, who tend to have low oxygen saturations in their
day to day life anyway. Although it is acknowledged that ideally we
should be aiming for an SaO2 > 92%, in the clinical setting this is not
always possible with exercise.
Consider the following case study:
B is a 31 year old man with a 20 year history of bronchiectasis. His
ABGs on discharge (after an intensive 6 week hospitalization) were: pH
7.47, pCO2 39mmHg, pO2 48mmHg, BiC 28mEq/L, SaO2 89% on room air.
(Consequentially he is now on 14 hours domicillary O2, at a flow rate of
3l/min). Despite these low oxygen measurements however, he has managed
to remain independent at home and has even returned to work (admittedly
with reduced hours to begin with.) My main problem with this man
however is keeping his SaO2 up during exercise. At the end of his
hospital stay he was able to walk on a treadmill for 20-30mins and
remain in control of his breathlessness. However even on 6-8 l/min O2
via a Hudson mask we were struggling to keep his SaO2 out of the low
80s. My question (and one which I have failed to find an answer to in
the literature) is at what point (at what SaO2?) is exercise
detrimental? What potential solutions exist? Or do we turn a blind eye
to low saturations in exercise?
William
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