An arteriovenous fistula increases exercise capacity in patients with COPD
| Autor: | Angel Martinez, Rodolfo Posadas-Valay, John Faul, Guillermo Elizondo-Riojas, Juan O. Galindo, Christopher B. Cooper |
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| Rok vydání: | 2010 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Cardiac output Time Factors Arteriovenous fistula Physical exercise Critical Care and Intensive Care Medicine Iliac Artery Pulmonary Disease Chronic Obstructive Arteriovenous Shunt Surgical Internal medicine medicine Humans Aged COPD Exercise Tolerance Vascular disease business.industry Respiratory disease Equipment Design Femoral Vein medicine.disease Surgery Treatment Outcome Circulatory system Breathing Cardiology Exercise Test Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Chest. 138(1) |
| ISSN: | 1931-3543 |
| Popis: | Background: Supplemental oxygen usually increases exercise capacity in hypoxemic COPD, but some patients are refractory because of venous admixture. An arteriovenous fi stula (AVF) with left-to-right shunt increases mixed venous oxygen content and cardiac output; therefore, this might improve arterial oxygen delivery. We hypothesized that creation of an AVF would therefore increase exercise capacity in severe COPD. Methods: We created an AVF in 12 patients with severe hypoxemic COPD: mean (SD) age, 66 (6) years; Pa o 2, 57.5 (3.0) mm Hg, and FEV 1 , 19% (8%) predicted. We measured 6-min walk distance (6MWD ) while the subjects were breathing room air and again while they were breathing portable supplemental oxygen at baseline, 6 weeks, and 12 weeks after creation of an AVF in the iliofemoral region. Results: After surgery, the mean (SEM) 6MWD increased from 217 (63) m at baseline to 272 (18) m and 276 (25) m, 6 weeks and 12 weeks after surgery, respectively. Patients who walked . 54 m further while breathing supplemental oxygen at baseline (n 5 5) increased 6MWD while breathing room air by 129 (34) m after 6 weeks ( P 5 .02) and by 124 (29) m after 12 weeks ( P 5 .004). Walk- ing distance did not change in patients who did not have a clinically meaningful response to oxygen at baseline. Conclusions: An iliofemoral AVF increased 6MWD patients with severe COPD, matching the improvement seen with supplemental oxygen. An initial response to supplemental oxygen pre- dicted a therapeutic response to the AVF. |
| Databáze: | OpenAIRE |
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