PURPOSE: Exercise in PR is associated with improved function in chronic lung disease. A subset of patients experience hypoxemia that may occur or worsen with exercise. We defined SEIH as SpO2 > 89% during exercise despite oxygen at < 6 lpm. Guidelines are not currently available for evaluation or management of SEIH. Our study surveyed the incidence of SEIH in PR programs and related clinical care.
METHODS: A nonscientific survey polled PR programs regarding SEIH patient volume, management, oxygen flow, interfaces, education, untoward events and exclusion from PR admission or exercise.
RESULTS: Sixty-eight PR programs responded: mean 14 (±25) SEIH patients seen annually, 18% (± 22%) of annual PR attendees. Interfaces included nasal cannula (NC) 62%, high flow NC 50%, oxymizer pendant 49%, non-rebreather mask (NRB) 41%, oxymizer cannula 37%, combination NC and NRB 25%, venturi mask 15%, oxymask 10%, transtracheal oxygen 3%. Single programs reported CPAP, Heliox, OxyArm and humidity collar. Twelve percent reported non-admission of SEIH patients and 13% not allowing SEIH patients to exercise. Mean maximum FIO2 % was 85%. Twelve percent reported non-admission to PR for SEIH and 13% reported not permitting exercise. Adverse events during PR included epistaxis (3%), rhinorrhea / nasal symptoms, chest pain, dizziness (1%). All programs taught breathing strategies, 99% pacing, 97% panic control. 1% of responders did not answer all queries.
CONCLUSIONS: The survey indicates that SEIH patients are commonly seen in PR with few negative outcomes associated with PR. Patients may require non-traditional oxygen delivery methods during PR, and strategies for dyspnea and panic control. However, no clinical guidelines currently exist for SEIH.
CLINICAL IMPLICATIONS: Based upon our initial findings, SEIH patients are commonly seen in PR without any evidence-based guidelines. There is a need for larger trials to evaluate the impact of PR on SEIH; effective treatment and exercise interventions, impact on health care utilization and survival.
DISCLOSURE: The following authors have nothing to disclose: Chris Garvey, Mary Hart
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