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Occupational and Environmental Lung Disease |

Indirect and Direct Gas Exchange at Maximum Exercise in Beryllium Sensitization and Disease*

Rita A. Lundgren, MS; Lisa A. Maier, MD, MSPH; Cecile S. Rose, MD, MPH; Ron C. Balkissoon, MD, DIH, MSc; Lee S. Newman, MD, MA, FCCP
Author and Funding Information

*From the Division of Environmental and Occupational Health Sciences, National Jewish Medical and Research Center, Denver, CO.

Correspondence to: Lee S. Newman, MD, MA, FCCP, National Jewish Medical and Research Center, 1400 Jackson St, Denver, CO 80206; e-mail: NewmanL@njc.org



Chest. 2001;120(5):1702-1708. doi:10.1378/chest.120.5.1702
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Study objectives: To determine whether pulse oximetry accurately estimates arterial blood gas measurements during exercise in the assessment of chronic beryllium disease (CBD) and beryllium sensitization (BeS).

Design: Participants underwent maximal exercise physiology testing in a clinical-practice setting. Oxygen saturation in the blood was measured through an indwelling arterial line and by pulse oximetry.

Setting: All exercise physiology tests were performed in the pulmonary physiology unit of the National Jewish Medical and Research Center (NJMRC) between December 1985 and November 1998.

Patients: We analyzed the exercise physiology data for 168 individuals who were referred to NJMRC for evaluation of possible CBD and underwent exercise testing. On evaluation, they subsequently received diagnoses of either CBD or BeS.

Results: In BeS subjects, the percentage of oxygen saturation as measured by pulse oximetry (Spo2) often underestimated the percentage of arterial oxygen saturation (Sao2) (mean [± SD] underestimation, 0.88 ± 4.6%) at maximum exercise and showed no significant correlation (r = −0.13; p = 0.3). The use of Spo2 misclassified 14.9% of BeS subjects as having abnormal gas exchange levels (< 90%) that were normal by arterial blood gas measurement. In contrast, Spo2 and Sao2 values correlated at maximum exercise in CBD subjects (r = −0.55; p = 0.0001) without exhibiting Spo2 underestimation of Sao2, and misclassification occurred in only 5.9%.

Conclusions: These data suggest that pulse oximetry cannot be used reliably to distinguish between CBD and BeS and, thus, is not an adequate substitute for arterial blood gas analysis with exercise.

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