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Original Research: CRITICAL CARE |

The Effect of Supplemental Oxygen on Hypercapnia in Subjects With Obesity-Associated Hypoventilation: A Randomized, Crossover, Clinical Study

Meme Wijesinghe, MBBS; Mathew Williams, DipExSci; Kyle Perrin, PhD; Mark Weatherall, MBChB; Richard Beasley, DSc
Author and Funding Information

From the Medical Research Institute of New Zealand (Drs Wijesinghe, Perrin, and Beasley and Mr Williams); Capital & Coast District Health Board (Drs Wijesinghe, Perrin, Weatherall, and Beasley and Mr Williams); and University of Otago Wellington (Dr Weatherall), Wellington, New Zealand; and University of Southampton (Dr Beasley), Southampton, England.

Correspondence to: Richard Beasley, DSc, Medical Research Institute of New Zealand, Private Bag 7902, Wellington 6242, New Zealand; e-mail: Richard.Beasley@mrinz.ac.nz


For editorial comment see page 975

Funding/Support: Dr Wijesinghe is a Wellington Hospitals and Health Foundation Research Fellow, and Dr Perrin is a Health Research Council of New Zealand Training Fellow.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(5):1018-1024. doi:10.1378/chest.10-1280
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Background:  It is unknown whether oxygen therapy causes worsening hypercapnia in patients with obesity-associated hypoventilation (OAH), similar to the response observed in COPD. The objectives of this study were to investigate whether breathing 100% oxygen results in an increase in hypercapnia in patients with OAH and the mechanisms of any effect.

Methods:  In this double-blind, randomized, controlled, crossover trial, 24 outpatients with newly diagnosed OAH inhaled 100% oxygen or room air for 20 min on 2 separate days. Transcutaneous CO2 tension (Ptco2), minute ventilation, and volume of dead space to tidal volume ratio were measured at baseline and at 20 min. A mixed linear model was used to determine differences between the two treatments.

Results:  The study was terminated in three subjects breathing 100% oxygen due to a Ptco2 increase ≥ 10 mm Hg, which occurred after 10:35, 13:20, and 15:51 min. Ptco2 increased by 5.0 mm Hg (95% CI, 3.1-6.8; P < .001) with oxygen compared with room air. Minute ventilation decreased by 1.4 L/min (95% CI, 0.11-2.6 L/min; P = .03), and volume of dead space to tidal volume ratio increased by 0.067 (95% CI, 0.035-0.10; P < .001) with oxygen compared with room air.

Conclusions:  Breathing 100% oxygen causes worsening hypercapnia in stable patients with OAH.

Trial registry:  Australia New Zealand Clinical Trials Registry; No.: ACTRN 12608000592347; URL: www.anzctr.org.au.

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