1. Measurement of oxygen saturation during exercise testing in pulmonary rehabilitation: a survey
Leung R1, McKeough Z1, McDonald C2, Jenkins S3, Holland A4,5, Hill K6, Morris N7, Hill C2, Lee A4, Cecins N3, Seale H7, Spencer L8, Alison J1
1Physiotherapy, The University of Sydney, Sydney, Australia; 2Respiratory and Sleep Medicine, Austin Health, Melbourne, Australia; 3Physiotherapy, Sir Charles Gairdner Hospital, Perth, Australia; 4Physiotherapy, Alfred Health, Melbourne, Australia;
5Physiotherapy, La Trobe University, Melbourne, Australia; 6Physiotherapy and Exercise Science, Curtin University, Perth, Australia; 7Physiotherapy, The Prince Charles Hospital, Brisbane, Australia and 8Physiotherapy, Royal Prince Alfred Hospital, Sydney, Australia
Measurement of oxygen saturation (SpO2) continuously during assessment of exercise capacity in people with COPD in pulmonary rehabilitation programs (PRPs) is recommended1,2.
Exercise-induced desaturation is common in people with COPD3,4. ERS/ATS technical standard suggested that exercise test should be ceased if SpO2 < 80% and resume when SpO2 ≥ 85% although safety of exercise testing with SpO2 < 80% has not been clearly examined1. In addition, access to supplemental oxygen is highly recommended when conducting exercise testing1.
Despite the measurement of SpO2 being common during exercise testing in PRPs, little is known about
the implementation of technical standard during exercise testing for people with COPD
Introduction
Results
265 programs were ed and 128 surveys were completed (48.3%) including 7 surveys which were partially completed (preliminary data).
Occupation of responders Experience of responders
Program settings
(Some programs are running at more than one site)
Program size
99% of programs used a six-minute walk test (6MWT) as the exercise assessment tool.
Majority of programs (>95%) measured SpO2, pulse rate and dyspnoea at the beginning and end of the exercise test.
Majority of programs (89%) measured blood pressure at the beginning of the exercise test.
SpO2 and pulse rate were mainly measured by pulse oximeter via finger probe (82%).
Measurement of SpO2 during the 6MWT
Do you impose a rest if patient desaturate during exercise test?
For programs which imposed a rest during the exercise test
Majority of the programs (78%) imposed a rest if patients desaturated to between 85% to 92%
12 programs (15%) indicated that a rest would not be imposed until SpO2 ≤ 80%
Results
Availability of supplemental oxygen during exercise test
available in 81% of programs but only 31% had a specific protocol on the provision of supplemental oxygen during exercise testing.
For programs without supplemental oxygen (19%), 50% were community programs and 45% were out-patients programs. More than half of them (54%) were small in size which had participants per year.
Protocol on the provision of supplemental oxygen during exercise testing in PRPs in Australia
Protocols varied greatly between programs.
Patients on long-term oxygen therapy (LTOT) continued to follow the prescription during exercise testing.
For patients not on LTOT, most protocols stated that a rest would be imposed if SpO2 dropped below 85-88% and supplemental oxygen would be provided. Clinicians aimed to maintain the SpO2 level above 88%.
Only a few programs stated that 6MWT would be repeated with supplemental oxygen for people with EID.
*EP: exercise physiologist
percentage
Measurement of SpO2 is common in clinical practice during an exercise tests in PRPs but the majority of programs measure SpO2 only once per minute rather than continuously.
A large number of programs impose a rest during the 6WMT before SpO2 reaching a critical value (SpO2 ≤ 80%).
Some programs did not have access to supplemental oxygen during exercise assessment.
Although SpO2 is commonly measured during an exercise test, the protocol for managing oxygen desaturation during an exercise test varied across programs and has not been standardised.
A standardised protocol for managing desaturation during an exercise test and provision of supplemental oxygen during an exercise test in PRPs is recommended.
Conclusion
To investigate
the implementation of the technical standard in people with COPD who demonstrate exercise-induced desaturation during exercise testing in PRPs in Australia
Aim
Percentage
Participants
Coordinators of PRPs listed on the Lung Foundation Australia’s database
Participants were invited to complete a purpose-designed anonymous online survey via .
Ethics approval was granted and consent was implied if surveys were completed and returned.
Trial registration: ACTRN
Method
Number o f participants per year
References & Acknowledgements
Holland et al (2014). ERJ, 44(6):
Singh et al (2014). ERJ, 446):
van Gestel AJ et al (2012). Respiration, 84: 353–9.
Jenkins et al (2011). Intern Med J, 41 (5):
Special thanks to participants who have completed the survey.
Please contact Dr Regina Leung for further information