Efeito da hiperóxia na oxigenação muscular periférica no início do exercício dinâmico de alta intensidade em pacientes não-hipoxêmicos ou levemente hipoxêmicos com Doença Pulmonar Obstrutiva Crônica (DPOC)

• Ano de defesa: 2009
• Autor(a) principal: Siqueira, Ana Cristina Barroso de [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Exercício; Fluxo sanguíneo; Hiperóxia; Oxigênio; Hemodinâmica; Consumo de oxigênio; Espectroscopia de luz próxima ao Infravermelho; Doença Pulmonar Obstrutiva Crônica; Hemodynamics; Hyperoxia; Spectroscopy, Near-Infrared; Oxygen consumption; Blood flow; Exercise; Oxygen; Pulmonary Disease, Chronic Obstructive
• Link de acesso: http://repositorio.unifesp.br/handle/11600/9352

There is convincing evidence that impaired microvascular O2 delivery (Q LO2mv) to the peripheral muscles limits the rate of increase in pulmonary O2 uptake ( O2p) at the onset of supra-gas exchange threshold exercise in patients with chronic obstructive pulmonary disease (COPD). It is currently unclear, however, whether O2 supplementation could actually improve Q LO2mv thereby accelerating O2p kinetics in patients who are not overtly hypoxemic (PaO2 > 60 mmHg). We therefore investigated the effects of hyperoxia (HiOX= 50% O2) and normoxia (NOX) on the kinetics of O2p and fractional O2 extraction in the vastus lateralis ( [deoxy- Hb+Mb] by near-infrared spectroscopy) in 11 non- or mildly-hypoxemic patients. HiOX increased exercise tolerance compared to NOX (P<0.05). At the on-exercise transient, however, HiOX was associated with faster [deoxy-Hb+Mb] kinetics (= 4.8 } 2.4 s vs. 6.7 } 3.0 s; P<0.05) and a response govershoot h in 7/11 patients suggesting impaired Q LO2mv. Subsequently, however, [deoxy-Hb+Mb] decreased to lower steady-state values compared to NOX in 9/11 patients (P<0.05). As a likely consequence of these opposite effects of HiOX on Q LO2mv (i.e., early impairment followed by later improvement), O2p kinetics were accelerated in 6 but slowed in 5 patients. Interestingly, patients in whom HiOX accelerated O2p kinetics showed consistently-larger reductions in gsteady-state h ..[deoxy-Hb+Mb] compared to their counterparts (HiOX . NOX= -23.4 (-55.5 to -5.8) ƒÊM/cm vs. -0.62 (-22.6 to 10.7) ƒÊM/cm; p<0.05). In conclusion, HiOX can transitorily impair the convective flow of O2 to the working peripheral muscles at the onset of heavy intensity exercise in patients with COPD who are not overtly hypoxemic. This effect, however, might be (over)compensated by a subsequent increase in local O2 availability in selected patients. These data seem to provide a mechanistic explanation for the heterogeneous effects of HiOX on O2p kinetics in this patient sub-population.