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Oxygen Therapy Improves Cardiac Index and Pulmonary Vascular Resistance in Patients With Pulmonary Hypertension^*

^* From the Pulmonary and Critical Care Unit (Drs. Roberts and Ginns), Cardiology Division (Drs. Lepore and Semigran), and General Medical Service (Dr. Maroo), Massachusetts General Hospital and Harvard Medical School, Boston, MA.

Correspondence to: Leo C. Ginns, MD, FCCP, Pulmonary and Critical Care Unit, Massachusetts General Hospital, Bigelow 806, Fruit St, Boston, MA 02114; e-mail: lginns{at}partners.org

Study objectives: We tested the hypothesis that breathing 100% oxygen could result in selective pulmonary vasodilatation in patients with pulmonary hypertension, including those patients who would not meet current Health Care Finance Administration guidelines for long-term oxygen therapy.

Design, setting, and patients: From 1996 to 1999, 23 adult patients (mean ± SEM age, 51 ± 4 years) with pulmonary arterial hypertension without left-heart failure underwent cardiac catheterization in a university teaching hospital while breathing air and then 100% oxygen.

Measurements and results: Treatment with 100% oxygen increased arterial oxygen saturation (91 ± 1% to 99 ± 0.1%, p < 0.05) and PaO₂ (64 ± 3 to 309 ± 28 mm Hg, p < 0.05). Treatment with 100% oxygen also decreased mean pulmonary artery pressure (56 ± 3 to 53 ± 2 mm Hg, p < 0.05) and increased cardiac index (2.1 ± 0.1 to 2.5 ± 0.2 L/min/m², p < 0.05). Calculated mean pulmonary vascular resistance (PVR) decreased from 14.1 ± 1.4 to 10.6 ± 1.0 Wood units (p < 0.05). Vasodilatation with 100% oxygen occurred preferentially in the pulmonary circulation (PVR/systemic vascular resistance, 0.53 ± 0.04 to 0.48 ± 0.03; p < 0.05). The magnitude of the PVR response to oxygen therapy was correlated only with decreasing patient age (r = 0.45, p < 0.05).

Conclusions: Treatment with 100% oxygen is a selective pulmonary vasodilator in patients with pulmonary hypertension, regardless of primary diagnosis, baseline oxygenation, or right ventricular function. Development of disease-specific oxygen prescription guidelines warrants consideration.

Key Words: oxygen therapy • pulmonary hypertension • pulmonary vasodilatation

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