Critique Term paper
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Critical Inquiry 10/31/00
The goal of the article, (Lack of Effect of Increased Inspired Oxygen Concentrations on Maximal Exercise Capacity or Ventilation in Stable Heart Failure. The American Journal of Cardiology, 84(12), Dec.15, 99. pp 1412-1416.) is to further study the effects of administration of increased inspired oxygen concentrations on maximal exercise capacity and exercise ventilation in heart failure. Recent uncontrolled studies have suggested improvement on maximal exercise capacity and a decreased exercise ventilation.
This study used 21% as normal and 60% as increased inspired oxygen concentrations. 16 patients performed staged, symptom-limited cycle ergometry using a randomized, double-blind, crossover study design. Measurements of minute ventilation, heart rate, blood pressure, leg blood flow, and arterial and venous lactate and oxygen content were obtained. The exercise times for the 2 categories did not differ (595 ± 179 seconds and 602 ± 181 seconds for 21% and 60% oxygen concentrations, respectively). Similarly there was no significant difference in any of the readings that were monitored between the 2 groups. It seems that supplemental oxygen is accepted as therapy in patients with decompensated heart failure. In this case patients have lowered hemoglobin oxygen saturation so higher concentrations could raise the hemoglobin oxygen saturation, reverse pulmonary vasoconstriction and enhance oxygen delivery to vital organs. Since this and other studies have tested patients who have normal hemoglobin oxygen concentrations even during maximal exercise, there is no way to increase oxygen uptake to the exercising limbs.
The patients in the study were men with New York Heart Association class II to III heart failure symptoms and severe left ventricular dysfunction. Mean age was 56 ± 9 years, and ejection fraction was 18 ± 6%. No patient was a current smoker. The exercise protocol was first to give a familiarization test. The patients performed pulmonary function tests including spirometry and maximum voluntary ventilation test. Then they performed an upright exercise test on an electronically braked cycle ergometer. This included a 2-minute resting period followed by increasing workloads of 25W every 3 minutes until limited by fatigue and / or shortness of breath. All tests were performed in the fasting state. Breath-by-breath ventilation, oxygen uptake, and carbon dioxide production were continuously measured through a mouthpiece connected to a metabolic cart. The EKG was continuously monitored and blood pressure was measured with sphygmomanometer. After the patients had undergone the familiarization...
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