Respiration
Clinical Investigations
Repetitive Hemodilution in Chronic Obstructive Pulmonary Disease and Pulmonary Hypertension: Effects on Pulmonary Hemodynamics, Gas Exchange, and Exercise CapacityBorst M.M. · Leschke M. · König U. · Worth H.Department of Cardiology, Pneumology, and Angiology, Heinrich Heine University Medical Centre, Düsseldorf, Germany
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Article / Publication Details
Published online: June 07, 1999
Issue release date: May – June
Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 4
ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)
For additional information: https://www.karger.com/RES
Abstract
Background: In cor pulmonale associated with severe chronic obstructive pulmonary disease (COPD), disturbances of pulmonary microcirculation may contribute significantly to hypoxemia, pulmonary hypertension, and exercise intolerance. Objective: It was tested whether reduction of blood viscosity induced by repetitive hemodilution might improve pulmonary hemodynamics and oxygen uptake. Methods: Seven patients with stable COPD (forced expiratory volume in 1 s 33 ± 3 % of predicted, means ± SE) and pulmonary hypertension were phlebotomized 5–6 times over a period of 3 months with substitution of 6% hydroxyethyl starch (molecular weight 40,000). This resulted in a stepwise reduction of the hematocrit from 53.3 ± 2.6 to 45.8 ± 3.1% and a reduction of whole blood viscosity from 9.8 ± 0.6 to 8.8 ± 0.7 mPa × s at a shear rate of 2.0 s–1. Before and after the treatment period, patients underwent cardiopulmonary exercise testing and right heart catheterization. Results: Mean pulmonary artery pressure (PAm) decreased from 30 ± 3 to 22 ± 2 mm Hg and arterial oxygen partial pressure (PaO2) increased from 63.2 ± 2.2 to 71.8 ± 3.7 mm Hg at rest. During peak exercise, PAm decreased from 59 ± 7 to 53 ± 7 mm Hg and PaO2 increased from 54.0 ± 5.7 to 63.2 ± 2.4 mm Hg after hemodilution. Peak oxygen consumption rose from 573 ± 84 to 750 ± 59 ml × min–1, corresponding to an increase in cardiac index from 4.25 ± 0.5 to 5.88 ± 0.76 liters × min–1 × m–2. Pulmonary vascular resistance fell from 345 ± 53 to 194 ± 32 dyn × s × cm–5. The patients’ peak exercise capacity increased from 9.2 ± 2.0 before to 13.5 ± 3.2 kJ at the end of the study (p < 0.05 for all differences, paired t test). Conclusion: The findings suggest that a prolonged improvement of pulmonary microcirculation by reducing blood viscosity may improve pulmonary gas exchange, central hemodynamics, and exercise tolerance in patients with severe COPD and pulmonary hypertension.
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Article / Publication Details
Published online: June 07, 1999
Issue release date: May – June
Number of Print Pages: 8
Number of Figures: 3
Number of Tables: 4
ISSN: 0025-7931 (Print)
eISSN: 1423-0356 (Online)
For additional information: https://www.karger.com/RES
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