What is the role of oxygen therapy in the treatment of cor pulmonale?

Updated: Dec 15, 2017
  • Author: Derek Leong, MD; Chief Editor: Henry H Ooi, MD, MRCPI  more...
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Answer

Answer

Oxygen therapy is of great importance in patients with underlying chronic obstructive pulmonary disease (COPD), [23] particularly when administered on a continuous basis. With cor pulmonale, the partial pressure of oxygen (PaO2) is likely to be below 55 mm Hg and decreases further with exercise and during sleep.

Oxygen therapy relieves hypoxemic pulmonary vasoconstriction, which then improves cardiac output, lessens sympathetic vasoconstriction, alleviates tissue hypoxemia, and improves renal perfusion. The multicenter, randomized Nocturnal Oxygen Therapy Trial (NOTT) showed that continuous low-flow oxygen therapy for patients with severe COPD resulted in significant reduction in the mortality rate. [24]

In general, in patients with COPD, long-term oxygen therapy is recommended when the PaO2 is less than 55 mm Hg or the O2 saturation is less than 88%. However, in the presence of cor pulmonale or impaired mental or cognitive function, long-term oxygen therapy can be considered even if the PaO2 is greater than 55 mm Hg or the O2 saturation is greater than 88%.

Although the impact of oxygen therapy on survival in patients with cor pulmonale due to pulmonary disorders other than COPD is unclear, it may provide some degree of symptomatic relief and improvement in functional status. Therefore, oxygen therapy plays an important role in both the immediate setting and long-term management, especially in patients who are hypoxic and have COPD.


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