Extremely obese patients may present with substantially reduced arterial oxygen tension despite otherwise normal standard pulmonary function tests.
Clinicians should consider arterial blood gas analysis in extremely obese patients despite normal pulmonary function tests; this Level 4 observation leaves open mechanisms and clinical relevance.
Preoperative pulmonary parameters were evaluated in 37 extremely obese but otherwise healthy patients. They were on average 100.9% overweight. X-ray of the chest, electrocardiograms, and residual volume, vital capacity, total lung capacity, maximum breathing capacity, forced expired volume in 1 second, and related ratios were all within the normal range. The alveolar-arterial oxygen gradient and the arterial carbon dioxide tension were also within the normal range. The only abnormal finding was a substantially reduced arterial oxygen tension. It is suggested that the measurement of functional residual capacity, closing volume, and the slope of the alveolar plateau (phase III in the single breath nitrogen washout technique) might give more valuable information.
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Andersen et al. (1977) studied this question.
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