Mechanisms of hypoxemia

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Abstract

Oxygen is an essential element for life and without oxygen humans can survive for few minutes only. There should be a balance between oxygen demand and delivery in order to maintain homeostasis within the body. The two main organ systems responsible for oxygen delivery in the body and maintaining homeostasis are respiratory and cardiovascular system. Abnormal function of any of these two would lead to the development of hypoxemia and its detrimental consequences. There are various mechanisms of hypoxemia but ventilation/perfusion mismatch is the most common underlying mechanism of hypoxemia. The present review will focus on definition, various causes, mechanisms, and approach of hypoxemia in human.

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Most cited references 216

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Site and nature of airway obstruction in chronic obstructive lung disease.

Peter Macklem, W Thurlbeck, Simon Hogg (1968)

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Physiological changes in respiratory function associated with ageing.

J Janssens, J C Pache, L Nicod (1999)

Physiological ageing of the lung is associated with dilatation of alveoli, enlargement of airspaces, decrease in exchange surface area and loss of supporting tissue for peripheral airways ("senile emphysema"), changes resulting in decreased static elastic recoil of the lung and increased residual volume and functional residual capacity. Compliance of the chest wall diminishes, thereby increasing work of breathing when compared with younger subjects. Respiratory muscle strength also decreases with ageing, and is strongly correlated with nutritional status and cardiac index. Expiratory flow rates decrease with a characteristic alteration in the flow-volume curve suggesting small airway disease. The ventilation-perfusion ratio (V'A/Q') heterogeneity increases, with low V'A/Q' zones appearing as a result of premature closing of dependent airways. Carbon monoxide transfer decreases with age, reflecting mainly a loss of surface area. In spite of these changes, the respiratory system remains capable of maintaining adequate gas exchange at rest and during exertion during the entire lifespan, with only a slight decrease in arterial oxygen tension, and no significant change in arterial carbon dioxide tension. Ageing tends to diminish the reserve of the respiratory system in cases of acute disease. Decreased sensitivity of respiratory centres to hypoxia or hypercapnia results in a diminished ventilatory response in cases of heart failure, infection or aggravated airway obstruction. Furthermore, decreased perception bronchoconstriction and diminished physical activity may result in lesser awareness of the disease and delayed diagnosis.

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Pulse oximetry: understanding its basic principles facilitates appreciation of its limitations.

Edward D Chan, Michael Chan, Mallory M Chan (2013)

Pulse oximetry has revolutionized the ability to monitor oxygenation in a continuous, accurate, and non-invasive fashion. Despite its ubiquitous use, it is our impression and supported by studies that many providers do not know the basic principles behind its mechanism of function. This knowledge is important because it provides the conceptual basis of appreciating its limitations and recognizing when pulse oximeter readings may be erroneous. In this review, we discuss how pulse oximeters are able to distinguish oxygenated hemoglobin from deoxygenated hemoglobin and how they are able to recognize oxygen saturation only from the arterial compartment of blood. Based on these principles, we discuss the various conditions that can cause spurious readings and the mechanisms underlying them.

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Author and article information

Journal

Journal ID (nlm-ta): Lung India

Journal ID (iso-abbrev): Lung India

Journal ID (publisher-id): LI

Title: Lung India : Official Organ of Indian Chest Society

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0970-2113

ISSN (Electronic): 0974-598X

Publication date (Print): Jan-Feb 2017

Volume: 34

Issue: 1

Pages: 47-60

Affiliations

[1] Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

[1 ] Navodaya Medical College Hospital and Research Center, Raichur, Karnataka, India

[2 ] Community Health Center, Kupvi, Nerwa, Shimla, Himachal Pradesh, India

Author notes

Address for correspondence: Dr. Malay Sarkar, Department of Pulmonary Medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India. E-mail: drsarkarmalay23@ 123456rediffmail.com

Article

Publisher ID: LI-34-47

DOI: 10.4103/0970-2113.197116

PMC ID: 5234199

PubMed ID: 28144061

SO-VID: 9a797ee7-1832-46a9-b466-652d31e1f82b

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Mechanisms of hypoxemia

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Abstract

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Most cited references 216

Site and nature of airway obstruction in chronic obstructive lung disease.

Physiological changes in respiratory function associated with ageing.

Pulse oximetry: understanding its basic principles facilitates appreciation of its limitations.

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