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Physiology

Hypoxia: Deficiency of Oxygen at the tissue level


Hypoxaemia: Reduction of arterial oxygen
Anaemic hypoxia: Normal PaO2 but reduced Hb
Ischaemic hypoxia: Normal PaO2 & Hb but poor delivery (blood flow) gives low tissue O2
Histotoxic hypoxia: Adequate tissue supply but toxin (eg cyanide) prevents use of oxygen.

Clinical consequences of hypoxia


1. Reduction of organ function
2. Irreversible organ damage

Causes of Hypoxia
1. Ventilation
2. Diffusion of gases
3. Pulmonary capillary blood flow
4. Carriages of gases by blood
5. Tissue extraction of O2

Ventilation
A cyclical movement of ambient air into and out of lung
Accomplished by
Contraction & relaxation of respiratory muscles
Elastic recoil of lungs
During quiet breathing, 2/3 of inspired air reaches alveoli (VA). The rest entered less well
perfused sites (VD), aka wasted ventilation.
Total ventilation (L/min) = VA+VD

Static lung volume: Depends on compliance of both chest wall & lung

Compliance of lung: Depends on


Elastic recoil of parenchyma ( reduced

Diffusion of gases
Passive movement of O2 abd CO2 between alveolar gas and pulmonary capillary blood
Depends on:
Matching of ventilation and blood flow
Diffusion of gas from alveolus to red blood cell
Availability of Hb

Transfer factor reduction


Alveolar-capillary interface (emphysema, fibrosis)
Problem with/in pulmonary capillaries (anaemia, diffuse lung fibrosis)

Pulmonary capillary blood flow


Depends on
Volume and distribution of right ventricular output
Gravity dependent- more blood to bases than apices in erect position

Reduces in pulmonary hypertension or extensive pulmonary embolism

Carriages of gases
O2 transported mainly by Hb and some in solution
CO2 transported by solution (as HCO3-) and Hb

Important factors
Influences in oxygen dissociation curve
Control factors Decrease Increase
Temperature Left Right shift
2.3-BPG Left Right shift
P(CO2) Left shift Right shift
pH Right shift (acidosis) Left shift (alkalosis)

*left shift= higher O2 affinity


*right shift = lower O2 affinity
* fetal hemoglobin has higher O2 affinity than adult hemoglobin; primarily due to much-
reduced affinity to 2,3-BPG

Causes of right shift mneumonics:


CADET, face Right = CO2, Acid, 2,3-DPG, Exercise and Temperature

Cardiac output & circulation


O2 delivery to body= arterial O2 content X cardiac output