Clinical and Physiological Consequences of Hypoxia/Hypoxemia in Healthy Subjects and Patients

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Pulmonology".

Deadline for manuscript submissions: closed (10 May 2023) | Viewed by 10894

Special Issue Editors


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Guest Editor
INSERM, Laboratoire HP2 (U 1300), Grenoble Alpes University and Sleep Laboratory, CHU Grenoble Alpes, France
Interests: sleep medicine; physiology; neurology; rehabilitation medicine; altitude; hypoxia

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Guest Editor
Pulmonology Department, University of Zurich, Zürich, Switzerland
Interests: human physiology; altitude; hypoxia; cardiorespiratory diseases

Special Issue Information

Dear Colleagues,

Low arterial oxygen content, termed hypoxemia, is often closely linked to respiratory or cardiovascular diseases or environmental conditions (high altitude, air travel). Hypoxemia has broad clinical and physiological consequences. It leads to insufficient availability of oxygen in tissues (hypoxia) and, therefore, may alter brain functionality, induce tissue remodeling and destruction, result in organ dysfunction and might promote progression of morbidity and mortality.

Diseases associated with hypoxemia are highly prevalent (COVID-19, chronic obstructive pulmonary disease, pulmonary hypertension, sleep apnea syndrome). Moreover, millions of people are living at high altitude places worldwide (8 million alone in Bogotá, 2640 m, Columbia). Intriguingly, current recommendations in patients with COPD recommend long-term oxygen therapy when the resting PaO2 value is <7.3 kPa (55 mmHg) or SaO2 <89 %, independent of living altitude. Moreover, the lack of well-designed studies complicates recommendations for patients with pre-existing cardiopulmonary diseases planning mountain sojourns, as well as treatments of patients permanently living at high-altitude places. On the other side, hypoxemia is not always deleterious; therefore, patients with ischemic heart disease might have a lower mortality rate when living at higher altitude (Ezzatti 2012, J Epidemiol Community Health). In accordance, millions of people migrate to higher altitudes, but not all of them have hypoxemic maladaptations; therefore, the pathways of hypoxemia are multifactorial and need more attention.

This Special Issue has the following aims:

1) To provide deep insights into the consequences of hypoxemia and hypoxia on the clinical, physiological and molecular level in humans.

2) To connect multiple areas of research and to improve evidence-based medicine in patients and highlanders suffering from hypoxemia.

3) To acquire a comprehensive understanding; to be able to improve current recommendations to prevent, treat or promote hypoxemia; to counsel patients planning to fly or live at high altitude; to protect healthy highlanders from suffering damage from chronic hypoxemia and hypoxia.

To accomplish these aims, we invite all research performed in humans focusing on the clinical, physiological and molecular level in any disease or condition related to or caused by hypoxemia and hypoxia. We welcome all forms of submissions: original research articles and review articles.

Prof. Dr. Martin Burtscher
Dr. Sébastien Baillieul
Dr. Michael Furian
Guest Editors

Manuscript Submission Information

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Keywords

  • hypoxia
  • hypoxemia
  • oxygen deficit
  • altitude
  • hypobaric hypoxia
  • normobaric hypoxia

Published Papers (5 papers)

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Editorial

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2 pages, 170 KiB  
Editorial
Special Issue “Clinical and Physiological Consequences of Hypoxia/Hypoxemia in Healthy Subjects and Patients”
by Michelle Meyer, Aglaia Forrer, Martin Burtscher and Michael Furian
J. Clin. Med. 2022, 11(13), 3904; https://doi.org/10.3390/jcm11133904 - 05 Jul 2022
Viewed by 1422
Abstract
This editorial of the Special Issue “Clinical and Physiological Consequences of Hypoxia/Hypoxemia in Healthy Subjects and Patients” aims to draw more attention to the broad and diverse field of hypoxia research and serves as an invitation for research groups to share their most [...] Read more.
This editorial of the Special Issue “Clinical and Physiological Consequences of Hypoxia/Hypoxemia in Healthy Subjects and Patients” aims to draw more attention to the broad and diverse field of hypoxia research and serves as an invitation for research groups to share their most recent findings with the medical community [...] Full article

Research

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15 pages, 2733 KiB  
Article
Microcirculatory and Rheological Adaptive Mechanisms at High Altitude in European Lowlander Hikers and Nepalese Highlanders
by Paolo Salvi, Andrea Grillo, Fausto Brunacci, Francesca Severi, Luca Montaguti, Sylvie Gautier, Lucia Salvi, Enzo Pretolani, Gianfranco Parati and Athanase Benetos
J. Clin. Med. 2023, 12(8), 2872; https://doi.org/10.3390/jcm12082872 - 14 Apr 2023
Cited by 1 | Viewed by 1066
Abstract
Background: Physical activity at high-altitudes is increasingly widespread, both for tourist trekking and for the growing tendency to carry out sports and training activities at high-altitudes. Acute exposure to this hypobaric–hypoxic condition induces several complex adaptive mechanisms involving the cardiovascular, respiratory and endocrine [...] Read more.
Background: Physical activity at high-altitudes is increasingly widespread, both for tourist trekking and for the growing tendency to carry out sports and training activities at high-altitudes. Acute exposure to this hypobaric–hypoxic condition induces several complex adaptive mechanisms involving the cardiovascular, respiratory and endocrine systems. A lack of these adaptive mechanisms in microcirculation may cause the onset of symptoms of acute mountain sickness, a frequent disturbance after acute exposure at high altitudes. The aim of our study was to evaluate the microcirculatory adaptive mechanisms at different altitudes, from 1350 to 5050 m a.s.l., during a scientific expedition in the Himalayas. Methods: The main haematological parameters, blood viscosity and erythrocyte deformability were assessed at different altitudes on eight European lowlanders and on a group of eleven Nepalese highlanders. The microcirculation network was evaluated in vivo by conjunctival and periungual biomicroscopy. Results: Europeans showed a progressive and significant reduction of blood filterability and an increase of whole blood viscosity which correlate with the increase of altitude (p < 0.02). In the Nepalese highlanders, haemorheological changes were already present at their residence altitude, 3400 m a.s.l. (p < 0.001 vs. Europeans). With the increase in altitude, a massive interstitial oedema appeared in all participants, associated with erythrocyte aggregation phenomena and slowing of the flow rate in the microcirculation. Conclusions: High altitude causes important and significant microcirculatory adaptations. These changes in microcirculation induced by hypobaric–hypoxic conditions should be considered when planning training and physical activity at altitude. Full article
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14 pages, 1615 KiB  
Article
Tent versus Mask-On Acute Effects during Repeated-Sprint Training in Normobaric Hypoxia and Normoxia
by Aldo A. Vasquez-Bonilla, Daniel Rojas-Valverde, Adrián González-Custodio, Rafael Timón and Guillermo Olcina
J. Clin. Med. 2021, 10(21), 4879; https://doi.org/10.3390/jcm10214879 - 22 Oct 2021
Cited by 4 | Viewed by 1919
Abstract
Repeated sprint in hypoxia (RSH) is used to improve supramaximal cycling capacity, but little is known about the potential differences between different systems for creating normobaric hypoxia, such as a chamber, tent, or mask. This study aimed to compare the environmental (carbon dioxide [...] Read more.
Repeated sprint in hypoxia (RSH) is used to improve supramaximal cycling capacity, but little is known about the potential differences between different systems for creating normobaric hypoxia, such as a chamber, tent, or mask. This study aimed to compare the environmental (carbon dioxide (CO2) and wet-globe bulb temperature (WGBT)), perceptual (pain, respiratory difficulty, and rate of perceived exertion (RPE)), and external (peak and mean power output) and internal (peak heart rate (HRpeak), muscle oxygen saturation (SmO2), arterial oxygen saturation (SpO2), blood lactate and glucose) workload acute effects of an RSH session when performed inside a tent versus using a mask. Twelve well-trained cyclists (age = 29 ± 9.8 years, VO2max = 70.3 ± 5.9 mL/kg/min) participated in this single-blind, randomized, crossover trial. Participants completed four sessions of three sets of five repetitions × 10 s:20 s (180 s rest between series) of all-out in different conditions: normoxia in a tent (RSNTent) and mask-on (RSNMask), and normobaric hypoxia in a tent (RSHTent) and mask-on (RSHMask). CO2 and WGBT levels increased steadily in all conditions (p < 0.01) and were lower when using a mask (RSNMask and RSHMask) than when inside a tent (RSHTent and RSNTent) (p < 0.01). RSHTent presented lower SpO2 than the other three conditions (p < 0.05), and hypoxic conditions presented lower SpO2 than normoxic ones (p < 0.05). HRpeak, RPE, blood lactate, and blood glucose increased throughout the training, as expected. RSH could lead to acute conditions such as hypoxemia, which may be exacerbated when using a tent to simulate hypoxia compared to a mask-based system. Full article
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15 pages, 1143 KiB  
Article
Predictors of Hypoxemia and Related Adverse Outcomes in Patients Hospitalized with COVID-19: A Double-Center Retrospective Study
by Rabea Asleh, Elad Asher, Oren Yagel, Tal Samuel, Gabby Elbaz-Greener, Arik Wolak, Ronen Durst, Eli Ben-Chetrit, Ran Nir-Paz, Yigal Helviz, Limor Rubin, Ariella Tvito, Michael Glikson and Offer Amir
J. Clin. Med. 2021, 10(16), 3581; https://doi.org/10.3390/jcm10163581 - 14 Aug 2021
Cited by 7 | Viewed by 2152
Abstract
Hypoxemia is a hallmark of coronavirus disease 2019 (COVID-19) severity. We sought to determine predictors of hypoxemia and related adverse outcomes among patients hospitalized with COVID-19 in the two largest hospitals in Jerusalem, Israel, from 9 March through 16 July 2020. Patients were [...] Read more.
Hypoxemia is a hallmark of coronavirus disease 2019 (COVID-19) severity. We sought to determine predictors of hypoxemia and related adverse outcomes among patients hospitalized with COVID-19 in the two largest hospitals in Jerusalem, Israel, from 9 March through 16 July 2020. Patients were categorized as those who developed reduced (<94%) vs. preserved (≥94%) arterial oxygen saturation (SpO2) within the first 48 h after arrival to the emergency department. Overall, 492 hospitalized patients with COVID-19 were retrospectively analyzed. Patients with reduced SpO2 were significantly older, had more comorbidities, higher body surface area (BSA) and body mass index (BMI), lower lymphocyte counts, impaired renal function, and elevated liver enzymes, c-reactive protein (CRP), and D-dimer levels as compared to those with preserved SpO2. In the multivariable regression analysis, older age (odds ratio (OR) 1.02 per year, p < 0.001), higher BSA (OR 1.16 per 0.10 m2, p = 0.003) or BMI (OR 1.05 per 1 kg/m2, p = 0.011), lower lymphocyte counts (OR 1.72 per 1 × 103/μL decrease, p = 0.002), and elevated CRP (1.11 per 1 mg/dL increase, p < 0.001) were found to be independent predictors of low SpO2. Severe hypoxemia requiring ventilatory support, older age, and pre-existing comorbidities, including underlying renal dysfunction and heart failure, were found to be significantly associated with in-hospital mortality. These findings suggest that assessment of predictors of hypoxemia early at the time of hospitalization with COVID-19 may be helpful in risk stratification and management. Full article
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Review

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16 pages, 764 KiB  
Review
Effects of Acute Exposure and Acclimatization to High-Altitude on Oxygen Saturation and Related Cardiorespiratory Fitness in Health and Disease
by Michael Furian, Markus Tannheimer and Martin Burtscher
J. Clin. Med. 2022, 11(22), 6699; https://doi.org/10.3390/jcm11226699 - 12 Nov 2022
Cited by 6 | Viewed by 2566
Abstract
Maximal values of aerobic power (VO2max) and peripheral oxygen saturation (SpO2max) decline in parallel with gain in altitude. Whereas this relationship has been well investigated when acutely exposed to high altitude, potential benefits of acclimatization on SpO2 and [...] Read more.
Maximal values of aerobic power (VO2max) and peripheral oxygen saturation (SpO2max) decline in parallel with gain in altitude. Whereas this relationship has been well investigated when acutely exposed to high altitude, potential benefits of acclimatization on SpO2 and related VO2max in healthy and diseased individuals have been much less considered. Therefore, this narrative review was primarily aimed to identify relevant literature reporting altitude-dependent changes in determinants, in particular SpO2, of VO2max and effects of acclimatization in athletes, healthy non-athletes, and patients suffering from cardiovascular, respiratory and/or metabolic diseases. Moreover, focus was set on potential differences with regard to baseline exercise performance, age and sex. Main findings of this review emphasize the close association between individual SpO2 and VO2max, and demonstrate similar altitude effects (acute and during acclimatization) in healthy people and those suffering from cardiovascular and metabolic diseases. However, in patients with ventilatory constrains, i.e., chronic obstructive pulmonary disease, steep decline in SpO2 and V̇O2max and reduced potential to acclimatize stress the already low exercise performance. Finally, implications for prevention and therapy are briefly discussed. Full article
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