HYPOXIA Periodic breathing •It is not regular, rhythmic, but respiration occurs in periods ("a moment to breathe, take a moment to not breathe„) • •CHEYNE-STOKES •BIOT‘S •„gasping“ •KUSSMAUL It has a spindle shape Hypoxia, hypoxemia •Hypoxia is a general name for a lack of oxygen in the body or individual tissues. •Hypoxemia is lack of oxygen in arterial blood. •Complete lack of oxygen is known as anoxia. The most common types of hypoxia: 1.Hypoxic - physiological: stay at higher altitudes, pathological: hypoventilation during lung or neuromuscular diseases 2.Transport (anemic) - reduced transport capacity of blood for oxygen (anemia, blood loss, CO poisoning) 3.Ischemic (stagnation) - restricted blood flow to tissue (heart failure, shock states, obstruction of an artery) 4.Histotoxic - cells are unable to utilize oxygen (cyanide poisoning - damage to the respiratory chain) Hypercapnia • Hypercapnia - increase of concentration of carbon dioxide in the blood or in tissues that is caused by retention of CO2 in the body • possible causes: total alveolar hypoventilation (decreased respiration or extension of dead space) • mild hypercapnia (5 -7 kPa) causes stimulation of the respiratory center (therapeutic use: pneumoxid = mixture of oxygen + 2-5% CO2) • hypercapnia around 10 kPa - CO2 narcosis - respiratory depression (preceded by headache, confusion, disorientation, a feeling of breathlessness) •hypercapnia over 12 kPa - significant respiratory depression - coma and death. HYPOXIA is oxygen deficiency at the cells or the tissue or the organs or the organism level OXYGEN FALL mmHg dry atmospheric air 159 humid atmospheric air 149 ideal alveolar gass 105 end-expirated air 105 Arterial blood 77 Cytoplasma – mitochondria 3-10 Mixed venous blood 40 Venous blood 20 S02401-002-f007 pO2 = 1 mmHg Hypoxia has been divided into following types: 1.Decrease oxidation of blood in the lung 2.Pulmonary disease 3.Venous-arterial shorts in circulation 4.Oxygen transport disorder (blood – tissue) 5.Decrease utilization of oxygen by the tissue 6. 1.Decrease oxidation of blood in the lung -hypoxic hypoxia: -lower oxygen in atmospherical air -hypoventilation (neuromuscular diseases) 1. 2. Pulmonary disease -hypoventilation : increase airway resistance (asthma bronchiale) or pulmonary compliance - - 3. Venous – arterial shunts from fetal circulation: ductus arteriosus Botali foramen ovale 4. Oxygen transport disorder (anemic hypoxia, stagnant hypoxia, ischemic hypoxia) -Anemia -Special type of hemoglobin (hemoglobin S-sickle cell anemia) -Decrease of temperature -Cardiovascular diseases -Local disorder in circulation 5. Decrease utilization of oxygen by the tissue (histotoxic hypoxia) -enzyme blocade of respiratory circle (poisoning) - e.g. Cyanid poisoning – cyanid inhibits cytochromoxidase; treatment: methylen blue or nitrites (methemoglobin + cyanid=cyanmetHg=nontoxic compound - -lower capacity of cells for utilization of oxygen (deficit of vitamins) hypoxie765.jpg Experiment Hypoxic hypoxia – use the Krogh respirometer Filling: ambient air with CO2 absorber (calcium hydroxide) Bed with fur and pillow I have no bow and arrow Hypoxia setup Hypoxic hypoxia – during a trip to high mountains e.g. with cable car to Mont Blanck Effect of high altitude on arterial oxygen saturation (numbers in parenthese are acclimatized value) Altitude barometric pO2 pCO2 pO2 arterial oxygen pressure in air in alveoli in alveoli saturation (m) (mmHg) (mmHg) (mmHg) (mmHg) (%) 0 760 159 40 (40) 104 (104) 97 (97) 3 048 523 110 36 (23) 67 (77) 90 (92) 6 096 349 73 24 (10) 40 (53) 73 (85) 9 134 249 47 24 (7) 18 (30) 24 (38) 12 192 141 29 15 240 87 18 Breathing pure oxygen altitude barometric pCO2 pO2 arterial oxygen pressure in alveoli in alveoli saturation (m) (mmHg) (mmHg) (mmHg) (%) 0 760 40 673 100 3 048 523 40 436 100 6 096 349 40 262 100 9 134 349 40 139 99 12 192 141 36 58 84 15 240 87 24 16 15 Work capacity at high altitude work capacity (compare with normal condition) (%) Unacclimatized 50 Acclimatized for 2 months 68 Native living at 4 023 m but working at 5 182 m above sea level 87 High altitude hypoxia – mountain sickness - mild step CNS disorientation GIT nausea Sensitivity headache Respiration increase BP increase HR increase, arrhythmias muscle loss of co-ordination High altitude hypoxia – middle step CNS dimness of vision, vertigo, anxiosity GIT nausea Sensitivity chest pain Respiration apnoe BP increase HR decrease, irregulary muscle spasmus High altitude hypoxia – severe step CNS coma GIT nausea, vomiting Sensitivity chest pain Respiration Cheyn-Stokesovo dýchání BP drop HR decrease Muscle muscle weakness Travelling by aircraft High risk for patients with: - Concentration of hemoglobin above 60 % - Atherosclerosis - severe step - Cardial insuficiency - Respiratory insuficiency - Hypertension - untreated (BP ower 200/100) (On board aicraft is pressure as on 2000 m above see level) Influence on SBP and DBP - lower pO2 stimulated sympaticus - increase periphery resistance - decrease stroke volume - decrease pulse pressure - decrease perfusion in tissues - redistribution of blood in circulation - increase of position of diaphragma (decrease hemodynamics and respiration) The traveling by craft is risk for patients with - cardio – vascular diseases - - tromb – embolic diseases Toxicity of oxygen The toxicity seems to be due to the production of the superoxid anion and H2O2 Causes: - inability to bind CO2 in venous blood - development of CO2 is more difficult due to toxic pulmonary oedema Critical values: > 40 kPa (300 mmHg) ..dependent on time Toxicity of oxygen Exposure – 8 hours:- Respiratory passages became irritated - Substernal distress - Nasal congestion - Sore throat - Cough - 24-48 hours: - damage of lungs – decrease production of surfactant TOXICITY of OXYGEN Recommendation: 100 % - give discontinuosly