HYPOXIA & HYPERCAPNIA

Zulkifli, dr., SpAn.Mkes

Dept of Anesthesiology & Reanimation
Medical Faculty
University of Sriwijaya

Definition
Hypoxia :
A pathological condition in which the
body is deprived of adequate oxygen
supply
Oxygenation is failure

Hypoxemia :
The oxygen concentration within the
arterial blood is abnormally low

Symptoms
Signs of oxygenation failure:
Tachypnea
Alkalemia (acidemia if concurrent
ventilatory failure)
Increased pulsus paradoxus
Cyanosis
Agitation Somnolence

TYPES OF HYPOXIA
A. HYPOXEMIC HYPOXIA (INADEQUATE ARTERIAL OXYGEN
TENSION)
CAUSES:

A. V/Q MISMATCH (EX: COPD)

B. SHUNT (EX: ATELECTASIS, PULM. EDEMA)
C. HYPOVENTILATION (EX: DRUG INDUCED)

B. ANEMIC HYPOXIA (DEFICIENT OXYGEN-CARRYING CAPACITY

OF THE BLOOD)
CAUSES:

A. ANEMIA (DECREASED HEMOGLOBIN)

B. CARBON MONOXIDE POISONING
C. SULFHEMOGLOBIN AND METHEMOGLOBIN

TYPES OF HYPOXIA
C. CIRCULATORY HYPOXIA (DECREASE PERIPHERAL CAPILLARY
BLOOD FLOW)
CAUSES:
A. DECREASED CARDIAC OUTPUT
B. VASCULAR INSUFFICIENCY (SEPSIS)

D. HISTOTOXIC HYPOXIA (DECREASED UTILIZATION OF OXYGEN

AT THE CELL LEVEL)
CAUSES:

A. CYANIDE POISONING
B. ALCOHOL POISONING (RARE)

Hypoxia - Etiologies
PaO2 = [FIO2 (PI PH2O)] (PaCO2 / RQ) (A-a gradient)
A-a gradient
V/Q mismatch
COPD
Pulmonary embolus
Pneumonia
Pulmonary edema
Anatomic shunt
Right to left intracardiac
shunts
Pulmonary AVMs
Impaired diffusion
Emphysema
Pulmonary fibrosis

FIO2
Suffocation

PI
High altitude

PaCO2
As above

Overview of Gas Exchange in the

Lungs

Adapted from: Costanzo, LS. Physiology, 1st ed.

1998.

Mathematical Description of Gas

Exchange
PaCO2 Partial pressure of CO2 in the arterial blood.
PACO2 Partial pressure of CO2 in the alveolar gas.
PaO2 Partial pressure of O2 in the arterial blood.
PAO2 Partial pressure of O2 in the alveolar gas.

Oxygen Transport
Oxygen is carried in the blood in 2
forms:
Dissolved O2 (~2% of total O2
content)
O2 bound to hemoglobin (~98% of
total O2 content)

Oxygen Transport
Total O2 content of blood (CaO2) =
Dissolved O2
+
O2 bound to
hemoglobin

Oxygen Transport
Total O2 content of blood (CaO2) =
PaO2

Solubility of O2 in
blood
+

O2 binding
capacity of
Hb

[Hb]

O2 sat

Oxygen Transport
(During Normal Gas
Exchange)

Total O2 content of blood (CaO2) =

PaO2

Solubility of O2 in
blood
+

O2 binding
capacity of
Hb

[Hb]

O2 sat

Oxygen Transport
(During Normal Gas
Exchange)

Total O2 content of blood (CaO2) =

100
mmHg

1.34mL
O2

O2___

0.003mL

100mL
+ blood mmHg
x 15g Hb

0.9
8

Oxygen Transport
(During Normal Gas
Exchange)

Total O2 content of blood (CaO2) =

0.3mL O2_
100mL blood
+
19.7mL
O2_

(Dissolved
O2)

(Hb-bound
O2)

CONTENT VS TENSION
(PaO2)

A. CONTENT= TOTAL AMOUNT OF OXYGEN CARRIED IN BLOOD

NORMAL = 20.7 VOL%

CALCULATION: CaO2 = [%sat x l.39 x content] + [PaO2 x 0.003]
EXAMPLES/NORMAL
NORMAL Hb% = 15 GM%,

0.98 02 SAT = PaO2 = 100mmHg

[1.39 X 0.98 x 15] + [100 x 0.003] = 20.7 vol.%

ANEMIA Hb 10g%, %sat = 98%, PaO2 = 100mmHg

[1.39 x 0.98 x 10] + [100 x 0.003] = 14.2

vol.%

HYPOXEMIA Hb% =15 gm%, %Sat=85%, PaO2=50mmHg

[1.39 x

0.85 x 15] = [50 x 0.003] = 18.0vol%

NORMAL MIXED VENOUS CONTENT = 15%

ARTERIAL VENOUS DIFFERENCE (A-V) = 5VOL%
5VOL

ONTENT VS TENSION (PaO2)

B. TENSION (PaO2) = AMOUNT OF OXYGEN DISSOLVED IN BLOOD

NORMAL = 100mmHg [100 x 0.003] = 0.3%

PaO2 = 1.5% OF THE TOTAL O2 CARRIED IN THE BLOOD ONLY

Hg O2 CONTENT CARRIES 19.2 VOL%

VS
PaO2 CONTENT CARRYING 1.5 VOL%
AS YOU CAN SEE PaO2 ISN'T ALWAYS THE MOST
IMPORTANT OXYGENATION INDICATOR

Pathophysiology
If oxygen delivery to cells is insufficient for the
demand (hypoxia)
hydrogen will be shifted to pyruvic acid converting it
to lactic acid

This temporary measure (anaerobic

metabolism) allows small amounts of energy to
be produced
Lactic acid build up in tissues and blood
is a sign of inadequate mitochondrial oxygenation
due to hypoxemia, poor blood flow (e.g., shock)
or a combination of both

If severe or prolonged it could lead to cell

death.

Hypoxia Treatment

Treat the underlying process

Increase FIO2 with supplemental oxygen
Reposition the body
Secretion management
Bronchodilation
Diuresis
Increase mean lung volume
Reduce O2 requirement
Consider transfusion if [Hb] < 7.0 g/dL

Hypercapnia
Respiratory failure manifesting as
hypercapnia is known as ventilatory
failure.
Signs of ventilatory failure:
Tachypnea
Acidemia
Increased pulsus paradoxus
Hyperinflation
Somnolence / Decreased mental status

Hypercapnia - Etiologies
PaCO2 =

VCO2 x PI
RR (VT VD)

VCO2 (Hypermetabolism)

VT

Fever
Seizures
Sepsis
Hyperalimentation

Skeletal muscle weakness

Impaired neuromuscular
transmission
Lung / chest wall compliance
Airway obstruction
COPD
Asthma
Obstructive sleep apnea

RR (Central hypoventilation)
Drugs
Brainstem lesions
VD
Obesity-hypoventilation syndrome Excessive PEEP

Hypercapnia - Treatment
Treat the underlying process
Non-invasive positive pressure
ventilation
Intubation and mechanical ventilation