Hipoxemia (hO2)

– Valoare ”normala” dependenta de varsta

Insuficienta respiratorie – Ecuatie de predictie: varsta, sex, presiune barometrica,
pozitie
• regula “70-70”
• PaO2=110 - varsta/2
Stefan Dumitrache-Rujinski • PaO2 = 109 - (0.43 X virsta in ani)
• PaO2 = 0.1834 PB - 0.24 (varsta) - 31.45 (la 1,400m)

Crapo RO, Jensen RL, Hegewald M, Tashkin DP. Arterial blood gas reference values for sea level and altitude of 1,400 meters. Am J Resp
Crit Care Med. 1999;160(5 Pt 1):1525-31
Helen M. Sorenson. Oxygenation in the elderly

Insuficienta respiratorie
– PaO2 < 60 mmHg (gazometrie sange arterial)
– SaO2 < 88-90% (pulsoximetrie)
• exista corespondenta SaO2-PaO2
– la pH normal • PaCO2 - ventilatia alveolara
curba de disociere a HbO2 • 35-45 mmHg (nu variaza cu varsta)
• Hipercapnia (HCO2) - hipoventilatie
– PaCO2>45mmHg
• Hipocapnia (hCO2) - hiperventilatie
– PaCO2<35mmHg
 Mecanisme fiziopatologice ale hipoxemiei in
bolile pulmoare cronice

Insuficienta respiratorie 1) Tulburare Ṽ/Q

– Tip I (PaO2<60mmHg) • BPOC

– TipII (PaO2<60mmHg & PaCO2>45mmHg) 2) Sunt

• pneumonie
3) Hipoventilatie alveolara (hipercapnie)
– Acuta si cronica
• b. neuromusculare, obezitate morbida, deformari torace
4) Membrana alveolo-capilara
• pneumopatii intersitiale difuze

Tulburare Ṽ/Q
• Dezechilibru Ṽ/Q
• Hipoventilatie alveolara (hipercapnie+hipoxemie)
– BPOC (hO2 ± HCO2)
• b. neuromusculare, obezitate morbida
• hO2 usor corectabila cu debite mici
• hipoxemia secundara CO2 alveolar crescut
• debitele mari de O2 pot agrava hipercapnia
• administrarea de oxigen agraveaza hipercapnia
• Extreme
– Spatiu mort (Ṽ/Q→∞)
• TEP • Membrana alveolo-capilara (hipoxemie)
• pneumopatii intersitiale difuze
– Sunt (Ṽ/Q→0)
• O2 aditional corecteaza hO2
• Pneumonie
• SDRA→ hO2 nu se corecteaza cu debite mari (PaO2/FiO2)
 EAB
“debitul crescut de oxigen poate agrava pH (logaritmul negativ al concentrației ionului de H+)
hipercapnia” – Acidoza pH<7,35
– Alcaloza pH>7,45
– aboleste stimulul determinat de hO2 asupra centrului
respirator – Respiratorie (pH~1/PaCO2) pH~HCO3/PaCO2
– agraveaza dezechilibrul ventilatie-perfuzie – Metabolica (pH~PaCO2)
• Von Euler-Liljestrand
– Rezerva alcalina / compensare renala

SDRA /ALI
• presiunea capilara blocata< 18 mmHg CATEGORIES OF RESPIRATORY FAILURE
– daca indisponibila: fara evidenta clinica de staza cardiaca stanga (presiune • Abnormalities of the Central Nervous System
creascuta in AS) • Abnormalities of the Peripheral Nervous System or Chest Wall
• PaO2/FiO2 < 300 mmHg (40 kPa) ALI (acute lung injury) • Abnormalities of the Airways
• PaO2/FiO2 < 200 mmHg (26.7 kPa) SDRA • Abnormalities of the Alveoli
Common causes of type I (hypoxemic) respiratory failure include the Common causes of type II (hypercapnic) respiratory
following: failure include the following:
• COPD
• Pneumonia • COPD
• Pulmonary edema • Drug overdose / Poisonings
• Pulmonary fibrosis • Myasthenia gravis
• Asthma
• Polyneuropathy
• Pneumothorax
• Pulmonary embolism • Poliomyelitis
• Pulmonary arterial hypertension • Primary muscle disorders
• Pneumoconiosis • Head and cervical cord injury
• Granulomatous lung diseases
• Cyanotic congenital heart disease
• Primary alveolar hypoventilation
• Bronchiectasis • Obesity-hypoventilation syndrome
• Acute respiratory distress syndrome (ARDS)
• Fat embolism syndrome

Evaluare Pulsoximetria
– determinare instantanee (SaO2)
– determinare continua (nocturna sau diurna)
– Gazometrie (pH, PaCO2, PaO2, SaO2, HCO3)
• arteriala
• capilara (sange mixt, arterializat)
– Pulsoximetrie (SaO2)
– Capnografie (CO2 exhalat, transcutanat)

SDR 15 SDR 15
 Pulsoximetria nocturna Hipoxemie intermitenta

Hipoxemie intermitenta
SDR 2012

SDR 12

SDR 12

SDR 12

Hipoxemie continua
Poligrafie cardio-respiratorie: SASO

SDR 2015

SDR 15

SDR 2012
 Hipoxemie continua Hipoxemie continua

SDR 15 SDR 15

Hipoxemie intermitenta

SDR 12

SaO 2 [%]
100
SaO 2 [%]
90 100

80 90
SOH 80
SDR 11

1 2 3 4 5 6 timp [h] SDR 10

SOH + SAS

1 2 3 4 5 6 timp [h]
SaO 2 [%]
100

90 80%

80

SAS2
SDR 11

1 2 3 4 5 6 timp [h]
 Indicaţii oxigenoterapie de lungă durată in BPOC

pacienţi cu insuficienţă respiratorie cronică, la distanţă de un episod acut si

cu tratament corect

• cu una din condiţiile:

O2
- PaO2 < 55 mmHG (sau SaO2<88%),
– Vasoconstrictie circulatia sistemica
- PaO2: 55-59 mmHG (sau SaO2 < 90%) si una din
– Vasodilatatie circulatia pulmonara
- semne clinice de cord pulmonar cronic / HTP

- poliglobulie (Ht > 55%)

• durata administrării cotidiene este de 15-16 ore/zi

Ventilatie Non Invaziva

O2

CPAP
CPAP EPAP
SaO 2 [%] SaO 2 [%]
CO2
100 100 IPAP
Hipercapnie →→ BPAP
90 CPAP 90
SDR 17

80 80
ΔP = IPAP - EPAP
SAS2 SAS2
SDR 11 SDR 11

1 2 3 4 5 6 timp [h] 1 2 3 4 5 6 timp [h]

 Mecanisme fiziopatologice - raspuns la terapie
mecanism patologie O2 & CO2 Efect O2
tulburare Ṽ/Q BPOC hO2±HCO2 debit mic corecteaza hO2
TEP
debit mare poate agrava HCO2
sunt Pneumonie hO2 O2 aditional corecteaza
SDRA debit mare nu corecteaza
hipoventilatie b.neuromusculare, HCO2+hO2 agraveaza HCO2, amelioreaza hO2
cutie toracica,
pleura
obezitate, droguri
MAC pneumopatii hO2 (de O2 aditional corecteaza hO2
interstițiale difuze efort)