Original Articles
Altitude, the Ratio of PaO2 to Fraction of Inspired Oxygen, and Shunt: Impact on the Assessment of Acute Lung Injury
J.R. Pérez-Padilla
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perezpad@servidor.unam.mx
Correspondence: Dr. J.R. Pérez-Padilla. Departamento de Fisiología Pulmonar y Clínica de Sueño. Instituto Nacional de Enfermedades Respiratorias. Tlalpan 4502. México DF. México
Correspondence: Dr. J.R. Pérez-Padilla. Departamento de Fisiología Pulmonar y Clínica de Sueño. Instituto Nacional de Enfermedades Respiratorias. Tlalpan 4502. México DF. México
Departamento de Fisiología Pulmonar and Clínica de Sueño, Instituto Nacional de Enfermedades Respiratorias, México DF, Mexico
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"apellidos" => "Pérez-Padilla" "email" => array:1 [ 0 => "perezpad@servidor.unam.mx" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:1 [ "entidad" => "Departamento de Fisiología Pulmonar and Clínica de Sueño, Instituto Nacional de Enfermedades Respiratorias, México DF, Mexico" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr. J.R. Pérez-Padilla. Departamento de Fisiología Pulmonar y Clínica de Sueño. Instituto Nacional de Enfermedades Respiratorias. Tlalpan 4502. México DF. México" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2003-12-02" "fechaAceptado" => "2004-03-09" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key Words" "identificador" => "xpalclavsec153139" "palabras" => array:6 [ 0 => "Shunt" 1 => "Oxygenation index" 2 => "Ratio PaO<span class="elsevierStyleInf">2</span> to fraction of inspired oxygen (FIO2)," 3 => "PaO2/FIO<span class="elsevierStyleInf">2</span>" 4 => "Acute respiratory distress syndrome (ARDS)" 5 => "Altitude" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec153138" "palabras" => array:5 [ 0 => "Cortocircuito" 1 => "Índices de oxigenación" 2 => "PaO2/FiO<span class="elsevierStyleInf">2</span>" 3 => "Síndrome de insuficiencia respiratoria progresiva del adulto (SIR-PA)" 4 => "Altitud" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">The ratio of PaO<span class="elsevierStyleInf">2</span> to the fraction of inspired oxygen (PaO<span class="elsevierStyleInf">2</span>/FIO<span class="elsevierStyleInf">2</span>) is commonly used to determine the severity of acute lung injury and acute respiratory distress syndrome (ARDS). The research presented here used computational models of the lung to analyze the effect of altitude on the PaO<span class="elsevierStyleInf">2</span>/FIO<span class="elsevierStyleInf">2</span> ratio and pulmonary shunt.</p><p class="elsevierStyleSimplePara elsevierViewall">At a given shunt, the PaO<span class="elsevierStyleInf">2</span>/FIO<span class="elsevierStyleInf">2</span> ratio is lower at higher altitudes. Therefore, when evaluating for ARDS based on a PaO<span class="elsevierStyleInf">2</span>/FIO<span class="elsevierStyleInf">2</span> ratio of <200 mm Hg, patients residing at high altitudes will have less shunt and, presumably, less severe lung injury than patients at sea level.</p><p class="elsevierStyleSimplePara elsevierViewall">This should be taken into consideration when comparing patients from different altitudes. Shunt should more often be measured directly or be estimated assuming a constant arteriovenous oxygen content difference.</p>" ] "es" => array:1 [ "resumen" => "<p class="elsevierStyleSimplePara elsevierViewall">El cociente presión arterial de oxígeno/fracción inspiratoria de oxígeno (PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span>) se utiliza comúnmente para definir el grado de lesión pulmonar y el síndrome de insuficiencia respiratoria progresiva del adulto. En el presente trabajo se analizan las modificaciones que experimenta el índice con la altura sobre el nivel del mar y con los cortocircuitos en modelos computacionales de pulmón.</p><p class="elsevierStyleSimplePara elsevierViewall">El cociente PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> disminuye con la altura sobre el nivel del mar al mismo cortocircuito. Por lo tanto, los pacientes que residen a alturas considerables sobre el nivel del mar tienen un cortocircuito menor y presumiblemente un grado de daño pulmonar menor que los residentes al nivel del mar en el momento de cumplir el criterio de síndrome de insuficiencia respiratoria progresiva del adulto con un cociente PaO<span class="elsevierStyleInf">2</span>/FiO<span class="elsevierStyleInf">2</span> de 200 Torr.</p><p class="elsevierStyleSimplePara elsevierViewall">Esta variación debe tomarse en cuenta para la comparación de pacientes cuando provienen de alturas diferentes e indica que se ha de utilizar más frecuentemente la medición directa del cortocircuito o bien el cortocircuito calculado, asumiendo una diferencia arteriovenosa del contenido de oxígeno constante.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "REFERENCES" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:21 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "BA Shapiro" 1 => "WT Peruzzi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "titulo" => "Manejo clínico de los gases sanguíneos" "fecha" => "1996" "editorial" => "Editorial Médica Panamericana" "editorialLocalizacion" => "Buenos Aires" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unreliability of oxygen tension-based indices in reflecting intrapulmonary shunting in the critically ill" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "RD Cane" 1 => "BA Shapiro" 2 => "R Templin" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Crit Care Med" "fecha" => "1988" "volumen" => "12" "paginaInicial" => "1243" "paginaFinal" => "1245" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arterial blood gas derived variables as estimates of intrapulmonary shunt in critically ill children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "JM Dean" 1 => "RC Wetzel" 2 => "MC Rogers" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Crit Care Med" "fecha" => "1985" "volumen" => "13" "paginaInicial" => "1029" "paginaFinal" => "1033" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of changes in arterial-mixed venous oxygen content difference (C(a-v)O2) on indices of pulmonary oxygen transfer in a model ARDS lung" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "M Nirmalan" 1 => "T Willard" 2 => "MO Columb" 3 => "P Nightingale" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2001" "volumen" => "86" "paginaInicial" => "477" "paginaFinal" => "485" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11573620" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "KISS and indices of pulmonary oxygen transfer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "CE Hahn" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Br J Anaesth" "fecha" => "2001" "volumen" => "86" "paginaInicial" => "465" "paginaFinal" => "467" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11573616" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Assessment of the efficiency of pulmonary oxygenation. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 3 | 6 |
| 2024 October | 49 | 47 | 96 |
| 2024 September | 44 | 45 | 89 |
| 2024 August | 59 | 97 | 156 |
| 2024 July | 54 | 55 | 109 |
| 2024 June | 55 | 68 | 123 |
| 2024 May | 63 | 61 | 124 |
| 2024 April | 37 | 48 | 85 |
| 2024 March | 22 | 46 | 68 |
| 2024 February | 29 | 45 | 74 |
| 2023 March | 3 | 11 | 14 |
| 2023 February | 22 | 64 | 86 |
| 2023 January | 32 | 73 | 105 |
| 2022 December | 40 | 78 | 118 |
| 2022 November | 32 | 69 | 101 |
| 2022 October | 49 | 99 | 148 |
| 2022 September | 59 | 64 | 123 |
| 2022 August | 48 | 87 | 135 |
| 2022 July | 29 | 96 | 125 |
| 2022 June | 31 | 78 | 109 |
| 2022 May | 30 | 112 | 142 |
| 2022 April | 34 | 135 | 169 |
| 2022 March | 39 | 149 | 188 |
| 2022 February | 37 | 90 | 127 |
| 2022 January | 38 | 140 | 178 |
| 2021 December | 25 | 123 | 148 |
| 2021 November | 21 | 102 | 123 |
| 2021 October | 33 | 124 | 157 |
| 2021 September | 42 | 154 | 196 |
| 2021 August | 23 | 113 | 136 |
| 2021 July | 28 | 76 | 104 |
| 2021 June | 27 | 109 | 136 |
| 2021 May | 32 | 96 | 128 |
| 2021 April | 75 | 225 | 300 |
| 2021 March | 32 | 163 | 195 |
| 2021 February | 15 | 117 | 132 |
| 2021 January | 25 | 79 | 104 |
| 2020 December | 25 | 69 | 94 |
| 2020 November | 25 | 61 | 86 |
| 2020 October | 26 | 62 | 88 |
| 2020 September | 18 | 56 | 74 |
| 2020 August | 30 | 65 | 95 |
| 2020 July | 23 | 71 | 94 |
| 2020 June | 34 | 49 | 83 |
| 2020 May | 33 | 88 | 121 |
| 2020 April | 37 | 128 | 165 |
| 2020 March | 33 | 89 | 122 |
| 2020 February | 25 | 62 | 87 |
| 2020 January | 31 | 53 | 84 |
| 2019 December | 32 | 44 | 76 |
| 2019 November | 18 | 55 | 73 |
| 2019 October | 11 | 46 | 57 |
| 2019 September | 26 | 43 | 69 |
| 2019 August | 14 | 32 | 46 |
| 2019 July | 21 | 33 | 54 |
| 2019 June | 15 | 39 | 54 |
| 2019 May | 31 | 82 | 113 |
| 2019 April | 45 | 85 | 130 |
| 2019 March | 23 | 45 | 68 |
| 2019 February | 19 | 25 | 44 |
| 2019 January | 12 | 32 | 44 |
| 2018 December | 10 | 33 | 43 |
| 2018 November | 27 | 36 | 63 |
| 2018 October | 33 | 30 | 63 |
| 2018 September | 14 | 37 | 51 |
| 2018 May | 8 | 0 | 8 |
| 2018 April | 4 | 11 | 15 |
| 2018 March | 8 | 3 | 11 |
| 2018 February | 3 | 8 | 11 |
| 2018 January | 5 | 13 | 18 |
| 2017 December | 6 | 7 | 13 |
| 2017 November | 5 | 25 | 30 |
| 2017 October | 9 | 31 | 40 |
| 2017 September | 6 | 19 | 25 |
| 2017 August | 12 | 30 | 42 |
| 2017 July | 20 | 26 | 46 |
| 2017 June | 11 | 49 | 60 |
| 2017 May | 10 | 50 | 60 |
| 2017 April | 2 | 36 | 38 |
| 2017 March | 7 | 27 | 34 |
| 2017 February | 0 | 38 | 38 |
| 2017 January | 1 | 32 | 33 |
| 2016 December | 5 | 16 | 21 |
| 2016 November | 19 | 25 | 44 |
| 2016 October | 15 | 22 | 37 |
| 2016 September | 23 | 22 | 45 |
| 2016 August | 11 | 7 | 18 |
| 2016 July | 8 | 14 | 22 |
| 2016 March | 2 | 0 | 2 |
| 2016 February | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 122 | 1 | 123 |
| 2015 September | 125 | 76 | 201 |
| 2015 August | 95 | 53 | 148 |
| 2015 July | 164 | 37 | 201 |
| 2015 June | 112 | 50 | 162 |
| 2015 May | 113 | 39 | 152 |
| 2015 April | 108 | 57 | 165 |
| 2015 March | 133 | 55 | 188 |
| 2015 February | 110 | 35 | 145 |
| 2015 January | 53 | 52 | 105 |
| 2014 December | 85 | 56 | 141 |
| 2014 November | 75 | 50 | 125 |
| 2014 October | 101 | 78 | 179 |
| 2014 September | 97 | 74 | 171 |
| 2014 August | 86 | 72 | 158 |
| 2014 July | 72 | 76 | 148 |
| 2014 June | 94 | 87 | 181 |
| 2014 May | 101 | 82 | 183 |
| 2014 April | 95 | 49 | 144 |
| 2014 March | 107 | 56 | 163 |
| 2014 February | 101 | 31 | 132 |
| 2014 January | 80 | 33 | 113 |
| 2013 December | 97 | 30 | 127 |
| 2013 November | 94 | 24 | 118 |
| 2013 October | 55 | 18 | 73 |
| 2013 September | 61 | 31 | 92 |
| 2013 August | 70 | 27 | 97 |
| 2013 July | 72 | 41 | 113 |
| 2013 June | 44 | 20 | 64 |
| 2013 May | 43 | 21 | 64 |
| 2013 April | 30 | 27 | 57 |
| 2013 March | 11 | 3 | 14 |
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