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. 1971 Apr;50(4):827–837. doi: 10.1172/JCI106554

Pulmonary Artery Pressure and Alveolar Gas Exchange in Man during Acclimatization to 12,470 ft

Richard S Kronenberg 1, Peter Safar 1, Joseph Lee 1, Fred Wright 1, William Noble 1, Eric Wahrenbrock 1, Robert Hickey 1, Edwin Nemoto 1, John W Severinghaus 1
PMCID: PMC291997  PMID: 5547278

Abstract

Pulmonary hemodynamics and gas exchange were studied in four physicians during 72 hr acclimatization to 12,470 ft. Pulmonary catheters were left in three subjects for 72 hr. Resting mean pulmonary arterial pressure (P̄ĀP̄) rose progressively during the first 24 hr from 10.3 ±1.0 to 21.1 ±4.0 torr and remained at this level. During this same 24 hr period cardiac output increased from 7.1 ±1.4 to 8.4 ±2.0 liters/min and total pulmonary resistance rose from 122 ±16 to 209 ±40 dynes·sec/cm-5. Excercise at 60 w after 24 hr of hypoxia increased P̄ĀP̄ to 28.8 ±5.1 torr and decreased total pulmonary resistance to 155 ±25. Shunt fractions were 11 ±3.8% after 24 hr at altitude and fell to 7 ±0% after 72 hr. Alveolar to arterial O2 difference (P(A-a)O2) breathing oxygen fell from 116 ±10.8 to 92 ±33.3 torr during the same period of acclimatization, whereas dead space to tidal volume ratio (VD/VT) rose from 33 ±4.0% to 40 ±5.3% and P(A-a)O2 breathing ambient air rose from 8 ±2.6 to 11 ±3.0 torr. Inspiratory static lung compliance decreased significantly from a control of 176 ±8 to 141 ±8 ml/cm H2O after 72 hr of hypoxia.

After 4-7 days at altitude, further deterioration in gas exchange was observed after a 5 mile, 1800 ft climb to the summit (14,255 ft) and return. P(A-a)O2 on air rose from 2.5 ±2.1 just before starting, to 16.3 ±2.8 at the summit (rested), and was still 9.0 ±2.2 several hours after returning. The O2-breathing values paralleled these, whereas dead space appeared to fall. We speculate that the hypoxic pulmonary hypertension which develops over 24 hr in some way may be responsible for a reduction of compliance and deterioration in oxygen exchange efficiency, possibly representing a sub-clinical form of pulmonary edema of high altitude. The increased alveolar to arterial O2 difference induced by hypoxic exercise persists for several hours of hypoxic rest.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. CANEPA A., CHAVEZ R., HURTADO A., ROTTA A., VELASQUEZ T. Pulmonary circulation at sea level and at high altitudes. J Appl Physiol. 1956 Nov;9(3):328–336. doi: 10.1152/jappl.1956.9.3.328. [DOI] [PubMed] [Google Scholar]
  2. Dawson A. Regional pulmonary blood flow in sitting and supine man during and after acute hypoxia. J Clin Invest. 1969 Feb;48(2):301–310. doi: 10.1172/JCI105986. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Haab P., Held D. R., Ernst H., Farhi L. E. Ventilation-perfusion relationships during high-altitude adatation. J Appl Physiol. 1969 Jan;26(1):77–81. doi: 10.1152/jappl.1969.26.1.77. [DOI] [PubMed] [Google Scholar]
  4. Hultgren H. N., Grover R. F. Circulatory adaptation to high altitude. Annu Rev Med. 1968;19:119–152. doi: 10.1146/annurev.me.19.020168.001003. [DOI] [PubMed] [Google Scholar]
  5. KREUZER F., TENNEY S. M., ANDRESEN D. C., SCHREINER B. F., NYE R. E., Jr, MITHOEFER J. C., VALTIN H., NAITOVE A. Alveolar-arterial oxygen gradient in the dog at altitude. J Appl Physiol. 1960 Sep;15:796–800. doi: 10.1152/jappl.1960.15.5.796. [DOI] [PubMed] [Google Scholar]
  6. KREUZER F., TENNEY S. M., MITHOEFER J. C., REMMERS J. ALVEOLAR-ARTERIAL OXYGEN GRADIENT IN ANDEAN NATIVES AT HIGH ALTITUDE. J Appl Physiol. 1964 Jan;19:13–16. doi: 10.1152/jappl.1964.19.1.13. [DOI] [PubMed] [Google Scholar]
  7. Klausen K. Cardiac output in man in rest and work during and after acclimatization to 3,800 m. J Appl Physiol. 1966 Mar;21(2):609–616. doi: 10.1152/jappl.1966.21.2.609. [DOI] [PubMed] [Google Scholar]
  8. Klingenmaier C. H., Behar M. G., Smith T. C. Blood oxygen content measured by oxygen tension after release by carbon monoxide. J Appl Physiol. 1969 May;26(5):653–655. doi: 10.1152/jappl.1969.26.5.653. [DOI] [PubMed] [Google Scholar]
  9. Lenfant C., Torrance J., English E., Finch C. A., Reynafarje C., Ramos J., Faura J. Effect of altitude on oxygen binding by hemoglobin and on organic phosphate levels. J Clin Invest. 1968 Dec;47(12):2652–2656. doi: 10.1172/JCI105948. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. MENON N. D. HIGH-ALTITUDE PULMONARY EDEMA: A CLINICAL STUDY. N Engl J Med. 1965 Jul 8;273:66–73. doi: 10.1056/NEJM196507082730202. [DOI] [PubMed] [Google Scholar]
  11. Penaloza D., Sime F. Circulatory dynamics during high altitude pulmonary edema. Am J Cardiol. 1969 Mar;23(3):369–378. doi: 10.1016/0002-9149(69)90517-7. [DOI] [PubMed] [Google Scholar]
  12. Reeves J. T., Halpin J., Cohn J. E., Daoud F. Increased alveolar-arterial oxygen difference during simulated high-altitude exposure. J Appl Physiol. 1969 Nov;27(5):658–661. doi: 10.1152/jappl.1969.27.5.658. [DOI] [PubMed] [Google Scholar]
  13. Rytand D. A., Frank A., Profant G. R. Simple optical methods for the recognition of atrial flutter, especially at slow atrial rates. Circulation. 1966 Jul;34(1):111–118. doi: 10.1161/01.cir.34.1.111. [DOI] [PubMed] [Google Scholar]
  14. SHARP J. T., GRIFFITH G. T., BUNNELL I. L., GREENE D. G. Ventilatory mechanics in pulmonary edema in man. J Clin Invest. 1958 Jan;37(1):111–117. doi: 10.1172/JCI103577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Severinghaus J. W., Bainton C. R., Carcelen A. Respiratory insensitivity to hypoxia in chronically hypoxic man. Respir Physiol. 1966;1(3):308–334. doi: 10.1016/0034-5687(66)90049-1. [DOI] [PubMed] [Google Scholar]
  16. Severinghaus J. W. Blood gas calculator. J Appl Physiol. 1966 May;21(3):1108–1116. doi: 10.1152/jappl.1966.21.3.1108. [DOI] [PubMed] [Google Scholar]
  17. Severinghaus J. W., Hamilton F. N. End-tidal gas sampler. J Appl Physiol. 1970 Feb;28(2):244–244. doi: 10.1152/jappl.1970.28.2.244. [DOI] [PubMed] [Google Scholar]

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