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Effects of Acute, Profound Hypoxia on Healthy Humans: Implications for Safety of Tests Evaluating Pulse Oximetry or Tissue Oximetry Performance

Bickler, Philip E. MD, PhD; Feiner, John R. MD; Lipnick, Michael S. MD; Batchelder, Paul BS; MacLeod, David B. FRCA; Severinghaus, John W. MD

doi: 10.1213/ANE.0000000000001421
Technology, Computing, and Simulation: Narrative Review Article
Continuing Medical Education

Extended periods of oxygen deprivation can produce acidosis, inflammation, energy failure, cell stress, or cell death. However, brief profound hypoxia (here defined as SaO2 50%–70% for approximately 10 minutes) is not associated with cardiovascular compromise and is tolerated by healthy humans without apparent ill effects. In contrast, chronic hypoxia induces a suite of adaptations and stresses that can result in either increased tolerance of hypoxia or disease, as in adaptation to altitude or in the syndrome of chronic mountain sickness. In healthy humans, brief profound hypoxia produces increased minute ventilation and increased cardiac output, but little or no alteration in blood chemistry. Central nervous system effects of acute profound hypoxia include transiently decreased cognitive performance, based on alterations in attention brought about by interruptions of frontal/central cerebral connectivity. However, provided there is no decrease in cardiac output or ischemia, brief profound hypoxemia in healthy humans is well tolerated without evidence of acidosis or lasting cognitive impairment.

Published ahead of print August 12, 2016.

From the *Department of Anesthesia and Perioperative Care, University of California at San Francisco School of Medicine, San Francisco, California, Clinimark Labs, Louisville, Colorado, and Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina.

Published ahead of print August 12, 2016.

Accepted for publication April 23, 2016.

Funding: Supported by the UCSF Hypoxia Research Laboratory from funds derived from the validation and testing of pulse oximeters. No sponsor directly funded the study or participated in study design.

Conflicts of Interest: See Disclosures at the end of the article.

This paper was presented as part of the international symposium “Innovations and Advances in Monitoring Perfusion, Oxygenation and Ventilation” held at St. Luke’s International University, Tokyo, October 2015.

Reprints will not be available from the authors.

Address correspondence to Philip E. Bickler, MD, PhD, Department of Anesthesia and Perioperative Care, University of California at San Francisco, 513 Parnassus Ave, Sciences S-256, San Francisco, CA 94143. Address email to

© 2017 International Anesthesia Research Society
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