Hypoxemia During Hemodialysis
1982; American Medical Association; Volume: 142; Issue: 7 Linguagem: Inglês
10.1001/archinte.1982.00340200118022
ISSN1538-3679
Autores Tópico(s)Respiratory Support and Mechanisms
Resumopatients with chronic renal failure receiving hemodialysis experience hypoxemia during routine dialysis. First reported, to our knowledge, by Johnson et al 1 in 1970, the fall in Pao 2 is typically 10% to 20% of baseline. This decrease is usually well tolerated, 2 but may be of critical importance in patients with limited pulmonary or cardiac reserve. We will review clinical evidence for pathophysiologic alterations—pulmonary and metabolic—that contribute to production of this hypoxemia. PHYSIOLOGIC APPROACH TO HYPOXEMIA Mechanisms of Arterial Hypoxemia Hypoxemia may result from five causes listed in the Table. Data needed to differentiate between these are shown. Categorization of hypoxemia physiologically aids in determining its cause, and provides a rational basis for choosing therapy. Alveolar Gas Equation and Arterial-Alveolar Po2 Difference In the Table, calculation of the arterial-alveolar PO 2 difference (aADO 2 ) provides the basis for distinguishing reduced fraction of oxygen in inspired air (FiO 2 ) and hypoventilation
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