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Forrer, Aglaia; Gaisl, Thomas; Sevik, Ahmet; Meyer, Michelle; Senteler, Luzi; Lichtblau, Mona; Bloch, Konrad Ernst; Ulrich, Silvia; Furian, Michael

Partial Pressure of Arterial Oxygen in Healthy Adults at High Altitudes : A Systematic Review and Meta-Analysis : A Systematic Review and Meta-Analysis

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  • Medientyp: E-Artikel
  • Titel: Partial Pressure of Arterial Oxygen in Healthy Adults at High Altitudes : A Systematic Review and Meta-Analysis : A Systematic Review and Meta-Analysis
  • Beteiligte: Forrer, Aglaia; Gaisl, Thomas; Sevik, Ahmet; Meyer, Michelle; Senteler, Luzi; Lichtblau, Mona; Bloch, Konrad Ernst; Ulrich, Silvia; Furian, Michael
  • Erschienen: American Medical Association (AMA), 2023
  • Erschienen in: JAMA Network Open
  • Sprache: Englisch
  • DOI: 10.1001/jamanetworkopen.2023.18036
  • ISSN: 2574-3805
  • Entstehung:
  • Anmerkungen:
  • Beschreibung: <jats:sec id="ab-zoi230547-4"><jats:title>Importance</jats:title><jats:p>With increasing altitude, the partial pressure of inspired oxygen decreases and, consequently, the Pa<jats:sc>o</jats:sc><jats:sub>2</jats:sub> decreases. Even though this phenomenon is well known, the extent of the reduction as a function of altitude remains unknown.</jats:p></jats:sec><jats:sec id="ab-zoi230547-5"><jats:title>Objective</jats:title><jats:p>To calculate an effect size estimate for the decrease in Pa<jats:sc>o</jats:sc><jats:sub>2</jats:sub> with each kilometer of vertical gain among healthy unacclimatized adults and to identify factors associated with Pa<jats:sc>o</jats:sc><jats:sub>2</jats:sub> at high altitude (HA).</jats:p></jats:sec><jats:sec id="ab-zoi230547-6"><jats:title>Data Sources</jats:title><jats:p>A systematic search of PubMed and Embase was performed from database inception to April 11, 2023. Search terms included <jats:italic>arterial blood gases</jats:italic> and <jats:italic>altitude</jats:italic>.</jats:p></jats:sec><jats:sec id="ab-zoi230547-7"><jats:title>Study Selection</jats:title><jats:p>A total of 53 peer-reviewed prospective studies in healthy adults providing results of arterial blood gas analysis at low altitude (&amp;amp;lt;1500 m) and within the first 3 days at the target altitude (≥1500 m) were analyzed.</jats:p></jats:sec><jats:sec id="ab-zoi230547-8"><jats:title>Data Extraction and Synthesis</jats:title><jats:p>Primary and secondary outcomes as well as study characteristics were extracted from the included studies, and individual participant data (IPD) were requested. Estimates were pooled using a random-effects DerSimonian-Laird model for the meta-analysis.</jats:p></jats:sec><jats:sec id="ab-zoi230547-9"><jats:title>Main Outcomes and Measures</jats:title><jats:p>Mean effect size estimates and 95% CIs for reduction in Pa<jats:sc>o</jats:sc><jats:sub>2</jats:sub> at HA and factors associated with Pa<jats:sc>o</jats:sc><jats:sub>2</jats:sub> at HA in healthy adults.</jats:p></jats:sec><jats:sec id="ab-zoi230547-10"><jats:title>Results</jats:title><jats:p>All of the 53 studies involving 777 adults (mean [SD] age, 36.2 [10.5] years; 510 men [65.6%]) reporting 115 group ascents to altitudes between 1524 m and 8730 m were included in the aggregated data analysis; 13 of those studies involving 305 individuals (mean [SD] age, 39.8 [13.6] years; 185 men [60.7%]) reporting 29 ascents were included in the IPD analysis. The estimated effect size of Pa<jats:sc>o</jats:sc><jats:sub>2</jats:sub> was −1.60 kPa (95% CI, −1.73 to −1.47 kPa) for each 1000 m of altitude gain (τ<jats:sup>2</jats:sup> = 0.14; <jats:italic>I</jats:italic><jats:sup>2</jats:sup> = 86%). The Pa<jats:sc>o</jats:sc><jats:sub>2</jats:sub> estimation model based on IPD data revealed that target altitude (−1.53 kPa per 1000 m; 95% CI, −1.63 to −1.42 kPa per 1000 m), age (−0.01 kPa per year; 95% CI, −0.02 to −0.003 kPa per year), and time spent at an altitude of 1500 m or higher (0.16 kPa per day; 95% CI, 0.11-0.21 kPa per day) were significantly associated with Pa<jats:sc>o</jats:sc><jats:sub>2</jats:sub>.</jats:p></jats:sec><jats:sec id="ab-zoi230547-11"><jats:title>Conclusions and Relevance</jats:title><jats:p>In this systematic review and meta-analysis, the mean decrease in Pa<jats:sc>o</jats:sc><jats:sub>2</jats:sub> was 1.60 kPa per 1000 m of vertical ascent. This effect size estimate may improve the understanding of physiological mechanisms, assist in the clinical interpretation of acute altitude illness in healthy individuals, and serve as a reference for physicians counseling patients with cardiorespiratory disease who are traveling to HA regions.</jats:p></jats:sec>
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