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Vol. 42. Num. 6.August - September 2018
Pages e13-e16Pages 327-396
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Vol. 42. Num. 6.August - September 2018
Pages e13-e16Pages 327-396
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DOI: 10.1016/j.medine.2018.05.013
A journey between high altitude hypoxia and critical patient hypoxia: What can it teach us about compression and the management of critical disease?
Un viaje entre la hipoxia de la gran altitud y la hipoxia del enfermo crítico: ¿qué puede enseñarnos en la compresión y manejo de las enfermedades críticas?
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M.L. Avellanas Chavala
Unidad de Medicina Intensiva, Hospital General San Jorge, Huesca, Spain
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Tables (5)
Table 1. Correlation among altitude, barometric pressure, atmospheric oxygen partial pressure (dry environment) and inspired oxygen partial pressure (with water vapor), and arterial oxygen partial pressure.
Table 2. Estimated arterial gas values at the summit of Mount Everest (see text).
Table 3. Products of some of the genes regulated by hypoxia inducible factor-1 (HIF-1) and their physiological function.
Table 4. Principal effects and actions of nitric oxide, adrenomedullin and adenosine.
Table 5. Genes, proteins and enzymes related to skeletal muscle mitochondrial acclimatization to high altitude hypoxia.
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Abstract

High altitude sickness (hypobaric hypoxia) is a form of cellular hypoxia similar to that suffered by critically ill patients.

The study of mountaineers exposed to extreme hypoxia offers the advantage of involving a relatively homogeneous and healthy population compared to those typically found in Intensive Care Units (ICUs), which are heterogeneous and generally less healthy.

Knowledge of altitude physiology and pathology allows us to understanding how hypoxia affects critical patients.

Comparable changes in mitochondrial biogenesis between both groups may reflect similar adaptive responses and suggest therapeutic interventions based on the protection or stimulation of such mitochondrial biogenesis.

Predominance of the homozygous insertion (II) allele of the angiotensin-converting enzyme gene is present in both individuals who perform successful ascensions without oxygen above 8000m and in critical patients who overcome certain disease conditions.

Keywords:
Hypobaric hypoxia
Altitude acclimatization
Critically ill patient
Hypoxia-inducible factor
Mitochondria
Resumen

La hipoxia de la altitud (hipoxia hipobárica) no deja de ser una hipoxia celular similar a la que presentan los enfermos críticos. Estudiar a los alpinistas expuestos a la hipoxia extrema ofrece la ventaja de que es una población relativamente homogénea y sana, en contraste con la población heterogénea y generalmente menos saludable que suele observarse en las Unidades de Cuidados Críticos. El conocimiento de la fisiología y la enfermedad de la altitud abren caminos para comprender en qué medida afecta la hipoxia a los pacientes críticos. Los cambios comparables en la biogénesis mitocondrial entre ambos grupos pueden reflejar respuestas adaptativas similares y sugieren intervenciones terapéuticas basadas en la protección o estimulación de la biogénesis mitocondrial.

El predominio del alelo homocigótico de inserción (II) de la enzima de conversión de la angiotensina está presente tanto en las ascensiones exitosas sin oxígeno por encima de los 8.000m como en la supervivencia de algunas enfermedades de los enfermos críticos.

Palabras clave:
Hipoxia hipobárica
Aclimatación a la altitud
Enfermo crítico
Factor inducible por la hipoxia
Mitocondria

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