TAILIEUCHUNG - Báo cáo y học: "Concepts in hypoxia reborn"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Concepts in hypoxia reborn. | Martin et al. Critical Care 2010 14 315 http content 14 4 315 CRITICAL CARE VIEWPOINT L_ Concepts in hypoxia reborn Daniel S Martin -2 Maryam Khosravi1 Mike PW Grocott1-3 and Michael G Mythen2-4 Abstract The human fetus develops in a profoundly hypoxic environment. Thus the foundations of our physiology are built in the most hypoxic conditions that we are ever likely to experience the womb. This magnitude of exposure to hypoxia in utero is rarely experienced in adult life with few exceptions including severe pathophysiology in critical illness and environmental hypobaric hypoxia at high altitude. Indeed the lowest recorded levels of arterial oxygen in adult humans are similar to those of a fetus and were recorded just below the highest attainable elevation on the Earth s surface the summit of Mount Everest. We propose that the hypoxic intrauterine environment exerts a profound effect on human tolerance to hypoxia. Cellular mechanisms that facilitate fetal well-being may be amenable to manipulation in adults to promote survival advantage in severe hypoxemic stress. Many of these mechanisms act to modify the process of oxygen consumption rather than oxygen delivery in order to maintain adequate tissue oxygenation. The successful activation of such processes may provide a new chapter in the clinical management of hypoxemia. Thus strategies employed to endure the relative hypoxia in utero may provide insights for the management of severe hypoxemia in adult life and ventures to high altitude may yield clues to the means by which to investigate those strategies. Introduction In the early 20th century after extensive studies of the ovine fetal circulation Sir Joseph Barcroft 1872-1947 postulated that the environment in which the human fetus develops would be comparable to that likely endured by an adult on the summit of Mount Everest 1 2 . He termed this intriguing hypothesis Everest Correspondence Centre for Altitude Space and

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