Types of hypoxia Anoxic or hypoxic This is due to a fall in the partial pressure of the inspired gas (PIO2) such

as at altitude, or if inspired oxygen is reduced in accidental misconnection of pipes under anaesthesia. This results in a fall in PAO2. An increase in PaCO2 or in the alveolar to arterial gradient for oxygen ((A-a)dO2) lowers PaO2 directly.

Anaemic This is due to failure of oxygen carriage, as a result of low Hb, with normal cardiac output and saturation, or to alteration in the oxygen carrying capacity of Hb as a result of combination with carbon monoxide. The latter binds more strongly with Hb than does oxygen with the result that the tissues receive an inadequate oxygen supply.

Ischaemic or Stagnant This results from inadequate blood perfusion to tissues due to myocardial failure, sepsis, raised systemic vascular resistance, or arterial embolism.

Histotoxic Here the oxygen delivery to the tissue is normal, but mitochondrial oxygen utilisation is defective, such as in cyanide poisoning Oxygen cascade from environment to cell Oxygen therapy is ultimately designed to ensure adequate mitochondrial oxygen tensions. The points at which failure to achieve this may occur are outlined in Table 12.1. TABLE 12.1 Causes and classification of hypoxia

System level

Defect
Low Inspired oxygen tension (PIO2)

Classification

Inspired gas Low barometric pressure (pB) Low alveolar ventilation Inspired gas to alveolar gas Raised oxygen consumption Venous admixture or shunt Alveolar gas to arterial blood V/Q inequality (>1) Impaired diffusion Arterial blood to cell Arterial blood to cell Low or inadequate blood flow Low haemoglobin Carbon monoxide poisoning Metabolic poisons Increased metabolism

Hypoxic

Hypoxic

Hypoxic

Ischaemic

Anaemic

Cell

Histotoxic Ischaemic