Supplemental CO2 improves oxygen saturation, oxygen tension, and cerebral oxygenation in acutely hypoxic healthy subjects

Abstract Oxygen is viewed in medicine as the sole determinant of tissue oxygenation, though carbon dioxide homeostasis is equally important and clinically often ignored. The aims of this study were as follows: (a) to examine the effects of different acute hypoxic conditions on partial pressure of arterial oxygen (PaO2), arterial oxygen saturation of hemoglobin (SaO2), and regional cerebral saturation of hemoglobin (rSO2); and (b) to evaluate supplemental CO2 as a tool to improve oxygenation in acutely hypoxic individuals. We hypothesized that exposure to gas mixtures with added CO2 would improve oxygenation in hypoxic human subjects. Twenty healthy subjects were exposed to 5‐min intervals of two gas mixtures: hypoxic gas mixture containing 8% oxygen, and a CO2‐enriched mixture containing 8% oxygen plus either 3% or 5% CO2. Ten subjects received the 3% CO2‐enriched mixture, and the remaining 10 subjects received the 5% CO2‐enriched mixture. The order of exposure was randomized. Blood gases, pulse oximetry, end‐tidal CO2, and cerebral oximetry were measured. Compared to the purely hypoxic gas group, PaO2 was increased in the 3% and 5% CO2‐enriched groups by 14.9 and 9.5 mmHg, respectively. Compared to pure hypoxia, SaO2 was increased in the 3% and 5% CO2‐enriched groups by 16.8% and 12.9%, respectively. Both CO2‐enriched gas groups had significantly higher end‐exposure rSO2 and recovered to baseline rSO2 within 1 min, compared to the pure hypoxic gas group, which returned to baseline in 5 min. These results suggest that in acutely hypoxic subjects, CO2 supplementation improves blood oxygen saturation and oxygen tension as well as cerebral oxygenation measures.