Insensitivity of VO2max to hemoglobin-P50 as sea level and altitude

O2 uptake in the lungs, and therefore arterial oxygenation, is favored by a low Hb-P50 but this inhibits tissue O2 extraction, raising the question of optimal P50 during maximal exercise when VO2 is limited by O2 supply. Using a model of the lungs and muscles connected by the circulation so that O2 transport is simultaneously considered in both sites, sensitivity of VO2max to P50 was determined at three altitudes: PB = 760, 464 and 253 Torr, encompassing sea level and Mt. Everest. At Pb = 760 Torr, VO2max peaked at P50 = 30 Torr, was 99.4% (of that at 30) at normal P50 (26.8) and exceeded 95% (of that at P50 = 30) over the P50 range from 24 to 43 Torr. Optimal P50 at PB = 464 Torr was 25 Torr, VO2max at P50 = 26.8 was reduced only 0.1% and exceeded 95% over the P50 range from 19 to 41 Torr. At Pb = 253, optimal P50 was 20 Torr, VO2max at P50 = 26.8 was reduced only 0.4% and exceeded 95% over the wide P50 range from 15 to 47 Torr. While this analysis shows that technically, optimal P50 falls with altitude, VO2max is insensitive to P50 over a range that widens with altitude, so that P50 changes over a realistic interval would not measurably affect VO2max.