Right shift of the oxyhemoglobin dissociation curve in acute respiratory distress syndrome

Deep hypoxia is known to increase the intraerythrocytic 2,3 diphosphoglycerate (DPG) level and therefore to induce a right shift of the oxyhemoglobin dissociation curve (ODC), which is considered to be a protective mechanism against tissular hypoxia. Our purpose was to assess whether the ODC is shifted to the right in patients with acute respiratory distress syndrome (ARDS) and whether this shift had a beneficial effect on tissue oxygenation. We have determined the whole ODC and related indices in 29 control subjects and 29 patients suffering from ARDS for at least 5 days. The ODC of the patients were shifted to the right from 20 to 95% saturation. Their DPG level was increased (19.9 +/- 3.9 mumol/gHb, mean +/- SD) as compared to control subjects (12.5 +/- 2.1 mumol/gHb). There was a highly significant relation in patients between their P50 (pO2 necessary to achieve 50% saturation) and their DPG according to the equation: P50 (kPa) = 0.03 DPG (mumol/gHb) + 3.24 (r = 0,54) (p < 0,001). It is likely that in such patients hypoxia is severe enough to stimulate the DPG synthesis and induce a right shift of the ODC. It is not at all certain that this shift has a favourable effect on tissue oxygenation. Indeed, the extreme values for PaO2 were from 3.43 to 7.96 kPa that correspond to SO2 of 48 to 91% where the ODC has not yet his upper part. A right shift decreases therefore the captation of oxygen from the lung. On the other hand theoretical studies have shown that at low arterial PO2 values a right shift of the ODC has a detrimental effect on release of oxygen from hemoglobin if the mixed venous PO2 is decreased. In order to quantify the amount of oxygen actually transmitted to the tissues, others factors are to be investigate as the PCO2 or the temperature.