• Lorenzo Berra, Kyle J Medeiros, Francesco Marrazzo, Sarvagna Patel, David Imber, Emanuele Rezoagli, Binglan Yu, Abraham Sonny, Edward A Bittner, Daniel Fisher, Daniel Chipman, Rohit Sharma, Hardik Shah, Brianna E Gray, HarrisN StuartNSHarvard Medical School, Boston, Massachusetts. Division of Wilderness Medicine, Massachusetts General Hospital, Boston, Massachusetts., Fumito Ichinose, and Vamsi K Mootha.
• Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts. Harvard Medical School, Boston, Massachusetts. lberra@mgh.harvard.edu.
• Respir Care. 2024 Oct 25; 69 (11): 140014081400-1408.

BackgroundBeneficial effects of breathing at [Formula: see text] < 0.21 on disease outcomes have been reported in previous preclinical and clinical studies. However, the safety and intra-hospital feasibility of breathing hypoxic gas for 5 d have not been established. In this study, we examined the physiologic effects of breathing a gas mixture with [Formula: see text] as low as 0.11 in 5 healthy volunteers.MethodsAll 5 subjects completed the study, spending 5 consecutive days in a hypoxic tent, where the ambient oxygen level was lowered in a stepwise manner over 5 d, from [Formula: see text] of 0.16 on the first day to [Formula: see text] of 0.11 on the fifth day of the study. All the subjects returned to an environment at room air on the sixth day. The subjects' [Formula: see text], heart rate, and breathing frequency were continuously recorded, along with daily blood sampling, neurologic evaluations, transthoracic echocardiography, and mental status assessments.ResultsBreathing hypoxia concentration dependently caused profound physiologic changes, including decreased [Formula: see text] and increased heart rate. At [Formula: see text] of 0.14, the mean [Formula: see text] was 92%; at [Formula: see text] of 0.13, the mean [Formula: see text] was 93%; at [Formula: see text] of 0.12, the mean [Formula: see text] was 88%; at [Formula: see text] of 0.11, the mean [Formula: see text] was 85%; and, finally, at an [Formula: see text] of 0.21, the mean [Formula: see text] was 98%. These changes were accompanied by increased erythropoietin levels and reticulocyte counts in blood. All 5 subjects concluded the study with no adverse events. No subjects exhibited signs of mental status changes or pulmonary hypertension.ConclusionsResults of the current physiologic study suggests that, within a hospital setting, delivering [Formula: see text] as low as 0.11 is feasible and safe in healthy subjects, and provides the foundation for future studies in which therapeutic effects of hypoxia breathing are tested.Copyright © 2024 by Daedalus Enterprises.

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