Partial Pressure of Arterial Oxygen in Healthy Adults at High Altitudes: A Systematic Review and Meta-Analysis

ImportanceWith increasing altitude, the partial pressure of inspired oxygen decreases and, consequently, the Pao(2) decreases. Even though this phenomenon is well known, the extent of the reduction as a function of altitude remains unknown. ObjectiveTo calculate an effect size estimate for the decrease in Pao(2) with each kilometer of vertical gain among healthy unacclimatized adults and to identify factors associated with Pao(2) at high altitude (HA). Data SourcesA systematic search of PubMed and Embase was performed from database inception to April 11, 2023. Search terms included arterial blood gases and altitude. Study SelectionA total of 53 peer-reviewed prospective studies in healthy adults providing results of arterial blood gas analysis at low altitude (<1500 m) and within the first 3 days at the target altitude (>= 1500 m) were analyzed. Data Extraction and SynthesisPrimary and secondary outcomes as well as study characteristics were extracted from the included studies, and individual participant data (IPD) were requested. Estimates were pooled using a random-effects DerSimonian-Laird model for the meta-analysis. Main Outcomes and MeasuresMean effect size estimates and 95% CIs for reduction in Pao(2) at HA and factors associated with Pao(2) at HA in healthy adults. ResultsAll of the 53 studies involving 777 adults (mean [SD] age, 36.2[10.5] years; 510 men [65.6%]) reporting 115 group ascents to altitudes between 1524 m and 8730 m were included in the aggregated data analysis; 13 of those studies involving 305 individuals (mean [SD] age, 39.8 [13.6] years; 185 men [60.7%]) reporting 29 ascents were included in the IPD analysis. The estimated effect size of Pao(2) was -1.60 kPa (95% CI, -1.73 to -1.47 kPa) for each 1000 m of altitude gain (tau(2)=0.14; I-2=86%). The Pao(2) estimation model based on IPD data revealed that target altitude (-1.53 kPa per 1000 m; 95% CI, -1.63 to -1.42 kPa per 1000 m), age (-0.01 kPa per year; 95% CI, -0.02 to -0.003 kPa per year), and time spent at an altitude of 1500 m or higher (0.16 kPa per day; 95% CI, 0.11-0.21 kPa per day) were significantly associated with Pao(2). Conclusions and RelevanceIn this systematic review and meta-analysis, the mean decrease in Pao(2) was 1.60 kPa per 1000 m of vertical ascent. This effect size estimate may improve the understanding of physiological mechanisms, assist in the clinical interpretation of acute altitude illness in healthy individuals, and serve as a reference for physicians counseling patients with cardiorespiratory disease who are traveling to HA regions. This systematic review and meta-analysis provides an effect size estimate for the decrease in Pao(2) with each kilometer of vertical gain and assesses factors associated with Pao(2) at high altitudes among healthy unacclimatized adults.