Skip to main content
  • Poster presentation
  • Published:

Normobaric oxygen paradox and the microcirculation in the critically ill patient: a prospective observational study


The normobaric oxygen paradox (NOP) is a recent concept that postulates the use of intermittent hyperoxia to stimulate erythropoietin (EPO) production [1]. Hyperoxia increases oxygen free radicals and may lead to endothelial damage and vasoconstriction [2]. We evaluated the microvascular response to transient hyperoxia and its effects on EPO production.


Six patients with hemodynamic stability and mechanically ventilated with FiO2 <50% were included in this prospective observational study. Patients underwent a 2-hour period of hyperoxia (FiO2 100%). The sublingual microcirculation (sidestream dark-field imaging (SDF)) was evaluated at baseline (t0), 2 hours after hyperoxia (t1), and 2 hours after return to basal FiO2 (t2). SDF monitoring was continuously performed also during the variation of FiO2 for 2 minutes. EPO levels were assayed at baseline and for 2 days.


An early vasoconstriction and a trend towards total vessel density (TVD) reduction were observed at t1 (Figure 1). The TVD tended to increase without returning to baseline levels at t2. EPO increased in four patients out of 6 (P = NS). A negative correlation was found between the change in TVD after hyperoxia (t1 - t0) and the change in EPO (r = -0.88, P = 0.03).

Figure 1
figure 1

TVD and NOP.


Hyperoxia leads to vasoconstriction that seems to be reversible at hyperoxia cessation. Further data are needed to verify the efficacy of the NOP in stimulating erythropoiesis in the critically ill. There might be a relation between hyperoxia-induced reduction in vessel density and the EPO increase.


  1. Balestra C, Germonpré P, Poortmans JR, Marroni A: J Appl Physiol. 2006, 100: 512-518. 10.1152/japplphysiol.00964.2005

    Article  CAS  PubMed  Google Scholar 

  2. Tsai AG, Cabrales P, Winslow RM, Intaglietta M: Am J Physiol Heart Circ Physiol. 2003, 285: H1537-H1545.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Rights and permissions

Reprints and permissions

About this article

Cite this article

Donati, A., Damiani, E., Colesnicenco, A. et al. Normobaric oxygen paradox and the microcirculation in the critically ill patient: a prospective observational study. Crit Care 18 (Suppl 1), P168 (2014).

Download citation

  • Published:

  • DOI: