Man has conquered Everest, been to the bottom of the deepest ocean, and even walked on the Moon by understanding pressure and oxygen. But the one area of life the technology has not influenced is the practice of medicine. Billions have been spent researching drugs to treat the brain and they have failed; drug companies are closing their neuroscience laboratories. This is because there is no substitute for oxygen. As the most astonishing discovery since DNA was unraveled has shown, oxygen, the gas in the air we all breathe, controls our most important genes. If we are sick or seriously injured and in intensive care, the amount of oxygen we can be given is limited by the weather. Without a simple pressure chamber, we are forced to accept a variation of more than 10% when just 2% more oxygen on the summit of Everest can mean the difference between life and death. We have already engineered the solution; the technology used in aircraft that sustains us flying at 40,000 feet can facilitate medical recovery safely on the ground. This book follows the human journey from conception to old age and presents evidence amassed over more than a century that can transform the care of patients with birth injury, head trauma, multiple sclerosis, stroke, and even reverse decline in old age. There is no more necessary and scientific action than to correct a deficiency of oxygen, especially in the brain and it is simple to give more.

This e-book will review special features of the cerebral circulation and how they contribute to the physiology of the brain. It describes structural and functional properties of the cerebral circulation that are unique to the brain, an organ with high metabolic demands and the need for tight water and ion homeostasis. Autoregulation is pronounced in the brain, with myogenic, metabolic and neurogenic mechanisms contributing to maintain relatively constant blood flow during both increases and decreases in pressure. In addition, unlike peripheral organs where the majority of vascular resistance resides in small arteries and arterioles, large extracranial and intracranial arteries contribute significantly to vascular resistance in the brain. The prominent role of large arteries in cerebrovascular resistance helps maintain blood flow and protect downstream vessels during changes in perfusion pressure. The cerebral endothelium is also unique in that its barrier properties are in some way more like epithelium than endothelium in the periphery. The cerebral endothelium, known as the blood-brain barrier, has specialized tight junctions that do not allow ions to pass freely and has very low hydraulic conductivity and transcellular transport. This special configuration modifies Starling's forces in the brain microcirculation such that ions retained in the vascular lumen oppose water movement due to hydrostatic pressure. Tight water regulation is necessary in the brain because it has limited capacity for expansion within the skull. Increased intracranial pressure due to vasogenic edema can cause severe neurologic complications and death.

This presentation describes various aspects of the regulation of tissue oxygenation, including the roles of the circulatory system, respiratory system, and blood, the carrier of oxygen within these components of the cardiorespiratory system. The respiratory system takes oxygen from the atmosphere and transports it by diffusion from the air in the alveoli to the blood flowing through the pulmonary capillaries. The cardiovascular system then moves the oxygenated blood from the heart to the microcirculation of the various organs by convection, where oxygen is released from hemoglobin in the red blood cells and moves to the parenchymal cells of each tissue by diffusion. Oxygen that has diffused into cells is then utilized in the mitochondria to produce adenosine triphosphate (ATP), the energy currency of all cells. The mitochondria are able to produce ATP until the oxygen tension or PO2 on the cell surface falls to a critical level of about 4–5 mm Hg. Thus, in order to meet the energetic needs of cells, it is important to maintain a continuous supply of oxygen to the mitochondria at or above the critical PO2 . In order to accomplish this desired outcome, the cardiorespiratory system, including the blood, must be capable of regulation to ensure survival of all tissues under a wide range of circumstances. The purpose of this presentation is to provide basic information about the operation and regulation of the cardiovascular and respiratory systems, as well as the properties of the blood and parenchymal cells, so that a fundamental understanding of the regulation of tissue oxygenation is achieved.

The Yearbook compiles the most recent developments in experimental and clinical research and practice in one comprehensive reference book. The chapters are written by well recognized experts in the field of intensive care and emergency medicine. It is addressed to everyone involved in internal medicine, anesthesia, surgery, pediatrics, intensive care and emergency medicine.

''In addition to a wide variety of traditional oxygen transport topics, particular areas have been selected for emphasis at the 1997 meeting, which are: Molecular and genetic techniques to study oxygen transport in health and disease Angiogenesis during hypoxia, ischemia, and development Physiological mechanisms of oxygen sensing Physiological fluctuations of cerebral blood flow, metabolism and oxygenation Near infrared and phsophorescence techniques for the assessment of blood and tissue oxygenation Advances in biotechnology of anticoagulants and blood substitutes. '' (excerpted from the Preface).