Effects of acute exposure to high altitude on ventilatory drive and respiratory pattern

To assess changes in ventilatory regulation in terms of central drive and timing, on exposure to high altitude, and the effects of induced hyperoxia at high altitude, six healthy normal lowland subjects (mean age 19.5 +/- 1.64 yr) were studied at low altitude (518 m) and on the first 4 days at high altitude (3,940 m). The progressive increase in resting expired minute ventilation (VE; control mean 9.94 +/- 1.78 to 14.25 +/- 2.67 l/min on day 3, P less than 0.005) on exposure to high altitude was primarily due to a significant increase in respiratory frequency (f; control mean 15.6 +/- 3.5 breaths/min to 23.8 +/- 6.2 breaths/min on day 3, P less than 0.01) with no significant change in tidal volume (VT). The increase in f was due to significant decreases in both inspiratory (TI) and expiratory (TE) time per breath; the ratio of TI to TE increased significantly (control mean 0.40 +/- 0.08 to 0.57 +/- 0.14, P less than 0.025). Mouth occlusion pressure did not change significantly, nor did the ratio of VE to mouth occlusion pressure. The acute induction of hyperoxia for 10 min at high altitude did not significantly alter VE or the ventilatory pattern. These results indicate that acute exposure to high altitude in normal lowlanders causes an increase in VE primarily by an alteration in central breath timing, with no change in respiratory drive. The acute relief of high altitude hypoxia for 10 min has no effect on the increased VE or ventilatory pattern.     

Influence of vanadium on acclimatization of humans to high altitude

 The study was conducted on human volunteers as controls as well as after administration of vanadyl sulphate on induction to high altitude (HA) at 3500 m. The plasma vanadium contents were significantly reduced in the control group on abrupt induction to HA on days 3 and 10, indicating redistribution to other organs/tissues under the stressful situation. In the vanadium salt-treated group, plasma vanadium contents were similar to those obtained at sea-level. Administration of vanadyl sulphate did not act as a diuretic. Moreover the vanadium supplemented group drank more water and also excrete less urine than the control group. Received: 1 November 1995 / Accepted: 9 October 1996     

Quantification of optic disc edema during exposure to high altitude shows no correlation to acute mountain sickness

Background

The study aimed to quantify changes of the optic nerve head (ONH) during exposure to high altitude and to assess a correlation with acute mountain sickness (AMS). This work is related to the Tuebingen High Altitude Ophthalmology (THAO) study.

Methodology/Principal Findings

A confocal scanning laser ophthalmoscope (cSLO, Heidelberg Retina Tomograph, HRT3®) was used to quantify changes at the ONH in 18 healthy participants before, during and after rapid ascent to high altitude (4559 m). Slitlamp biomicroscopy was used for clinical optic disc evaluation; AMS was assessed with Lake Louise (LL) and AMS-cerebral (AMS-c) scores; oxygen saturation (SpO₂) and heart rate (HR) were monitored. These parameters were used to correlate with changes at the ONH. After the first night spent at high altitude, incidence of AMS was 55% and presence of clinical optic disc edema (ODE) 79%. Key stereometric parameters of the HRT3® used to describe ODE (mean retinal nerve fiber layer [RNFL] thickness, RNFL cross sectional area, optic disc rim volume and maximum contour elevation) changed significantly at high altitude compared to baseline (p<0.05) and were consistent with clinically described ODE. All changes were reversible in all participants after descent. There was no significant correlation between parameters of ODE and AMS, SpO₂ or HR.

Conclusions/Significance

Exposure to high altitude leads to reversible ODE in the majority of healthy subjects. However, these changes did not correlate with AMS or basic physiologic parameters such as SpO₂ and HR. For the first time, a quantitative approach has been used to assess these changes during acute, non-acclimatized high altitude exposure. In conclusion, ODE presents a reaction of the body to high altitude exposure unrelated to AMS.     

急性高原暴露后左心功能变化及与急性高原病的关系

目的：研究青年男性由平原急进高原后心脏血流动力学变化及其与急性高原病的关系。方法：分别检测218名健康青年男性在平原及急进高原24h内的血压、心卒和血氧饱和度,使用彩色多普勒超声仪检测左心功能;根据路易斯湖评分标准将受试者分为急性高原病纽（AMS组）和无急性高原病组（无AMS组）。结果：急性高原暴露后心率、舒张压、平均动脉压、左室射血分数、每搏输出量、每博指数、心输出量、心脏指数显著增加（P〈0．05）,血氧饱和度、左室收缩末容积则显著降低（P〈0．05）;急进高原后AMS组心率、收缩压、平均动脉压显著高于无AMS组（P〈0．05）,每博指数、左室舒张末容积显著低于无AMS组（P〈0．05）。结论：健康男性青年急性高原暴露后左心室收缩功能增强,左室舒张末容积、心率、每博指数可能作为预测急性高原病的参考指标。     

Effect of acute exposure to 3660 m altitude on orthostatic responses and tolerance.

Orthostatic reflexes were examined at 375 m and after 60 min of exposure in a hypobaric chamber at 3660 m using a 20-min 70 degrees head-up tilt (HUT) test. Mean arterial blood pressure, R wave-R wave interval (RRI), and mean cerebral blood flow velocity (MFV) were examined with coarse-graining spectral analysis. Of 14 subjects, 7 at 375 m and 12 at 3660 m were presyncopal. Immediately on arrival to high altitude, breathing frequency and MFV increased, and endtidal PCO2, RRI, RRI complexity, and the parasympathetic nervous system indicator decreased. MFV was similar in HUT at both altitudes. The sympathetic nervous system indicator increased with tilt at 3660 m, whereas parasympathetic nervous system indicator decreased with tilt at both altitudes. Multiple regression analysis of supine variables from either 375 or 3660 m and the time to presyncope at 3660 m indicated that, after 1 h of exposure, increased presyncope at altitude was the result of 1). ineffective peripheral vasoconstriction, despite increased cardiac sympathetic nervous system activity with HUT, and 2). insufficient cerebral perfusion owing to cerebral vasoconstriction as the result of hypoxic hyperventilation-induced hypocapnia.     

Influence of exposure to moderate altitude on the plasma concentraton of cortisol, aldosterone, renin, testosterone, and gonadotropins

The influence of 11 days at moderate altitude (2,000 m) combined with exercise on plasma concentration of testosterone, FSH (follicle-stimulating hormone), LH (luteinizing hormone), cortisol, aldosterone, and renin activity was studied in ten healthy subjects. Within 48 h of arrival at moderate altitude a significant increase in testosterone was found whereas FSH had decreased significantly and LH showed a tendency to decrease. Cortisol increased significantly at the beginning and reached a maximum at the end of altitude exposure. The plasma aldosterone level rose continuously and on the last day of altitude was significantly elevated. Plasma renin activity showed a tendency to decrease. On return to low land all measured parameters returned to base line values within 2 days. The findings of increases in plasma levels of aldosterone and testosterone (and serum T3 and T4, as reported by others) are in contrast to the previously found decrease of urinary excretion of all these hormones. This appears to be a distinct dissociation of serum levels of adrenal (and thyroid) hormones from their urinary excretion. The observed increase in plasma aldosterone is probably mediated through ACTH and the rise in plasma potassium, since plasma renin activity showed an opposite trend. The rise in plasma testosterone is probably of adrenal origin since plasma gonadotropins declined simultaneously. The increase of plasma levels of glucocorticoids, mineralocorticoids, and androgens after an ascent from 600 m to 2,000 m above sea level is compatible with an ACTH-mediated stimulation of the entire adrenal cortex and/or a diminished elimination of adrenal steroids: The concomitant fall of FSH, LH, and plasma renin would then be a consequence of a direct negative feedback inhibition of these hormones.     

Influence of brief high intensity exercise on plasma adrenaline and noradrenaline levels]

This study was conducted to determine catecholamine response to maximal intensity exercise of a few seconds' duration. To do this, epinephrine (E) and norepinephrine (NE) levels were measured during Force-Velocity Test. Blood samples were taken at the end of each sprint. Compared to rest (E0 = 77.4 +/- 3.8 pg/ml), the E concentration significantly increased after the first sprint (E2 = 109.8 +/- 14.7 pg/ml) and after the last one (E8 = 126.9 +/- 19.4 pg/ml) which correspond to the exhaustion state of our subjects. NE concentration doubled after the first sprint (NE2 = 589.1 +/- 94.7 pg/ml) and remained at this level until the end of the test. E2 seems to have been a stress reaction to an unfamiliar test. E8 may represent the "exercise plus exhaustion" stimulus on the stimulation of the adrenal gland (AG). This would suggest that stimulus intensity plays a role even when duration is very brief, although the time factor seems to limit the response of AG. The evolution of NE suggest that the brief duration of the sprints may limit the adatation response of NE to energy demands.     

Effects of high altitude exposure on components of blood and urine in mountaineers

Physiological correlations with impaired or umimpaired performance at high altitude were sought among 24 blood and urine parameters measured in 50 mountaineers and 21 observers before (preclimb) and after (postclimb) expeditions on Mt. McKinley. Values and per cent changes were compared for five degrees of impairment at high altitude. Average preclimb values were all near established normal levels and no correlations with subsequent involvement at high altitude were found. Postclimb samples contained more Hb, PCV, urea, LDH, and HBD and less bilirubin (P < 0.05). But no association was found between degrees of altitude impairment and preclimb/postclimb changes in any of the 24 blood and urine parameters. Additional results from samples collected at 4300 m showed "weaker" mountaineers excreted 1/4 as much Na in urine and had 50% more serum FFA concentration than stronger mountaineers.

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Zusammenfassung Bei 50 Bergsteigern und 21 Beobachtern wurden vor und nach einer Expedition zum Mt. McKinley (Alaska) für 24 Parameter im Blut und Harn die Beziehungen zur Abschwächung der Leistung in grosser Höhe untersucht. Zum Vergleich wurden 5 Grade von unbeeinflusster bis schwerer Schädigung in der Höhe verwendet. Die mittleren Werte vor dem Aufstieg lagen alle im Bereich der Normbreite. Beziehungen zu nachfolgenden Komplikationen in der Höhe bestanden nicht. Nach dem Aufstieg waren Hgb, Hämatokrit, Harnstoff, LDH, Hydroxybutyric Dehydrogenase erhöht und Bilirubin erniedrigt (P < 0, 05). Es liess sich jedoch für keinen Parameter eine Beziehung zwischen dem Ausmass der Höhenschädigung und den Veränderungen vor und nach dem Aufstieg nachweisen. Zusätzliche Ergebnisse von Proben, die in 4300 m Höhe gesammelt wurden, ergaben, dass schwache Bergsteiger ein Viertel soviel Na im Harn ausschieden und 50% mehr freie Fettsäuren im Blut aufwiesen als starke Bergsteiger.

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Resume On a mesuré 24 paramètre du sang et de l'urine de 50 alpinistes et 21 observateurs avant et après l'ascension du Mont McKinley (Canada). On a établi ensuite la corrélation physiologique existant entre ces paramètres et une diminution éventuelle des performances. Les valeurs absolues et le taux de modification ont été comparés à 5 degrés de diminution des capacités physiques à haute altitude. Les valeurs moyennes des analyses faites avant l'ascension ont toutes été voisines du niveau normal et on n'a pas constaté de corrélation avec les performances individuelles subséquentes. Les échantillons recueillis après l'ascension contenaient davantage de Hb, PCV, urée, LDH, et HBD, mais moins de bilirubine (P < 0, 05). On n'a cependant trouvé aucune relation entre le degré de diminution des performances et les modifications d'aucun des 24 paramètres retenus du sang ou de l'urine avant et après l'ascension. Des échantillons prélevés à 4300 m d'altitude ont montré que les alpinistes peu aguerris ne sécrétaient que le 1/4 du Na par l'urine, mais avaient 50% d'acides gras libres de plus dans le sang que les montagnards les plus résistants.

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Work supported by Themis Contract No DADA 17-68-C-8018