Effects of hyperventilation on pulmonary blood flow and recirculation time of humans

We used direct invasive techniques to measure the effects of hyperventilation on the pulmonary blood flow (Q) and on recirculation time of helium and of carbon dioxide in humans. The subjects hyperventilated with a tidal volume of 1.5 liters (BTPS) and a frequency of 20 or 30 breaths/min. There was no significant change in Q from control at either level of hyperventilation. Helium first appeared in the pulmonary artery within 12 s from the onset of hyperventilation and increased by approximately 0.7% of its equilibrium arterial value per second at both levels of hyperventilation. In contrast, the PVCO2 remained at base-line level until 43 s from the onset of hyperventilation. We conclude that hyperventilation at 30 or 45 l/min with constant tidal volume does not significantly affect the value of Q and that the amount of recirculation of the two gases does not result in underestimation of Q when this variable is measured by indirect respiratory rebreathing techniques.     

Effects of passive limb movement on pulmonary ventilation

This study was undertaken to determine if the observed increase in ventilation during passive limb movement was a reflex hyperventilation or a response to an increased metabolic need for oxygen. Experiments on human volunteers were designed to test the hypothesis that the rapid increase of ventilation at the onset of exercise was due to stimulation of the joints. Results of these studies showed significant increases in ventilation, oxygen consumption, carbon dioxide production, ventilation/oxygen consumption ratio, and heart rate compared to rest and recovery values. The data lead to the conclusion that the rapid increase of ventilation at the onset of exercise is a true hyperventilation and that stimulation of the joints can be a significant contributor to increased pulmonary ventilation.     

Interrelations of hypocapnia, hypoxia, cerebral blood flow and electrical activity of the brain under voluntary hyperventilation in humans

Changes of different physiological parameters in human caused by hyperventilation of 3-min and longer duration were investigated and correlated. It was found that during 3-min hyperventilation, resulting in 4.5-5 fold increase of the respiration velocity, similar phasing changes of the central and cerebral haemodynamics occurred. The blood flow velocity according to the rheographic data during the hyperventilation first increases, reaching maximum at 1st - 2nd min of the test, and then decreases, reaching minimum at 2nd - 3rd min after it's end, and then slowly increases. Cerebral blood flow velocity during all the 3 min of the hyperventilation in most of the subjects keeps being increased, and after the test - decreased. At the same time transcutaneous pressure of carbon dioxide changes differently - decreases to minimum (approximately 25 mmHg) at the end of the test and then increases, reaching approximately 90% of the background level, at 5th min after the end of the test. Oxygen saturation of the blood during the test is found to be 98-100% and decreases to 90% at 5th min after it's end, which in overall with cerebral blood flow decrease appears to be the factor of the brain's hypoxia. In different subjects "mirror" changes of the EEG spectral power of different EEG ranges in relation to transcutaneous pressure of carbon dioxide dynamics were revealed by the hyperventilation. Taking into account the factors of duration or recurrence of the hyperventilation is important for the understanding the interrelations of cerebral haemodynamics, hypocapnia, hypoxia and electrical activity of the brain. It was found that after the recurrent hyperventilation of increasing amount (several times in hour by 3 min) cerebral blood flow might decrease markedly against the background of relatively small changes of electrical activity of the brain. The discussing of the data presented in the paper is carried out from the point of view of important role of tissue oxygen utilization mechanisms of the brain in adaptation to hypoxia and hypocapnia.     

Mitochondrial oxygen sensing of acute hypoxia in specialized cells - Is there a unifying mechanism?

Acclimation to acute hypoxia through cardiorespiratory responses is mediated by specialized cells in the carotid body and pulmonary vasculature to optimize systemic arterial oxygenation and thus oxygen supply to the tissues. Acute oxygen sensing by these cells triggers hyperventilation and hypoxic pulmonary vasoconstriction which limits pulmonary blood flow through areas of low alveolar oxygen content. Oxygen sensing of acute hypoxia by specialized cells thus is a fundamental pre-requisite for aerobic life and maintains systemic oxygen supply. However, the primary oxygen sensing mechanism and the question of a common mechanism in different specialized oxygen sensing cells remains unresolved. Recent studies unraveled basic oxygen sensing mechanisms involving the mitochondrial cytochrome c oxidase subunit 4 isoform 2 that is essential for the hypoxia-induced release of mitochondrial reactive oxygen species and subsequent acute hypoxic responses in both, the carotid body and pulmonary vasculature. This review compares basic mitochondrial oxygen sensing mechanisms in the pulmonary vasculature and the carotid body.     

Standardized estimation of external respiration function

External respiration in healthy males has, in addition to eupnea, six functionally active variants with one or several indices deviating from the normal values. Hyperpnea and hypopnea are determined by deviations in general oxygen consumption accompanied by adequate changes in pulmonary ventilation and gas exchange. Inhibition of gas exchange in the respiratory parts of the lungs is a typical primary event of hyperventilation, a fact indicated by a decrease in the coefficient of oxygen consumption and a compensatory increase in the minute respiratory volume during hyperventilation. Tension of the respiratory system is especially pronounced during enhanced oxygen consumption (O₂C). Highly effective bradypnea is characterized by infrequent and deep breathing. No tension of the respiratory system is observed even for increased O₂C. This state may be considered a genotypic and phenotypic variant of normal respiration. The data obtained may be used to automate the assessment of gas exchange in the respiratory parts of the lungs.     

The oxygen cost of breathing in man: effects of altitude, training, and race

The oxygen cost of breathing was determined by an open-circuit method with voluntary hyperventilation over a wide range of volumes. In 11 lowland residents the oxygen cost (ml/1 STPD) of extra ventilation (BTPS) was 3.3 ml/1 at sea level and 2.1 ml/1 after 16 days at 4000 m; the corresponding cost for ventilation STPD was 4.2 ml/1 at altitude and 4.1 ml/1 at sea level. In acclimatized persons at altitude, including both native Indian and European residents, the cost of breathing varied from 2.5 to 3.7 ml/1. On the average, the cost of breathing for acclimatized subjects was 3.1 ml/1 (BTPS), only slightly lower (5 to 10%) than that for lowlanders at sea level. This relatively higher cost with acclimatization, though still lower than at sea level, may reflect pulmonary congestion concomitant with altitude sojourn. Group differences in the cost of breathing could not be ascribed to athletic training, racial background, or permanent altitude residence, nor was there a difference of cost during quiet seated hyperventilation versus cost during free wheel bicycle pedalling. Individual, group, altitude, and acclimatizational differences in the cost of breathing could affect oxygen intake at rest and work, as well as the regulation of ventilation.     

Hyperventilation, alkalosis, prostaglandins, and pulmonary circulation of the newborn

This study was designed to determine whether the effects of hyperventilation on the pulmonary circulation of the newborn lamb were 1) due to mechanical factors or to respiratory alkalosis; and 2) mediated by prostaglandins. Six control lambs were studied during normal ventilation and during hyperventilation with, and without, decreased carbon dioxide (CO2). Five lambs were given indomethacin and studied similarly. In control lambs, hyperventilation with decreased CO2 decreased pulmonary arterial pressure from 26 +/- 2.2 to 18 +/- 1.0 (SE) Torr (P less than or equal to 0.005) and pulmonary vascular resistance from 0.099 +/- 0.035 to 0.070 +/- 0.011 Torr X kg-1 X min-1 (P less than or equal to 0.015). Hyperventilation with normal CO2 did not affect the pulmonary circulation. Hyperventilation with decreased CO2 increased pulmonary arterial concentrations of 6-ketoprostaglandin F1 alpha, a major metabolite of prostacyclin, in control lambs but not in the indomethacin-treated lambs. However, it affected the pulmonary circulation of the control- and indomethacin-treated lambs similarly. In conclusion, hyperventilation affected the pulmonary circulation by respiratory alkalosis not by mechanical factors and prostaglandins did not mediate its effects.     

The 1988 Stevenson Memorial lecture. Physiological responses to severe hypoxia in man

Recent measurements at extreme altitude and in low pressure chamber simulations have clarified the human responses to extreme hypoxia. Man can only tolerate the severe oxygen deprivation of great altitudes by an enormous increase in ventilation which has the advantage of defending the alveolar PO2 against the reduced inspired PO2. Nevertheless the arterial PO2 on the Everest summit is less than 30 Torr (1 Torr = 133.3 Pa). An interesting consequence of the hyperventilation is that the respiratory alkalosis greatly increases the oxygen affinity of the hemoglobin and assists in oxygen loading by the pulmonary capillary. The severe hypoxemia impairs the function of many organ systems including the central nervous system, and there is evidence of residual impairment of memory and manipulative skill in climbers returning from great altitudes. At the altitude of Mt. Everest, maximal oxygen uptake is reduced to 20-25% of its sea level value, and it is exquisitely sensitive to barometric pressure. It is likely that the seasonal variation of barometric pressure affects the ability of man to reach the summit without supplementary oxygen.     

Effects of hypo- and hyper-capnia on myocardial blood flow and metabolism during epinephrine infusion in the dog

We have previously demonstrated a 40% increase in myocardial blood flow (MBF) during hypercapnia but no significant decrease of MBF during hypocapnia. The present study was undertaken to evaluate if epinephrine infusion, which increases both myocardial oxygen consumption (MVo2) and myocardial performance, might influence the effects of hypocapnia and hypercapnia on MBF. Induction of hypocapnia was performed by hyperventilation in closed-chest dogs anesthetized with pentobarbital. By adding carbon dioxide to the inspiratory gas, normocapnia and hypercapnia were created. Epinephrine infusion (0.8 microgram X kg-1 X min-1) increased MBF and cardiac output (CO) by 90 and 140%, respectively, while MVo2 was increased by 45%. Epinephrine had a direct coronary vasodilating effect in excess of myocardial needs evidenced by increased oxygen content of the coronary sinus blood. During epinephrine infusion, induction of hypocapnia effected no change of MBF, while myocardial oxygen extraction increased significantly. Although oxygen saturation (So2) and Po2 in the coronary sinus blood decreased, these values remained well above those with hypocapnia without epinephrine infusion, thereby excluding impaired oxygen supply to the heart. Hypercapnia induced an increase of MBF by nearly 40% despite the coronary vasodilatation already induced by epinephrine infusion.     

导管引导介入治疗急性中高危肺动脉栓塞临床研究

目的:评估导管引导介入治疗急性中高危肺动脉栓塞的有效性及安全性。方法:顾性分析2012年1月至2018年6月在柳州市工人医院血管外科诊治的112例急性中高危肺动脉栓塞患者资料。根据治疗方案分单纯抗凝组(共38例)、导管介入+抗凝治疗组(共74例),对比两组肺动脉压及肺动脉栓塞严重指数降低情况、肺栓塞症状改善率、住院时长和出血并发症发生率;以其随访中肺栓塞复发率和慢性血栓性肺动脉高压发生率。根据介入方案不同,介入治疗组包括AngioJet机械吸栓(共13例)、猪尾导管碎栓及溶栓(61例);分别对比两种介入方案术前及术后的动脉血氧分压、指脉氧、心率及肺动脉压、弥勒指数评估治疗效果。结果:两组术前人口学特征、发病时间、DVT并发率、肺动脉压、肺动脉栓塞严重指数等无明显差异(P均0.05)。介入治疗组在降低肺动脉压及肺动脉严重指数、症状的改善率、缩短住院时间上明显优于单纯抗凝组(P分别为0.000、0.001、0.01、0.003);而相关出血并发症发生率无统计学差异(P0.05)。通过分别对比介入治疗两种方案的术前及术后动脉血氧分压、指脉氧、心率及肺动脉压、弥勒指数,两种治疗方案在这五个指标均有明显改善(P值均0.05)。随访6月至7年,肺栓复发率在单纯抗凝组、导管介入+抗凝治疗组分别为10.5%、6.8%,统计学差异显著(P=0.004);慢性血栓性肺动脉高压发生率分别为5.3%、1.4%,统计学差异显著(P=0.000)。结论:导管引导介入治疗对急性中高危肺动脉栓塞治疗是安全有效的,且可明显降低复发及慢性肺动脉高压的发生率。     

Fetal pulmonary vasodilation and vasoreactivity during metabolic acidaemia

We studied the pulmonary vascular response to progressive metabolic acidaemia and to an abrupt increase in oxygen tension during metabolic acidaemia in 8 chronically-prepared fetal sheep. Left pulmonary artery blood flow was measured by electromagnetic flow transducer. Two and a half hour infusion of NH4Cl into the fetal inferior vena cava caused pH to fall to 6.94 +/- 0.01 from 7.37 +/- 0.01 (P less than 0.001). During this period of progressive metabolic acidaemia, left pulmonary artery blood flow increased from a baseline value of 60 +/- 8 to 105 +/- 14 ml.min-1 (P less than 0.002). Pulmonary artery pressure did not change significantly and calculated pulmonary vascular resistance fell indicating fetal pulmonary vasodilation. PO2 rose significantly (19.8 +/- 0.7 to 24.1 +/- 1.8 torr; P less than 0.03) and oxygen saturation fell (54.6 +/- 2.8% to 38.9 +/- 3.5%; P less than 0.001) confirming a rightward shift of the oxyhaemoglobin dissociation curve. During acidaemia, administration of 100% oxygen to the ewe further increased fetal PO2 to 37.9 +/- 2.3 torr within 10 min (P less than 0.001) and this increase in PO2 was accompanied by an increase in left pulmonary artery blood flow (P less than 0.001), a fall in pulmonary artery pressure (P less than 0.03) and a decrease in pulmonary vascular resistance (P less than 0.001) indicating further vasodilation. The response of the fetal pulmonary circulation to a 2-h period of increased oxygen tension was qualitatively similar in acidaemic and non-acidaemic fetuses. We conclude that the progressive metabolic acidaemia imposed by these experimental conditions increases pulmonary blood flow likely through an increase in fetal PO2 and that metabolic acidaemia does not block the normal vasodilatory response to an increase in oxygen tension.     

Comparison of buffer and red blood cell perfusion of guinea pig heart oxygenation

Myocardial mean myoglobin oxygen saturation was determined spectroscopically from isolated guinea pig hearts perfused with red blood cells during increasing hypoxia. These experiments were undertaken to compare intracellular myoglobin oxygen saturation in isolated hearts perfused with a modest concentration of red blood cells (5% hematocrit) with intracellular myoglobin saturation previously reported from traditional buffer-perfused hearts. Studies were performed at 37 degrees C with hearts paced at 240 beats/min and a constant perfusion pressure of 80 cmH2O. It was found that during perfusion with a hematocrit of 5%, baseline mean myoglobin saturation was 93% compared with 72% during buffer perfusion. Mean myoglobin saturation, ventricular function, and oxygen consumption remained fairly constant for arterial perfusate oxygen tensions above 100 mmHg and then decreased precipitously below 100 mmHg. In contrast, mean myoglobin saturation, ventricular function, and oxygen consumption began to decrease even at high oxygen tension with buffer perfusion. The present results demonstrate that perfusion with 5% red blood cells in the perfusate increases the baseline mean myoglobin saturation and better preserves cardiac function at low oxygen tension relative to buffer perfusion. These results suggest that caution should be used in extrapolating intracellular oxygen dynamics from buffer-perfused to blood-perfused hearts.     

Increased propensity for apnea in response to acute elevations in left atrial pressure during sleep in the dog.

Periodic breathing is commonly observed in chronic heart failure (CHF) when pulmonary capillary wedge pressure is abnormally high and there is usually concomitant tachypneic hyperventilation. We hypothesized that acute pulmonary hypertension at pressures encountered in CHF and involving all of the lungs and pulmonary vessels would predispose to apnea/unstable breathing during sleep. We tested this in a chronically instrumented, unanesthetized dog model during non-rapid eye movement (NREM) sleep. Pulmonary hypertension was created by partial occlusion of the left atrium by means of an implanted balloon catheter in the atrial lumen. Raising mean left atrial pressure by 5.7 +/- 1.1 Torr resulted immediately in tachypneic hyperventilation [breathing frequency increased significantly from 13.8 to 19.9 breaths/min; end-tidal P(CO2) (P(ET(CO2))) fell significantly from 38.5 to 35.9 Torr]. This tachypneic hyperventilation was present during wakefulness, NREM sleep, and rapid eye movement sleep. In NREM sleep, this increase in left atrial pressure increased the gain of the ventilatory response to CO2 below eupnea (1.3 to 2.2 l.min(-1).Torr(-1)) and thereby narrowed the CO2 reserve [P(ET(CO2)) (apneic threshold) - P(ET(CO2)) (eupnea)], despite the decreased plant gain resulting from the hyperventilation. We conclude that acute pulmonary hypertension during sleep results in a narrowed CO2 reserve and thus predisposes toward apnea/unstable breathing and may, therefore, contribute to the breathing instability observed in CHF.     

CARDIORESPIRATORY FUNCTION

Accurate evaluation of the degree of impairment of pulmonary function in persons with fibrosis and emphysema requires: (1) ventilatory measurements from rapid spirogram tracings (vital capacity, maximal breathing capacity and the time required to blow the air from the lungs); (2) determination of the degree of bronchospasm present; (3) determination of the degree of pulmonary emphysema (residual air expressed quantitatively as percent of total lung volume); (4) determination of the arterial blood oxygen saturation at rest and immediately after step-up exercise; (5) measurement of the oxygen extraction from inspired air (per cent of oxygen removed) during rest and exercise; (6) determination of the oxygen up-take during exercise; and (7) observation of the duration of dyspnea after step-up exercise.No single physiologic test is adequate in evaluating impairment of pulmonary function, and roentgenograms of the chest are unreliable as a sole basis for appraisal of disability.In industrial medicine, pulmonary function studies make possible (a) more accurate diagnosis and evaluation of pulmonary disability; and (b) earlier detection and thus prevention of prolonged exposure by susceptible individuals to environmental hazards.     

The increase of carbon dyoxidi production at hypoxia in health subjects

Pulmonary gas exchange, SpO2 and heart rate at 15-min hypoxia (respiration by air with 0.17; 0.15 and 0.13 oxygen fractions) have been investigated in 24 health subjects. It has been established, results of the group analysis and the results of the individual analysis had been differed. Reaction on hypoxia at the group analysis had been found only at 0.13 02 fraction. It was only hyperventilation. The individual analysis had revealed 4 types of reaction on hypoxia already at 0.17 and 0.15 02 fractions: (1) hyperventilation, (2) decrease of oxygen consumption, (3) increase of ventilation effectiveness, (4) increase of CO2 production. The mechanisms of last reaction are unknown, but we supposed it was connected with anaerobic metabolism. The reactions were detected at light hypoxia (0.17 and 0.15 oxygen fractions) in 90% health subjects when SpO2 decreased to 87-93%. The increase ventilation has been detected at hypoxia within respiration 0.13 oxygen in 60% subjects when SpO2 decreased to 83-87%, while other reactions were nearly absent.     

Investigation of liquid-solid hydrodynamic boundary layers and oxygen requirements in hairy root cultures.

Rates of oxygen uptake, growth and alkaloid production by hairy roots in submerged culture were investigated using a recirculation reactor allowing operation at high liquid velocities for removal of hydrodynamic boundary layers. Measurements were performed at dissolved oxygen tensions of 31-450% air saturation. Critical oxygen concentrations for Atropa belladonna hairy roots were above air saturation, viz. 100-125% air saturation for oxygen uptake and 150% air saturation for growth, demonstrating that these roots cultivated in reactors with air sparging are oxygen-limited. The critical oxygen tension for oxygen uptake by Solanum aviculare hairy roots was 75% air saturation. Both the specific oxygen uptake rate and specific growth rate of A. belladonna hairy roots were dependent on the mass (g dry weight) of roots present; even in the absence of boundary layers, growth did not remain exponential over the entire culture period. Cryo-scanning electron microscopy showed that hairy roots grown submerged in liquid medium were covered with thick layers of hydrated mucilage and root hairs, representing a significant additional barrier to oxygen transfer. Roots protruding out of the liquid medium showed no evidence of mucilage accumulation. The specific oxygen demand of A. belladonna root tips was 3.3-11.5 times higher than for the remainder of the roots, the ratio increasing as the dissolved oxygen tension was reduced. Specific growth rates, biomass yields from sugar, and atropine levels were maximum at around 150% air saturation, but decreased significantly with oxygen concentrations above ca. 200%.     

Mechanism of the fast neurogenic component of the respiratory response to muscular work]

Dynamics of pulmonary ventilation, electric activity of the intercostal muscles and of the alveolar gas composition was studied in 12 healthy men during dosaged muscular work; these men were given different gas mixtures to breathe. The respiratory response at the initial period of work in inhalation of the hypoxic-hypercapnic gas mixture was greater than that in persons who breathed room air. This response practically disappeared after oxygen hyperventilation. Apparently the rapid component of the ventilation response to the muscular work was largely due to increased sensitivity of the respiratory centre to the chemoreceptive drive.     

Prolonged post-hyperventilation apnea in two young adults with hyperventilation syndrome

Background

The prognosis of hyperventilation syndrome (HVS) is generally good. However, it is important to proceed with care when treating HVS because cases of death following hyperventilation have been reported. This paper was done to demonstrate the clinical risk of post-hyperventilation apnea (PHA) in patients with HVS.

Case presentation

We treated two patients with HVS who suffered from PHA. The first, a 21-year-old woman, had a maximum duration of PHA of about 3.5?minutes and an oxygen saturation (SpO₂) level of 60%. The second patient, a 22-year-old woman, had a maximum duration of PHA of about 3?minutes and an SpO₂ level of 66%. Both patients had loss of consciousness and cyanosis. Because there is no widely accepted regimen for treating patients with prolonged PHA related to HVS, we administered artificial ventilation to both patients using a bag mask and both recovered without any after effects.

Conclusion

These cases show that some patients with HVS develop prolonged PHA or severe hypoxia, which has been shown to lead to death in some cases. Proper treatment must be given to patients with HVS who develop PHA to protect against this possibility. If prolonged PHA or severe hypoxemia arises, respiratory assistance using a bag mask must be done immediately.

     

Cardiorespiratory function

ACCURATE EVALUATION OF THE DEGREE OF IMPAIRMENT OF PULMONARY FUNCTION IN PERSONS WITH FIBROSIS AND EMPHYSEMA REQUIRES: (1) ventilatory measurements from rapid spirogram tracings (vital capacity, maximal breathing capacity and the time required to blow the air from the lungs); (2) determination of the degree of bronchospasm present; (3) determination of the degree of pulmonary emphysema (residual air expressed quantitatively as percent of total lung volume); (4) determination of the arterial blood oxygen saturation at rest and immediately after step-up exercise; (5) measurement of the oxygen extraction from inspired air (per cent of oxygen removed) during rest and exercise; (6) determination of the oxygen up-take during exercise; and (7) observation of the duration of dyspnea after step-up exercise. No single physiologic test is adequate in evaluating impairment of pulmonary function, and roentgenograms of the chest are unreliable as a sole basis for appraisal of disability. In industrial medicine, pulmonary function studies make possible (a) more accurate diagnosis and evaluation of pulmonary disability; and (b) earlier detection and thus prevention of prolonged exposure by susceptible individuals to environmental hazards.     

Effect of oxygen concentration on the growth of Nannochloropsis sp. at low light intensity

In large-scale microalgal production in tubular photobioreactors, the build-up of O(2) along the tubes is one of the major bottlenecks to obtain high productivities. Oxygen inhibits the growth, since it competes with carbon dioxide for the Rubisco enzyme involved in the CO(2) fixation to generate biomass. The effect of oxygen on growth of Nannochloropsis sp. was experimentally determined in a fully controlled flat-panel photobioreactor operated in turbidostat mode using an incident photon flux density of 100?μmol photons m(-2) s(-1) and with only the oxygen concentration as variable parameter. The dissolved oxygen concentration was varied from 20 to 250% air saturation. Results showed that there was no clear effect of oxygen concentration on specific growth rate (mean of 0.48?±?0.40?day(-1)) upon increasing the oxygen concentration from 20% to 75% air saturation. Upon further increasing the oxygen concentration, however, a linear decrease in specific growth rate was observed, ranging from 0.48?±?0.40?day(-1) at a dissolved oxygen concentration of 75% air saturation to 0.18?±?0.01?day(-1) at 250% air saturation. In vitro data on isolated Rubisco were used to predict the quantum yield at different oxygen concentrations in the medium. The predicted decrease in quantum yield matches well with the observed decrease that was measured in vivo. These results indicate that the effect of oxygen on growth of Nannochloropsis sp. at low light intensity is only due to competitive inhibition of the Rubisco enzyme. At these sub-saturating light conditions, the presence of high concentrations of oxygen in the medium induced slightly higher carotenoid content, but the increased levels of this protective antioxidant did not diminish the growth-inhibiting effects of oxygen on the Rubisco.