Clamping end-tidal carbon dioxide during graded exercise with control of inspired oxygen.

Exercise- and hypoxia-induced hyperventilation decreases the partial pressure of end-tidal carbon dioxide (PETCO2), which in turn exerts many physiological effects. Several breathing circuits that control PETCO2 have been previously described, but their designs are not satisfactory for exercise studies where changes in inspired oxygen (FIO2) may be desired. This study is the first report of a breathing system that can maintain PETCO2 constant within a single session of graded submaximal exercise and graded hypoxia. Thirteen fit and healthy subjects completed two bouts of exercise consisting of three 3min stages on a cycle ergometer with increasing exercise intensity in normoxia (Part A; 142±14, 167±14, 192±14W) or with decreasing FIO2 at a constant exercise intensity (Part B; 21, 18, and 14%). One bout was a control (CON) where PETCO2 was not manipulated, while during the other bout the investigator clamped PETCO2 within 2mmHg (CO2Clamp) using sequential gas delivery (SGD). During the final 30s of each exercise stage during CO2Clamp, PETCO2 was successfully maintained in Part A (43±4, 44±4, 44±3mmHg; P=0.44) and Part B (45±3, 46±3, 45±3mmHg; P=0.68) despite the increases in ventilation due to exercise. These findings demonstrate that this SGD circuit can be used to maintain isocapania in exercising humans during progressively increasing exercise intensities and changing FIO2.

Cardiovascular response to functional electrical stimulation and dynamic tilt table therapy to improve orthostatic tolerance.

Orthostatic hypotension is a common condition for individuals with stroke or spinal cord injury. The inability to regulate the central nervous system will result in pooling of blood in the lower extremities leading to orthostatic intolerance. This study compared the use of functional electrical stimulation (FES) and passive leg movements to improve orthostatic tolerance during head-up tilt. Four trial conditions were assessed during head-up tilt: (1) rest, (2) isometric FES of the hamstring, gastrocnemius and quadriceps muscle group, (3) passive mobilization using the Erigo dynamic tilt table; and (4) dynamic FES (combined 2 and 3). Ten healthy male subjects experienced 70 degrees head-up tilt for 15 min under each trial condition. Heart rate, blood pressure and abdominal echograms of the inferior vena cava were recorded for each trial. Passive mobilization and dynamic FES resulted in an increase in intravascular blood volume, while isometric FES only resulted in elevating heart rate. No significant differences in blood pressure were observed under each condition. We conclude that FES combined with passive stepping movements may be an effective modality to increase circulating blood volume and thereby tolerance to postural hypotension in healthy subjects.

Non-invasive prospective targeting of arterial P(CO2) in subjects at rest.

Accurate measurements of arterial P(CO(2)) (P(a,CO(2))) currently require blood sampling because the end-tidal P(CO(2)) (P(ET,CO(2))) of the expired gas often does not accurately reflect the mean alveolar P(CO(2)) and P(a,CO(2)). Differences between P(ET,CO(2)) and P(a,CO(2)) result from regional inhomogeneities in perfusion and gas exchange. We hypothesized that breathing via a sequential gas delivery circuit would reduce these inhomogeneities sufficiently to allow accurate prediction of P(a,CO(2)) from P(ET,CO(2)). We tested this hypothesis in five healthy middle-aged men by comparing their P(ET,CO(2)) values with P(a,CO(2)) values at various combinations of P(ET,CO(2)) (between 35 and 50 mmHg), P(O(2)) (between 70 and 300 mmHg), and breathing frequencies (f; between 6 and 24 breaths min(-1)). Once each individual was in a steady state, P(a,CO(2)) was collected in duplicate by consecutive blood samples to assess its repeatability. The difference between P(ET,CO(2)) and average P(a,CO(2)) was 0.5 +/- 1.7 mmHg (P = 0.53; 95% CI -2.8, 3.8 mmHg) whereas the mean difference between the two measurements of P(a,CO(2)) was -0.1 +/- 1.6 mmHg (95% CI -3.7, 2.6 mmHg). Repeated measures ANOVAs revealed no significant differences between P(ET,CO(2)) and P(a,CO(2)) over the ranges of P(O(2)), f and target P(ET,CO(2)). We conclude that when breathing via a sequential gas delivery circuit, P(ET,CO(2)) provides as accurate a measurement of P(a,CO(2)) as the actual analysis of arterial blood.