The Valsalva maneuver: an indispensable physiological tool to differentiate intra versus extracranial near-infrared signal.

Developing near-infrared spectroscopy (NIRS) parameter recovery techniques to more specifically resolve brain physiology from that of the overlying tissue is an important part of improving the clinical utility of the technology. The Valsalva maneuver (VM) involves forced expiration against a closed glottis causing widespread venous congestion within the context of a fall in cardiac output. Due to the specific anatomical confines and metabolic demands of the brain we believe a properly executed VM has the ability to separate haemodynamic activity of brain tissue from that of the overlying scalp as observed by NIRS, and confirmed by functional magnetic resonance imaging (fMRI). Healthy individuals performed a series of standing maximum effort VMs under separate observation by frequency domain near-infrared spectroscopy (FD-NIRS) and fMRI. Nine individuals completed the clinical protocol (6 males, age 21-40). During the VMs, brain and extracranial tissue targeted signal were significantly different (opposite direction of change) in both fMRI and NIRS (p=0.00025 and 0.00115 respectively), with robust cross correlation of parameters between modalities. Four of these individuals performed further VMs after infiltrating 2% xylocaine/1:100,000 epinephrine (vasoconstrictor) into scalp tissue beneath the probes. No significant difference in the cerebrally derived parameters was observed. The maximum effort VM has the ability to separate NIRS observable physiology of the brain from the overlying extracranial tissue. Observations made by this FD cerebral NIRS device are comparable with fMRI in this context.

Cerebral Oxygenation in Traumatic Brain Injury: Can a Non-Invasive Frequency Domain Near-Infrared Spectroscopy Device Detect Changes in Brain Tissue Oxygen Tension as Well as the Established Invasive Monitor?

The cost and highly invasive nature of brain monitoring modality in traumatic brain injury patients currently restrict its utility to specialist neurological intensive care settings. We aim to test the abilities of a frequency domain near-infrared spectroscopy (FD-NIRS) device in predicting changes in invasively measured brain tissue oxygen tension. Individuals admitted to a United Kingdom specialist major trauma center were contemporaneously monitored with an FD-NIRS device and invasively measured brain tissue oxygen tension probe. Area under the curve receiver operating characteristic (AUROC) statistical analysis was utilized to assess the predictive power of FD-NIRS in detecting both moderate and severe hypoxia (20 and 10 mm Hg, respectively) as measured invasively. Sixteen individuals were prospectively recruited to the investigation. Severe hypoxic episodes were detected in nine of these individuals, with the NIRS demonstrating a broad range of predictive abilities (AUROC 0.68-0.88) from relatively poor to good. Moderate hypoxic episodes were detected in seven individuals with similar predictive performance (AUROC 0.576-0.905). A variable performance in the predictive powers of this FD-NIRS device to detect changes in brain tissue oxygen was demonstrated. Consequently, this enhanced NIRS technology has not demonstrated sufficient ability to replace the established invasive measurement.

Frequency-domain vs continuous-wave near-infrared spectroscopy devices: a comparison of clinically viable monitors in controlled hypoxia.

The Near-infrared spectroscopy (NIRS) has not been adopted as a mainstream monitoring modality in acute neurosurgical care due to concerns about its reliability and consistency. However, improvements in NIRS parameter recovery techniques are now available that may improve the quantitative accuracy of NIRS for this clinical context. Therefore, the aim of this study was to compare the abilities of a continuous-wave (CW) NIRS device with a similarly clinically viable NIRS device utilising a frequency-domain (FD) parameter recovery technique in detecting changes in cerebral tissue saturation during stepwise increases of experimentally induced hypoxia. Nine healthy individuals (6M/3F) underwent a dynamic end-tidal forced manipulation of their expiratory gases to induce a stepwise induced hypoxia. The minimum end-tidal oxygen partial pressure (EtO2) achieved was 40 mm Hg. Simultaneous neurological and extra-cranial tissue NIRS reading were obtained during this protocol by both tested devices. Both devices detected significant changes in cerebral tissue saturation during the induction of hypoxia (CW 9.8 ± 2.3 %; FD 7.0 ± 3.4 %; Wilcoxon signed rank test P < 0.01 for both devices). No significant difference was observed between the saturation changes observed by either device (P = 0.625). An observably greater degree of noise was noticed in parameters recovered by the FD device, and both demonstrated equally variable baseline readings (Coefficient of variance 8.4 and 9.7 % for the CW and FD devices, respectively) between individuals tested. No advantageous difference was observed in parameters recovered from the FD device compared with those detected by CW.

Does arterial health affect VO2peak and muscle oxygenation in a sedentary cohort?

PURPOSE: An association between arterial health and peak oxygen consumption (VO2peak) has been demonstrated; however, little is known about how arterial health influences muscular oxygenation during exercise. The aim of this study was to gain insight into the relations between arterial health, VO2peak, and muscle oxygenation in a middle-age sedentary population. METHODS: Radial augmentation index (AIx) (via pulse wave analysis) of 21 sedentary middle-age participants (15 females and six males; age, 54.7 ± 5.4; body mass index, 29.0 ± 4.7 kg·m; mean ± SD) was assessed, and on another day ( < 7 d), participants completed a modified Bruce protocol (MBP). Using near-infrared spectroscopy, total oxygenation index (TOI) of the left flexor carpi ulnaris and the left vastus lateralis were monitored throughout the MBP. Independent and average (arm + leg) percentage decrease in TOI between stage 1 of the MBP and maximal exertion (TOIdiff) during MBP was calculated. Changes between dependent variables were correlated using Pearson product-moment correlations and were interpreted as follows: r > 0.5, strong; 0.5 > r > 0.3, moderate; and r < 0.3, weak. RESULTS: We observed moderate negative correlation between AIx and VO2peak (r = -0.34, -0.63 to -0.03; Pearson correlation, 90% confidence limits) and strong negative correlation between AIx and average TOIdiff (r = -0.58, -0.78 to -0.27). The VO2peak and average TOIdiff were strongly correlated (r = 0.55, 0.23-0.77). CONCLUSIONS: Arterial health seems to be an important determinant of muscle oxygenation during exercise. In turn, muscle oxygenation during exercise is strongly related to VO2peak. Developing training modalities to prioritize arterial health outcomes may be a useful way of improving VO2peak in this population.

Environmental physiology research presented at ICEE2013.

The 15th International Conference on Environmental Ergonomics, Queenstown, New Zealand, February 11 to 15, 2013 (ICEE2013) brought together researchers interested in work and exercise physiology, safety, comfort and performance in various stressful and extreme environments.