Differential pathlength factor for diffuse photon scattering through tissue by a pulse-response method

Although near-infrared (NIR) spectroscopy may one day provide a noninvasive measurement of oxidative metabolism in tissue, the method cannot be fully quantitative until the mean pathlength traveled by photons between reference and output detectors (i.e, optrodes) is known. In NIR spectroscopy, photons are transported primarily by diffuse scattering, and their mean pathlength can be expressed by a differential path factor (DPF) whose value is greater than the interoptrode distance. Beginning with a P1 diffusion approximation of the Boltzmann equation, one-dimensional photon currents originating from plane, line, and point photon sources were analyzed. DPF was formulated from the attenuation of light intensity generated by constant sources, and an equation for the mean time of flight of photons between reference and output optrodes, delta tau, was derived for arbitrarily pulsed sources. The results indicate that (1) the attenuation of light in tissue does not, in general, vary with interoptrode distance in the manner predicted by Beer's law; (2) the relationship between DPF and interoptrode distance is nonlinear and geometry-dependent; and (3) in spite of these nonidealities, DPF is equal to the product of delta tau and the speed of light.

Recovery of cerebral metabolism and mitochondrial oxidation state is delayed after hypothermic circulatory arrest

To study the effect of deep hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral metabolism and oxygenation, we measured the cerebral metabolic rate for oxygen (CMRO2) and assessed brain oxygenation by near infrared spectroscopy before, during, and after hypothermic bypass in 15 pediatric patients. One group underwent repair during deep hypothermic bypass (18 degrees C) with continuous flow (n = 9); the second group underwent deep hypothermic bypass with total circulatory arrest (n = 6). In the continuous-flow group, CMRO2 returned to control during rewarming and after cardiopulmonary bypass, as did oxyhemoglobin and deoxyhemoglobin in brain tissue. In the total circulatory arrest group, the oxyhemoglobin and the oxidation state of cytochrome aa3 oxidase decreased significantly during circulatory arrest. After cardiopulmonary bypass, the cytochrome oxidation state and the CMRO2 were significantly lower than control measurements, and brain tissue deoxyhemoglobin was elevated. Results of this study indicate that intracellular brain oxygenation decreases significantly during circulatory arrest and remains impaired after rewarming and cardiopulmonary bypass despite normalization of oxygen availability.

Prevention of H2O2 generation by monoamine oxidase protects against CNS O2 toxicity

Toxicity to the central nervous system (CNS) by hyperbaric oxygen (HBO) presumably relates to increased production of reactive oxygen species. The sites of generation of reactive oxygen species during HBO, however, have not been fully characterized in the brain. We investigated the relationship between regional generation of hydrogen peroxide (H2O2) in the brain in the presence of an irreversible inhibitor of catalase, aminotriazole (ATZ), and protection from CNS O2 toxicity by a monoamine oxidase (MAO) inhibitor, pargyline. At 6 ATA of oxygen, pargyline significantly protected rats from CNS O2 toxicity whereas ATZ enhanced O2 toxicity. In animals pretreated with ATZ, HBO inactivated 21-40% more catalase than air exposure in the six brain regions studied. Because ATZ-mediated inactivation of catalase was H2O2 dependent, the decrease in catalase activity during hyperoxia was proportional to the intracellular production of H2O2. Pargyline, administered 30 min before HBO, inhibited MAO by greater than 90%, prevented ATZ inhibition of catalase activity during HBO, and reversed the augmentation of CNS O2 toxicity by ATZ. These findings indicate that H2O2 generated by MAO during hyperoxia is important to the pathogenesis of CNS O2 toxicity in rats.

Venous gas emboli and complement activation after deep repetitive air diving

Complement activity has been linked to decompression sickness (DCS), but the effects of intravascular bubbles on complement activation are poorly understood. We have investigated intravascular complement activation by measuring red blood cell (RBC)-bound C3d after repetitive air diving in man. Subjects were exposed to a single, 20 min, 170 fsw (feet of sea water) dive, or to 2 such dives with a 6-h surface interval. Doppler monitoring for venous gas emboli was performed postdive. Predive blood samples were studied to determine sensitivity of complement to activation by air bubbles. Other predive and postdive venous samples were evaluated for intravascular complement activation. No cases of DCS occurred in 39 dives. Baseline complement sensitivity appeared normally distributed, thus "sensitive" and "insensitive" subjects were not clearly distinguishable. RBC-bound C3d did not increase after 1 dive but did increase after the repetitive dive (P less than 0.05). Furthermore, maximum bubble grade was independent of complement activation.

Quantitative proton magnetic resonance imaging in focal cerebral ischemia in rat brain

Proton magnetic resonance (MR) imaging has been recommended as a diagnostic tool for the detection of focal cerebral ischemia. We compared microscopic MR images of rat brains after focal cerebral ischemia with evidence of histological damage found on corresponding silver-impregnated or cresyl violet-stained brain sections. Ten male Wistar rats were subjected to permanent unilateral occlusions of the right middle cerebral and common carotid arteries under halothane anesthesia. Twenty-four hours later the area of injury on MR images amounted to 26% of the total slice area, whereas only 9% of the total slice area was necrotic on histological sections from the same animals. The infarcted areas on tissue sections were surrounded by regions of selective neuronal injury in the cerebral cortex and occasionally in the hippocampus. The area of injury on MR images was larger than the combined areas of infarction and selective neuronal injury on histological sections. Areas of increased T2 values on MR images extended medially into noninfarcted striatum and laterally and dorsally into noninfarcted cortex. The lateral and dorsal areas on MR images frequently coincided with cortical areas in which considerable selective neuronal injury was present in the upper cortical layers. We hypothesize that the abnormal areas on MR images above histologically normal brain tissue represent the ischemic penumbra. If true, this is the first demonstration of the ischemic penumbra by MR imaging and may reflect our use of Wistar rats, a new image analysis technique, and ultra-high resolution MR imaging.

Dynamic mechanisms of cardiac oxygenation during brief ischemia and reperfusion

Myocardial oxygenation may be altered markedly by changes in tissue blood flow. During brief ischemia and reperfusion produced by transient occlusion of the left anterior descending artery in 10 open-chest dogs, changes in the oxygenation of tissue hemoglobin (Hb) plus myoglobin (Mb) and the oxidation-reduction (redox) state of mitochondrial cytochrome aa3 were monitored continuously using near-infrared spectroscopy. The nondestructive optical technique indicated that coronary occlusion produced an abrupt drop in tissue oxygen stores (tHb02 + Mb02), tissue blood volume (tBV), and the oxidation level of cytochrome aa3. Changes in the cytochrome oxidation state were related inversely to transmural collateral blood flow within the ischemic region (r = 0.77) measured with radiolabeled microspheres. Furthermore, there was a direct relationship (r = 0.91) between collateral blood flow and the tissue level of desaturated Hb and Mb (tHb + Mb). Reperfusion after 2 min of ischemia led to a synchronous overshoot of baseline in coronary flow and tBV followed by supranormal increases in tHb + Mb02 and the oxidation level of cytochrome aa3. The tHb + Mb level increased transiently during reperfusion. This response correlated inversely with collateral flow during ischemia (r = 0.91). Accordingly, the time required to reach peak tHb + Mb levels was shortest in dogs with high collateral flows (r = 0.75). Thus collateral blood flow partially sustains myocardial oxygenation during coronary artery occlusion and influences tissue reoxygenation early during reperfusion.

Regional H2O2 concentration in rat brain after hyperoxic convulsions

O2 toxicity of the central nervous system (CNS) may be a result of enhanced generation of reactive O2 species such as superoxide and H2O2 at high PO2. In this study, we measured H2O2 production in six regions of the rat brain before and after convulsions induced by hyperbaric hyperoxia (HBO). H2O2 concentration was determined ex vivo using a method based on the H2O2-dependent decline in catalase activity in the presence of the irreversible inhibitor of compound I, 3-amino-1,2,4-triazole. Regional catalase activity in the brain ranged from 0.029 +/- 0.004 to 0.055 +/- 0.004 mumol O2.min-1.micrograms DNA-1 in cerebellum and medulla-pons, respectively. In the presence of aminotriazole, catalase activity declined after HBO-induced convulsions to 26-45% of normoxic values. The rates of inactivation of catalase were used to predict average steady-state values for H2O2 concentration in different brain structures. Estimated H2O2 concentrations during HBO varied from 31 to 51 pM in cerebellum and posterior subcortex and represented increases of 2.2-7.3 times normoxic values. These findings suggest that H2O2 is an important mediator of selective neuronal vulnerability to CNS O2 toxicity.

Cerebral oxygen availability by NIR spectroscopy during transient hypoxia in humans

The effects of mild hypoxia on brain oxyhemoglobin, cytochrome a,a3 redox status, and cerebral blood volume were studied using near-infrared spectroscopy in eight healthy volunteers. Incremental hypoxia reaching 70% arterial O2 saturation was produced in normocapnia [end-tidal PCO2 (PETCO2) 36.9 +/- 2.6 to 34.9 +/- 3.4 Torr] or hypocapnia (PETCO2 32.8 +/- 0.6 to 23.7 +/- 0.6 Torr) by an 8-min rebreathing technique and regulation of inspired CO2. Normocapnic hypoxia was characterized by progressive reductions in arterial PO2 (PaO2, 89.1 +/- 3.5 to 34.1 +/- 0.1 Torr) with stable PETCO2, arterial PCO2 (PaCO2), and arterial pH and resulted in increases in heart rate (35%) systolic blood pressure (14%), and minute ventilation (5-fold). Hypocapnic hypoxia resulted in progressively decreasing PaO2 (100.2 +/- 3.6 to 28.9 +/- 0.1 Torr), with progressive reduction in PaCO2 (39.0 +/- 1.6 to 27.3 +/- 1.9 Torr), and an increase in arterial pH (7.41 +/- 0.02 to 7.53 +/- 0.03), heart rate (61%), and ventilation (3-fold). In the brain, hypoxia resulted in a steady decline of cerebral oxyhemoglobin content and a decrease in oxidized cytochrome a,a3. Significantly greater loss of oxidized cytochrome a,a3 occurred for a given decrease in oxyhemoglobin during hypocapnic hypoxia relative to normocapnic hypoxia. Total blood volume response during hypoxia also was significantly attenuated by hypocapnia, because the increase in volume was only half that of normocapnic subjects. We conclude that cytochrome a,a3 oxidation level in vivo decreases at mild levels of hypoxia. PaCO is an important determinant of brain oxygenation, because it modulates ventilatory, cardiovascular, and cerebral O2 delivery responses to hypoxia.

Near-infrared optical responses in feline brain and skeletal muscle tissues during respiratory acid-base imbalance

The effects of hyper- and hypocapnia on oxidative metabolism were evaluated by near-infrared (NIR) multiwavelength spectroscopy in intact brain and skeletal muscle tissues of the anesthetized cat. A 3-wavelength NIR algorithm was used to monitor cytochrome a,a3 oxidation state, regional blood volume, and tissue oxyhemoglobin and O2 stores simultaneously in brain and muscle in ventilated animals. Incremental hypercapnia was produced in 10 cats by raising arterial pCO2 from 27.0 +/- 1.3 to 95.1 +/- 1.9 mmHg with inspired CO2. Hypercapnia produced progressive increases in cerebral HbO2, blood volume, and cytochrome a,a3 oxidation state (P less than 0.01). In contrast, CO2 simultaneously decreased all 3 NIR parameters in intact hindlimb muscles (P less than 0.01). Blood volume changes during hypercapnia correlated with changes in blood flow measured qualitatively by intravascular injections of indocyanine green dye. Hypocapnia produced by hyperventilation in 8 cats lowered paCO2 from 28.5 +/- 0.4 to 13.5 +/- 0.5 mmHg. Hypocapnia decreased cerebral HbO2, blood volume, and cytochrome a,a3 redox level (P less than 0.05), but NIR changes were not seen in skeletal muscle. These experiments demonstrate preferential distribution of oxygen to brain during hypercapnia and the ability of NIR spectroscopy to assess regional oxygenation in multiple tissues non-invasively.

In vivo binding of carbon monoxide to cytochrome c oxidase in rat brain

The possibility of binding of CO to cytochrome c oxidase (cytochrome a,a3) in brain cortex has been examined in vivo by reflectance spectrophotometry. During ventilation with CO-containing gases, cytochrome a,a3 absorption at 605 nm increased in the parietal cortex of anesthetized rats during carboxyhemoglobin (HbCO) formation. HbCO levels, measured by changes in absorption at 569-586 nm in vivo, correlated positively with arterial HbCO by CO oximetry. Arterial blood pressure and calculated O2 content varied inversely with HbCO. During CO exposure, decreases in blood pressure, O2 content, and cytochrome a,a3 oxidation level could be reversed partly at constant HbCO by compression to 3 atmospheres absolute (ATA). After removing CO from inspired gas at 3 ATA, optical and physiological parameters recovered completely to control values except for minor persistent elevations of HbCO. Difference spectra from parallel experiments at constant HbCO revealed absorption minima at 588-592 nm and 600-605 nm as a result of hyperbaric exposure. Spectral analysis of these components was consistent with partial dissociation of a cytochrome a3-CO complex and cytochrome a reoxidation with increasing dissolved O2 in hyperbaric conditions.

Eicosanoids and the hemodynamic course of live Escherichia coli-induced sepsis in baboons

Time-related changes in eicosanoid release and hemodynamic parameters were characterized in baboons during the early development of sepsis induced by intravenous (i.v.) infusion of live Escherichia coli (4 x 10(10) organisms/kg) in baboons. Plasma levels of thromboxane B2 (TxB2), a stable metabolite of thromboxane A2 (TxA2), rose rapidly in arterial, venous, and pulmonary arterial blood after infusion of live E. coli, attaining maximal increases at 30 min and returning to control values by 60 min. In contrast, plasma concentrations of 6-keto-PGF1 alpha rose slowly after infusion, reaching peak concentrations at 120 min, then slowly returned to control values between 4 and 5 hr after infusion of live E. coli. Hemodynamic values remained stable during the first 2 hr after infusion, although early changes in cellular energy metabolism and incipient hemodynamic failure were inferred from pyrexia, tachycardia, and metabolic acidosis. At 3 hr, signs of further hemodynamic compromise developed, including increased venous PCO2, reduced pulmonary capillary wedge pressure, and reduced stroke volume, followed by gradual increases in systemic and pulmonary vascular resistance. These factors coincided with progressive reductions in cardiac output and deteriorating circulatory efficiency. The time course of events following infusion of live E. coli indicates that alterations in cellular energy provision occurred early (within 1 hr), whereas central hemodynamic parameters decayed much more slowly. Additionally, TxA2 and PGI2 appear related to the early events in the development of sepsis as their release preceded cardiocirculatory failure.

Spectrophotometry of b-type cytochromes in rat brain in vivo and in vitro

Terminal oxidase inhibitors such as cyanide (CN) and carbon monoxide (CO) produce different absorption changes in the intact brain, suggesting different mitochondrial responses to the inhibitors. In the present study, the nature of the cytochromes involved in CO and CN responses in vivo was investigated by low-temperature spectroscopy of rat brain, frozen in situ, and of preparations of brain homogenate and isolated mitochondria. Comparison of the spectra from different preparations at the high resolution afforded by low-temperature spectroscopy indicated that absorption responses to CO in vivo originated from mitochondrial b cytochromes. Further detailed spectral analysis of mitochondrial preparations revealed three CN-insensitive b cytochromes in nonsynaptic brain mitochondria; one cytochrome could be reduced by succinate in the presence of CN, the second could be reduced by succinate plus ATP, and the third could be reduced only by anaerobiosis. The spectral characteristics of the mitochondrial b cytochromes, when compared with spectra from CO-exposed brain tissue frozen in situ, strongly implicated the energy-dependent cytochrome b in the oxidation-reduction (redox) responses caused by CO in vivo.

Should hyperbaric oxygen be used to treat the pregnant patient for acute carbon monoxide poisoning? A case report and literature review

Carbon monoxide (CO) is the leading cause of death due to poisoning. Although uncommon, CO poisoning does occur during pregnancy and can result in fetal mortality and neurological malformations in fetuses who survive to term. Uncertainty arises regarding the use of hyperbaric oxygen (HBO) as a treatment for the pregnant patient because of possible adverse effects on the fetus that could be induced by oxygen at high partial pressures. While the dangers of hyperoxia to the fetus have been demonstrated in animal models, careful review of animal studies and human clinical experience indicates that the short duration of hyperoxic exposure attained during HBO therapy for CO poisoning can be tolerated by the fetus in all stages of pregnancy and reduces the risk of death or deformity to the mother and fetus. A case is presented of acute CO poisoning during pregnancy that was successfully treated with HBO. Recommendations are suggested for the use of HBO during pregnancy.

Behavior of the copper band of cytochrome c oxidase in rat brain during FC-43-for-blood substitution

FC-43-for-blood substitution experiments were conducted in anesthetized rats to evaluate NIR spectroscopic responses by living brain to exchange transfusion at very low hematocrits. The NIR responses to the exchange process also assess the ability of multiwavelength algorithms to measure independent changes in the relative amounts of Hb, tHbO2 and oxidized cytochrome a,a3 in the tissue. These data indicate that FC-43 circulation at high FIO2 (1.00) delivers sufficient O2 to the rat brain to maintain the oxidation state of the mitochondrial oxidase near pre-exchange values. The results also confirm the ability of four wavelength algorithms to distinguish changes in the oxidized copper band of cytochrome a,a3 from changes in absorption by Hb and HbO2.

Reversal of carbon monoxide-cytochrome c oxidase binding by hyperbaric oxygen in vivo

Cytochrome a,a3 redox state of the parietal cortex of pentobarbital anesthetized rats was continuously monitored through intact skull with four wavelength differential spectrophotometry during exposure to 90% O2 plus either 1.0 or 0.5% CO at 1 and 3 (ATA). The formation of HbCO was monitored in the brain by absorbance differences between 569 and 586 nm and correlated positively in graded 0.25 to 1% CO exposures with measured HbCO levels. Exposure to 90% O2, 1% or 0.5% CO (balance N2) decreased mean arterial pressure (MAP), calculated arterial O2 content and cytochrome a,a3 oxidation measured at 605 nm relative to 620 nm while HbCO rose. After compression to 3 ATA, rats breathing CO mixtures increased MAP and O2 content with reoxidation of cytochrome a,a3 while HbCO remained constant. Further treatment of both groups with 90% O2 at 3 ATA recovered the above parameters to at least control values except small persistent elevations of HbCO. Difference spectra recorded from 568 to 620 nm in parallel experiments showed twin absorbance peaks at 588 to 592 nm and 600 to 605 nm in response to CO. These absorbance maxima were consistent with formation of the cytochrome a3-CO complex and cytochrome a reduction respectively. These studies indicate that CO binds to reduced cytochrome a3 in blood circulated rat cortex in CO hypoxia and this effect can be reversed by increasing dissolved arterial O2 content at 3 ATA.

Direct effects of CO on cerebral energy metabolism in bloodless rats

Cerebrocortical b-cytochromes have been found to be sensitive to reduction in the presence of CO and O2 in vivo. CO-mediated cytochrome b reduction responses in "bloodless" rats were correlated in this study with changes in concentrations of high energy and glycolytic intermediates measured in cortex after rapid brain freezing. Cytochrome redox state and metabolite concentrations also were compared with cerebral blood flow (CBF) and cerebral metabolic rate for O2 (CMRo2) measured before and after CO administration. No definite biochemical evidence of energy limitation was found in parietal cortex after the fluorocarbon-for-blood exchange; however, CO had direct effects on brain metabolite concentrations. Fifteen-minute CO exposures at inspired CO/O2 of 0.003-0.06 increased cerebrocortical phosphocreatine and ADP and decreased creatine concentration. CO exposure produced no significant changes in either ATP concentration or CMRo2, although CBF increased slightly. These findings may be interpreted to indicate that CO binding to cytochrome aa3 at low CO/O2 in vivo increases extramitochondrial pH relative to that within the mitochondrial matrix. In the process, cytochrome b reduction levels increase, possibly signaling an increased efficiency of oxidative phosphorylation relative to O2 uptake by unblocked respiratory chains.

Prognosis of patients with cirrhosis and chronic liver disease admitted to the medical intensive care unit

Patients with hepatic failure admitted to the medical ICU (MICU) generally have a poor prognosis. To determine if there were readily identifiable clinical factors associated with a high predictive value for outcome, we reviewed retrospectively the charts of 100 patients with serious liver disease admitted to the MICU. The overall mortality of the group was 64%. We found that Child's class, a need for mechanical ventilation, and an elevated serum creatinine had the greatest prognostic significance. Ninety-one percent of the patients receiving assisted ventilation, 89% of the patients in Child's class C, and 93% of the patients with creatinine values greater than 1.3 mg/dl died during their MICU admission. Furthermore, a multivariant regression analysis indicated that patients in Child's class C receiving mechanical ventilation who had an abnormal serum creatinine (greater than 1.3 mg/dl) during the first 72 h in the MICU had only a 2% survival rate.

Cyanide-related changes in cerebral O2 delivery and metabolism in fluorocarbon-circulated rats

Cyanide-induced cytotoxicity is primarily a result of inhibition of O2 uptake by the terminal enzyme of the mitochondrial respiratory chain, cytochrome-c oxidase (cytochrome aa3). The oxidase in the brain is highly vulnerable to cyanide cytotoxicity, but few studies have evaluated the effects of cyanide on cerebral oxygen metabolism. In the present study, we measured oxidation-reduction responses of cerebrocortical cytochrome aa3 to cyanide and related changes in cerebral blood flow (CBF) and O2 metabolism (CMRO2). Accurate measurement of cytochrome aa3 redox state in vivo by reflectance spectrophotometry was accomplished by using fluorocarbon-circulated rats to eliminate spectral interference from hemoglobin. The data indicate that constant intravenous infusions of cyanide caused rapid, progressive reduction responses by cerebrocortical cytochrome aa3 concomitant with increases in CBF of up to 200%. However, CMRO2 was maintained near normal until cerebral O2 delivery began to fall. These cerebral oxidative responses to cyanide may be explained either by redistribution of intracellular O2 supply to mitochondria respiring in an O2-dependent manner or by branching effects within brain mitochondria in vivo.

Near infrared monitoring of human skeletal muscle oxygenation during forearm ischemia

Changes in tissue oxygenation of forearm muscles were measured by near infrared (NIR) spectrophotometry in 10 healthy adults during tourniquet ischemia and venous outflow restriction. Muscle O2 stores were depleted rapidly by forearm ischemia manifest by a progressive decrease in tissue oxyhemoglobin and oxymyoglobin over 4-5 min. Muscle ischemia significantly decreased the oxidation level of cytochrome aa3, to below resting base line after only 1.5 min, and the enzyme became fully reduced after 6.5 min. After 8 min of ischemia, tourniquet release was accompanied by a transient increase in muscle blood volume due to influx of oxyhemoglobin. The cytochrome aa3 oxidation level increased above resting base line within 1 min after tourniquet release. Transcutaneous PO2 measurements recorded simultaneously from the same forearm correlated poorly with the kinetics of O2 availability and cytochrome oxidation in the underlying muscle tissue; this was not unexpected because overlying skin did not contribute significantly to NIR muscle signals. Venous outflow restriction without inflow obstruction increased muscle deoxyhemoglobin and tissue blood volume but did not change muscle O2 stores or cytochrome aa3 oxidation level. The ability of the NIR technique to detect dynamic trends in tissue oxygenation reveals that muscle O2 is rapidly consumed during tourniquet ischemia and rapidly restored by hyperemic responses after brief ischemia.

Interstitial lung disease and domestic wood burning

A 61-yr-old woman was evaluated for dyspnea on exertion and interstitial lung disease. A unique association between inhaled particulates from wood burning and interstitial pneumonitis was demonstrated. Bronchoalveolar lavage revealed numerous particulates and fibers, as well as cellular and immunoglobulin abnormalities. The particles were shown to be carbonaceous by energy dispersive X-ray analysis (EDXA). Inflammation and fibrosis were found surrounding them on open biopsy. The particle source was traced to a malfunctioning wood-burning heater in the patient's home. We present this case to highlight the usefulness of BAL and EDXA in the elucidation of particle-associated lung disease.

Effect of fluorocarbon-for-blood exchange on regional cerebral blood flow in rats

Cerebrocirculatory responses to total perfluorocarbon (FC-43)-for-blood replacement (Hct less than 1%) were studied in anesthetized, ventilated rats breathing 100% O2. Changes in total and regional cerebral blood flow (CBF) were measured using the radiolabeled-microsphere technique. The data were compared with two control groups of hemoglobin-circulated animals; one group was exposed to arterial hypoxia (arterial PO2 = 40 Torr) and the other to isovolemic hemodilution with Krebs-Henseleit-albumin (KHA) solution (mean Hct = 11%). Exchange transfusion with FC-43 doubled total and regional CBF, causing preferential flow increases to the cortex and cerebellum. Estimated cerebrovascular resistance fell to 50% of the preexchange value. Both hemodilution and hypoxia control experiments produced CBF responses similar to those obtained in FC-43 animals. Although calculated arterial O2 contents in all three groups of animals were similar, blood viscosity was normal in hypoxic rats and reduced in KHA and FC-43 animals. Since arterial and cerebrovenous PO2s were both high in fluorocarbon-circulated rats, our results suggest that decreased O2 content and perhaps lower viscosity of the circulating fluorocarbon were responsible for increases in CBF required to maintain sufficient delivery of O2 to the brain.

O2 dependence of in vivo brain cytochrome redox responses and energy metabolism in bloodless rats

Oxygen-dependent changes in brain cytochrome redox state and cerebrocortical energy metabolism were evaluated in fluorocarbon-circulated rats at hematocrits of less than 1%. Redox levels of three respiratory chain cytochrome complexes, b, c, and a,a3 (cytochrome c oxidase), were continuously measured directly through the intact skulls of animals using reflectance spectrophotometry. The in vivo redox status of cytochromes at different FiO2 was directly compared with in vitro measured changes in cortical metabolites known to reflect energy production, i.e., glucose, pyruvate, lactate, phosphocreatine (PCr), ADP, and ATP. Lowering the FiO2 to less than 1.0 caused the cytochromes to become increasingly more reduced. This was associated with increased tissue accumulation of pyruvate and lactate and a concomitant increase in the lactate/pyruvate (L/P) ratio. At FiO2 = 0.6, cytochromes b, c, and a,a3 were 57, 53, and 46% reduced, respectively. There was no apparent cerebral energy deficit since changes in cortical PCr, ADP, and ATP concentrations were not statistically significant. Bloodless animals did not survive below FiO2 = 0.5. At this FiO2, the inability of the animals to sustain arterial pressure correlated (r = 0.87) with depletion of PCr and further increases in the L/P ratio (r = 0.66). Yet, the cortical ATP content was reduced by only 9% of control value. These data provide direct evidence that fluorocarbon emulsion (FC-43) sustains brain oxygenation and energy metabolism at high partial pressures of molecular O2. At lower FiO2, however, mitochondrial O2 uptake becomes limited as a function of decreasing perfusion pressure.