Validation of near-infrared spectroscopy in humans

Effects of age on muscle energy metabolism and oxygenation in the forearm muscles

PURPOSE

The effects of aging on muscle metabolism and oxygenation have not yet been elucidated. We evaluated the effects of aging on energy metabolism and oxygenation in sedentary healthy subjects by simultaneously measuring 31P-magnetic resonance spectroscopy (MRS) and near-infrared spectroscopy (NIRS).

METHODS

Nine young (28.1 +/- 5.0 yr) and nine older (61.4 +/- 4.6 yr) healthy subjects were studied. The 31P-MR spectrum was obtained every 15 s during and after hand gripping exercise. Intracellular pH (pHi) and PCr/(PCr+Pi) [PCr: phosphocreatine, Pi: inorganic phosphate] were calculated as an index of energy metabolism. The time constant of the PCr/(PCr+Pi) recovery (tau PCr) was calculated. With NIRS, we evaluated the recovery rates of oxygenated (RHbO2) and deoxygenated hemoglobin (RHb) during the initial 10 s of recovery.

RESULTS

The PCr/(PCr+Pi) and pHi at rest and at completion of the exercise and tau PCr did not differ between young and older subjects. However, RHbO2 and RHb were significantly slower in older subjects than in young subjects.

CONCLUSIONS

The results suggest that muscle energy metabolism in the forearm muscle was not affected by aging. The slower RHbO2 and RHb in older subjects suggested impaired O2 supply, which was probably due to impaired peripheral circulation caused by the process of aging.

Splanchnic perfusion evaluation during hemorrhage and resuscitation with gastric near-infrared spectroscopy

OBJECTIVE

The purpose of this study was to use a prototype side-illuminating near-infrared spectroscopy (NIRS) nasogastric probe to continuously measure changes in gastric tissue oxygen saturation (Sto2) in a pig hemorrhage model.

METHODS

Swine (n = 12; 6 per group) underwent laparotomy and placement of a gastric NIRS probe, jejunal tonometer, superior mesenteric artery (SMA) flow probe, and a portal vein catheter. Animals underwent hemorrhage (28 mL/kg) t = 0 to 20 minutes (where t = time). Pigs in group I were resuscitated (t = 20-40 minutes) with lactated Ringer's solution (84 mL/kg), whereas group II had no resuscitation.

RESULTS

A significant decrease in mean arterial pressure and SMA flow was observed after hemorrhage. SMA flow significantly correlated in group I with both NIRS Sto2 (r = 0.58, p = 0.0001) and regional CO2 (r = -0.54, p = 0.0001). In group II, superior mesenteric flow correlated with NIRS Sto2 (r = 0.30, p = 0.03), but not regional CO2 (r = -0.23, p = 0.09).

CONCLUSION

Direct measurement of tissue oxygen saturation with a prototype side-illuminating near-infrared spectroscopy gastric probe appeared to rapidly reflect changes in splanchnic perfusion.

Contact-free spectroscopy of leg ulcers: principle, technique, and calculation of spectroscopic wound scores

Objective wound monitoring is an essential tool for evidence-based medicine in leg ulcers and other chronic wounds. Non-invasive and contact-free optical remittance spectroscopy seems to be a useful approach as it can provide additional information with respect to more traditional techniques of wound scoring. Twenty-three patients with chronic venous, arterial, and mixed leg ulcers were enrolled in this study. The clinical state of the ulcers was documented by a clinical wound score (quantity, color, and consistency of granulation tissue). The spectroscopic readings were performed with a novel diode-array spectrometer system in the visible and near-infrared range of the spectrum (400-1600 nm) with a resolution of 5 nm. The wound spectra mainly depend on the absorption of hemoglobin and water. The maximum correlation coefficients of mean remittance spectra with the clinical wound scores did not exceed +/- 0.5. Discriminant and cluster analysis were applied for spectral classification of wound scores. By using cross-validation the percentage of correct predicted wound scores was about 69%. Our results indicate that the application of optical visible and near-infrared spectroscopy could be a valuable remedy for the clinician.

Effect of eccentric exercise on muscle oxidative metabolism in humans

PURPOSE

The purpose of this study was to evaluate the effects of eccentric exercise on muscle oxidative function.

METHODS

Thirteen subjects performed high-intensity eccentric cycling for 30 min. Muscle oxidative function in vastus lateralis was evaluated by measurements of respiration in permeabilized muscle fibers (skinned fibers) and from the kinetics of oxyhemoglobin (oxyHb) saturation measured with near infrared spectroscopy (NIRS).

RESULTS

After eccentric cycling, all subjects reported extensive delayed onset muscle soreness (DOMS), but plasma markers of muscle damage (creatine kinase and beta-glucuronidase activity) were not significantly altered. The half time of oxyHb desaturation after circulatory occlusion (128 +/- 11 s, mean +/- SE) and oxyHb resaturation after restoration of blood flow (13.8 +/- 0.7 s) were not significantly changed after eccentric cycling (N = 7). Respiration in skinned muscle fibers measured in the absence of ADP and in the presence of a submaximal (0.1 mM) or maximal ADP concentration (1 mM) was not significantly changed after eccentric cycling (N = 6). The sensitivity of respiration to ADP was not significantly changed after eccentric cycling.

CONCLUSIONS

Muscle oxidative function (maximal respiration and respiratory control by ADP) was not compromised after high-intensity eccentric cycle exercise. Furthermore, NIRS indicates that after eccentric cycling muscle oxygen utilization and local oxygen transport at rest are unchanged. It is concluded that eccentric cycling, although causing DOMS, does not negatively affect skeletal muscle oxidative function.

Performance of near-infrared spectroscopy in measuring local O(2) consumption and blood flow in skeletal muscle

The aim of this study was to investigate local muscle O(2) consumption (muscV(O(2))) and forearm blood flow (FBF) in resting and exercising muscle by use of near-infrared spectroscopy (NIRS) and to compare the results with the global muscV(O(2)) and FBF derived from the well-established Fick method and plethysmography. muscV(O(2)) was derived from 1) NIRS using venous occlusion, 2) NIRS using arterial occlusion, and 3) the Fick method [muscV(O(2(Fick)))]. FBF was derived from 1) NIRS and 2) strain-gauge plethysmography. Twenty-six healthy subjects were tested at rest and during sustained isometric handgrip exercise. Local variations were investigated with two independent and simultaneously operating NIRS systems at two different muscles and two measurement depths. muscV(O(2)) increased more than fivefold in the active flexor digitorum superficialis muscle, and it increased 1.6 times in the brachioradialis muscle. The average increase in muscV(O(2(Fick))) was twofold. FBF increased 1.4 times independent of the muscle or the method. It is concluded that NIRS is an appropriate tool to provide information about local muscV(O(2)) and local FBF because both place and depth of the NIRS measurements reveal local differences that are not detectable by the more established, but also more global, Fick method.

Ventilatory response in metabolic acidosis and cerebral blood volume in humans

The relationship between alterations in cerebral blood volume (CBV) and central chemosensitivity regulation was studied under neutral metabolic conditions and during metabolic acidosis. Fifteen healthy subjects (56+/-10 years) were investigated. To induce metabolic acidosis, ammonium chloride (NH(4)Cl) was given orally. CBV was measured using Near Infrared Spectroscopy during normo- and hypercapnia and related to inspired ventilation (V(i)). A mean acute metabolic acidosis of Delta pH - 0.04 was realized with a mean decreased arterialized capillary PCO(2) (P(c)CO(2)) of 0.20 kPa (1.5 mmHg) (both P<0.001). During normocapnia, CBV was 3.51+/-0.71 and 3.65+/-0.56 ml 100 g(-1) (mean+/-S.D.), measured under neutral metabolic conditions and during acute metabolic acidosis, respectively (ns). Corresponding values of V(i) were 7.6+/-1.4 and 10.0+/-2.4 l min(-1) (P<0.01), respectively. The slopes of the CO(2)-responsiveness (DeltaCBV/DeltaP(c)CO(2) and DeltaV(i)/DeltaP(c)CO(2)), were not significantly different during both metabolic conditions. A significant correlation between DeltaCBV/DeltaP(c)CO(2) and DeltaV(i)/DeltaP(c)CO(2) was found during metabolic acidosis (P<0.01), but not under neutral metabolic conditions. CBV does not contribute in a predictable way to the regulation of central chemoreceptors.

Validity of NIR spectroscopy for quantitatively measuring muscle oxidative metabolic rate in exercise

The purpose of this study was to examine the validity of the quantitative measurement of muscle oxidative metabolism in exercise by near-infrared continuous-wave spectroscopy (NIRcws). Twelve male subjects performed two bouts of dynamic handgrip exercise, once for the NIRcws measurement and once for the (31)P-magnetic resonance spectroscopy (MRS) measurement as a standard measure. The resting muscle metabolic rate (RMRmus) was independently measured by (31)P-MRS during 15 min of arterial occlusion at rest. During the first exercise bout, the quantitative value of muscle oxidative metabolic rate at 30 s postexercise was evaluated from the ratio of the rate of oxyhemoglobin/myoglobin decline measured by NIRcws during arterial occlusion 30 s after exercise and the rate at rest. Therefore, the absolute values of muscle oxidative metabolic rate at 30 s after exercise [VO(2NIR(30))] was calculated from this ratio multiplied by RMRmus. During the second exercise bout, creatine phosphate (PCr) resynthesis rate was measured by (31)P-MRS at 30 s postexercise [Q((30))] under the same conditions but without arterial occlusion postexercise. To determine the validity of NIRcws, VO(2NIR(30)) was compared with Q((30)). There was a significant correlation between VO(2NIR(30)), which ranged between 0.018 and 0. 187 mM ATP/s, and Q((30)), which ranged between 0.041 and 0.209 mM ATP/s (r = 0.965, P < 0.001). This result supports the application of NIRcws to quantitatively evaluate muscle oxidative metabolic rate in exercise.

Functional muscle ischemia in neuronal nitric oxide synthase-deficient skeletal muscle of children with Duchenne muscular dystrophy

Duchenne muscular dystrophy (DMD) is a fatal disease caused by mutation of the gene encoding the cytoskeletal protein dystrophin. Despite a wealth of recent information about the molecular basis of DMD, effective treatment for this disease does not exist because the mechanism by which dystrophin deficiency produces the clinical phenotype is unknown. In both mouse and human skeletal muscle, dystrophin deficiency results in loss of neuronal nitric oxide synthase, which normally is localized to the sarcolemma as part of the dystrophin-glycoprotein complex. Recent studies in mice suggest that skeletal muscle-derived nitric oxide may play a key role in the regulation of blood flow within exercising skeletal muscle by blunting the vasoconstrictor response to alpha-adrenergic receptor activation. Here we report that this protective mechanism is defective in children with DMD, because the vasoconstrictor response (measured as a decrease in muscle oxygenation) to reflex sympathetic activation was not blunted during exercise of the dystrophic muscles. In contrast, this protective mechanism is intact in healthy children and those with polymyositis or limb-girdle muscular dystrophy, muscle diseases that do not result in loss of neuronal nitric oxide synthase. This clinical investigation suggests that unopposed sympathetic vasoconstriction in exercising human skeletal muscle may constitute a heretofore unappreciated vascular mechanism contributing to the pathogenesis of DMD.

Metabolic modulation of sympathetic vasoconstriction in human skeletal muscle: role of tissue hypoxia

Sympathetically evoked vasoconstriction is modulated by skeletal muscle contraction, but the underlying events are incompletely understood. During contraction, intramuscular oxygenation decreases with increasing exercise intensity. We therefore hypothesized that tissue hypoxia plays a crucial role in the attenuation of sympathetic vasoconstriction in contracting skeletal muscle. In 19 subjects, near-infrared spectroscopy was used to measure decreases in muscle oxygenation (DeltatHbO2+MbO2) as an estimate of the vasoconstrictor response to reflex sympathetic activation with lower body negative pressure (LBNP) in the microcirculation of resting and contracting forearm muscles. Oxygen delivery to the muscles was reduced by decreasing (a) arterial O2 content by breathing 10 % O2, or (b) muscle perfusion by applying forearm positive pressure (FPP, +40 mmHg). In resting forearm, reflex sympathetic activation decreased muscle oxygenation by 11 +/- 1 %. Handgrip alone at 5 and 20 % of maximal voluntary contraction (MVC) decreased muscle oxygenation by 4 +/- 1 and 28 +/- 4 %, respectively. When superimposed on handgrip, LBNP-induced decreases in muscle oxygenation were preserved during handgrip at 5 % MVC, but were abolished during handgrip at 20 % MVC. Oral administration of aspirin (1 g) did not restore the latter response. When the decrease in forearm muscle oxygenation elicited by handgrip at 20 % MVC was mimicked by either (a) systemic hypoxia plus 5 % handgrip (DeltatHbO2+MbO2, -32 +/- 3 %), or (b) hypoperfusion of resting muscle by FPP (DeltatHbO2+MbO2, -26 +/- 6 %), LBNP-induced decreases in muscle oxygenation were greatly attenuated. These data suggest that local tissue hypoxia is involved in the metabolic attenuation of sympathetic vasoconstriction in the microcirculation of exercising human skeletal muscle. The specific underlying mechanism remains to be determined, although products of the cyclo-oxygenase pathway do not appear to be involved.

Lumbar erector spinae oxygenation during prolonged contractions: implications for prolonged work

Owing to the recent interest in torso stabilization exercises together with many questions regarding the duration of prolonged isometric holds in occupational settings, the authors attempted to assess the level of back muscle oxygenation during prolonged isometric contractions. Specifically, this study recorded relative oxygen saturation of haemoglobin/myoglobin using Near Infrared Spectroscopy (NIRS) in the L3 erector mass during prolonged isometric contractions at intensities from 2 to 30% of maximum voluntary contraction (MVC). It was hypothesized that available oxygen to these muscles is severely compromised even at moderate levels of activation observed in occupational work. Eight volunteers without a history of lower back pain or injury participated in this study. The exercise task involved isometric contraction of the lower erector spinae at five different levels of each subject's maximal voluntary contraction: 2, 5, 10, 20 and 30% MVC, presented in random order. Subjects were placed in a sitting position, with a curved plastic plate secured horizontally to the pelvis to minimize movement at the hip joint. During extensor exertions, they were restrained with a harness that was attached at chest level to a load cell. Each isometric contraction was performed for 30 s followed by 1 min of rest. All levels of contraction demonstrated reduction in oxygen. Given the concern for motion artefact on the NIRS signal, sham trials were conducted where the subjects went through the procedure of attaching the pulling cable but no active pull was performed. These trials showed no change in the NIRS signal. At this time NIRS appears to be the only non-invasive instrumentation available to indicate total available muscle oxygen during low level, prolonged work. Although the specific tissue volume sampled by NIRS cannot be positively identified, it appears that tissue oxygenation in the lumbar extensor musculature is reduced as a function of contraction intensity, even at levels as low as 2% of MVC. These data have implications for prolonged work where postures requiring isometric contractions are sometimes held for hours, and where musculoskeletal illness has been linked to prolonged contraction levels above 2%MVC--these data suggest a possible biological pathway.

In vivo optical/near-infrared spectroscopy and imaging of metalloproteins

A number of medical applications of near-infrared spectroscopy are growing closer to clinical acceptance, and new techniques involving both spectroscopy and imaging are evolving rapidly. In vivo spectroscopy and, more recently, imaging techniques are largely based upon optical electronic transitions involving the metal centers of hemoglobin (blood), myoglobin (muscle) and cytochrome aa3 (mitochondria). The wide variety of near-IR based applications includes heart and stroke research, monitoring cerebral oxygenation of premature babies, and 'functional activation' (response of brain to mental tasks). All of these applications are founded upon changes in hemoglobin O2 saturation; these changes are monitored by following trends in the near-infrared absorptions of deoxyhemoglobin (760 nm) and oxyhemoglobin (920 nm). The same absorptions provide a basis for imaging regional variations in blood oxygenation. This report presents and discusses examples, both from the literature and from our recent work, of near-infrared spectroscopy and imaging in medical applications.

Metabolic modulation of sympathetic vasoconstriction in exercising skeletal muscle

The tight coupling of oxygen supply and utilization in exercising skeletal muscle is the result of complex interactions between local mechanisms that control muscle blood flow and substrate utilization and systemic mechanisms that control cardiac output and arterial pressure. The role of the sympathetic nervous system in the integration of these responses, specifically the interaction between sympathetic activation and local vasodilator mechanisms in exercising muscle, has been an active area of research for many years yet remains incompletely understood. The functional consequence of sympathetic activation in exercising skeletal muscle has been the subject of considerable debate. Previous studies in animals and humans have suggested that sympathetic vasoconstricton in active muscle is (a) well maintained and serves to limit active hyperaemia, thereby preventing muscle blood flow from outstripping cardiac output in order to preserve blood pressure and vital organ perfusion or (b) greatly attenuated in order to optimize muscle perfusion, a concept that has been termed 'functional sympatholysis'. Studies performed over the past 70 years have provided conflicting evidence regarding the relative importance of sympathetic vasoconstriction vs. functional sympatholysis in exercising skeletal muscle. The focus of this review is mainly on recent studies in anaesthetized animal preparations and in conscious humans that have provided evidence for the metabolic modulation of sympathetic vasoconstriction in contracting skeletal muscle and have identified a number of key underlying mechanisms that extend the initial concept of sympatholysis.

Utility of near-infrared spectroscopy in the diagnosis of lower extremity compartment syndrome

OBJECTIVE

To determine the utility of near-infrared spectroscopy in the diagnosis of lower extremity compartment syndrome (CS).

METHODS

Nine patients with CS confirmed by physical examination and elevated compartment pressures (64 +/- 17 mm Hg) were evaluated before and after fasciotomy. Control readings were also performed on 33 surgical patients who had no evidence of CS. The deltoid muscle was used as a reference value.

RESULTS

The deltoid muscle oxygen saturation (StO2) readings revealed a mean = 84 +/- 17% prefasciotomy and mean = 83 +/- 12% postfasciotomy in the CS group. The control group had a mean StO2 of 83 +/- 11%. In the CS group, the leg compartment with the highest pressure had a StO2 mean = 56 +/- 27% before fasciotomy. This value was statistically significantly lower (p < 0.05) than either the postfasciotomy mean StO2 in that compartment (82 +/- 16%) or the values found in matched control patients with no evidence of CS (87 +/- 7%).

CONCLUSION

Near-infrared spectroscopy-derived StO2 values in the lower extremities of trauma patients with CS were diminished relative to the control patients and usually normalized after fasciotomy. Near-infrared spectroscopy evaluation may offer a rapid, noninvasive method of assessing extremities at risk for CS.

Measurement of peripheral oxygen utilisation in neonates using near infrared spectroscopy: comparison between arterial and venous occlusion methods

The aim of this study was to develop an arterial occlusion method and compare it with the venous occlusion method for measurement of peripheral oxygen utilisation in neonates using near infrared spectroscopy (NIRS). Twenty healthy neonates were studied. Arterial occlusion was produced by inflating a neonatal blood pressure cuff to 100 mmHg for 30-40 s and oxygen utilisation (VO(2)) was calculated using the HbO(2) decrement slope following occlusion. Venous occlusion was produced by inflating the cuff to 30 mmHg for 15-20 s and VO(2) was calculated by: VO(2)=HbTx4x(SaO(2)-SvO(2)), where SaO(2) is the arterial oxygen saturation measured by pulse oximetry and SvO(2) is the venous oxygen saturation measured by NIRS. Each baby had a minimum of three arterial and three venous occlusions. Criteria were developed for acceptance/rejection of an occlusion. Using the arterial method, the mean VO(2) was 1.12 mM cm(-1) O(2)/min (S.D.=0.25), (95% CI=1.00-1.24 mM cm(-1) O(2)/min). The coefficient of variation was 6.6+/-4.1%. Using the venous method, the mean VO(2) was 1.60 mM cm(-1) O(2)/min (S.D.=0.48), (95% CI=1. 38-1.82 mM cm(-1) O(2)/min). The coefficient of variation was 12. 6+/-5.7%. The correlation between the two methods was weak (r=0.28 and r(2) was 0.08). The mean difference between the two methods was 0. 47 mM cm(-1) O(2)/min (S.D.=0.51). The limits of agreement were -0. 53 to 1.47 mM cm(-1) O(2)/min. The arterial method gives more consistent results.

Oxygen supply-consumption balance in the thigh muscles during exhausting knee-extension exercise

The purpose of this study was to investigate the difference in muscle oxygenation between the individual muscles involved in an exhaustive knee-extension exercise. Eight active women performed exercise by extending the knee joint from 90 degrees to 30 degrees (60 extensions min-1) at 20%, 30%, and 40% maximum voluntary contraction (MVC). Changes in oxy-(delta HbO2), deoxy-(delta Hb), and total (delta HbT) hemoglobin concentrations, and oxygen saturation (delta SO2NIRS = HbO2/HbT) in the vastus lateralis (VL) and rectus femoris (RF) muscles were measured with a spatially resolved near-infrared spectrometer (NIRS). The delta SO2NIRS in the VL and RF decreased rapidly from the pre-exercise control value (VL: 75.6 +/- 0.9%; RF: 81.6 +/- 1.6%) at the onset of exercise at three different intensities, although no significant difference in delta SO2NIRS was found between the two muscles at this time. However, the delta SO2NIRS decreased more rapidly thereafter and reached a lower value at exhaustion in the VL than in the RF. The difference in delta SO2NIRS between the VL (-10.3 +/- 1.7%) and RF (-4.0 +/- 1.0%) was significant (p < 0.05) when exercise intensity was 30% MVC. When the decreases in delta HbO2 and delta HbT (p < 0.05) were compared at different exercise intensities, the values at 30% and 40% MVC were significantly lower (delta HbO2: p < 0.01; delta HbT: p < 0.05) than those at 20% MVC in the VL, but there was no significant difference in any of the parameters in the RF, or in delta Hb in the VL. These results suggest that the muscle oxidative response to exhaustive knee-extension exercise differed between the VL and RF muscles. At exhaustion, oxygen saturation decreased to a lower level in the VL than in the RF, and an intensity-dependent difference in muscle oxygenation parameters was observed at 30% MVC in the VL but not in the RF muscles.

Quantification of ischemic muscle deoxygenation by near infrared time-resolved spectroscopy

The purpose of this study was to quantify muscle deoxygenation in human skeletal muscles using near infrared time-resolved spectroscopy (NIRTRS) and compare NIRTRS indicators and blood saturation. The forearm muscles of five healthy males (aged 27-32 yrs.) were monitored for changes in hemoglobin saturation (SO2) during 12 min of arterial occlusion and recovery. SO2 was determined by measuring the temporal profile of photon diffusion at 780 and 830 nm using NIRTRS, and was defined as SO2-TRS. Venous blood samples were also obtained for measurements of SvO2, and PvO2. Interstitial PO2(PintO2) was monitored by placing an O2 electrode directly into the muscle tissue. Upon the initiation of occlusion, all parameters fell progressively until reaching a plateau in the latter half of occlusion. It was observed at the end of occlusion that SO2-TRS (24.1 +/- 5.6%) agreed with SvO2 (26.2 +/- 6.4) and that PintO2 (14.7 +/- 1.0 Torr) agreed with PvO2 (17.3 +/- 2.2 Torr). The resting O2 store (oxygenated hemoglobin) and O2 consumption rate were 290 microM and 0.82 microM s-1, respectively, values which reasonably agree with the reported results. These results indicate that there was no O2 gradient between vessels and interstisium at the end of occlusion.

A modular NIRS system for clinical measurement of impaired skeletal muscle oxygenation

Near-infrared spectrometry (NIRS) is a well-known method used to measure in vivo tissue oxygenation and hemodynamics. This method is used to derive relative measures of hemoglobin (Hb) + myoglobin (Mb) oxygenation and total Hb (tHb) accumulation from measurements of optical attenuation at discrete wavelengths. We present the design and validation of a new NIRS oxygenation analyzer for the measurement of muscle oxygenation kinetics. This design optimizes optical sensitivity and detector wavelength flexibility while minimizing component and construction costs. Using in vitro validations, we demonstrate 1) general optical linearity, 2) system stability, and 3) measurement accuracy for isolated Hb. Using in vivo validations, we demonstrate 1) expected oxygenation changes during ischemia and reactive hyperemia, 2) expected oxygenation changes during muscle exercise, 3) a close correlation between changes in oxyhemoglobin and oxymyoglobin and changes in deoxyhemoglobin and deoxymyoglobin and limb volume by venous occlusion plethysmography, and 4) a minimal contribution from movement artifact on the detected signals. We also demonstrate the ability of this system to detect abnormal patterns of tissue oxygenation in a well-characterized patient with a deficiency of skeletal muscle coenzyme Q(10). We conclude that this is a valid system design for the precise, accurate, and sensitive detection of changes in bulk skeletal muscle oxygenation, can be constructed economically, and can be used diagnostically in patients with disorders of skeletal muscle energy metabolism.

Assessment of muscle oxygenation in the horse by near infrared spectroscopy

This study examined the ability of near infrared spectroscopy (NIRS) to noninvasively determine changes to muscle oxygenation in the resting horse. Five horses had (NIRS) performed over extremity muscle while under general anaesthesia, first with 8 min limb ischaemia, then systemic hypoxaemia for 5 min. A second group of 6 awake horses had NIRS performed over extremity muscle while being administered hypoxic gas (F(I)O2 0.10) for 5 min, and after return to steady state, limb ischaemia was induced for an additional 5 min. In the anaesthetised horses' ischaemia induced marked and significant muscle deoxygenation of haemoglobin/myoglobin (P<0.01), with corresponding arterial saturation decreasing from 98.9 to 81.9%. Hypoxaemia induced small yet significant muscle deoxygenation (P<0.01) that was 3.2% of the ischaemia deoxygenation signal, with a corresponding decrease in arterial saturation from 98.6 to 90.4%. In the awake horses muscle deoxygenation was not detectable during hypoxia despite reduction of arterial saturation from 97.8 to 86.8%, whereas ischaemia induced rapid and significant deoxygenation of muscle (P<0.05), with corresponding reduction of venous saturation from 78.4 to 75.4%. In neither group of horses was there evidence of cytochrome aa3 reduction, despite complete ischaemia for up to 8 min. NIRS changes in the resting horse muscle clearly differed between ischaemia and hypoxaemia, and can readily show muscle deoxygenation in clinically relevant hypoxaemia in the horse under anaesthesia. Further, as the deoxygenation signal induced by ischaemia was clearly detectable above a background movement artefact, NIRS application to study of muscle oxygenation in the working horse should be explored.

Cold pressor stimulation effect on hemodynamic changes following sustained isometric contraction in human jaw-closure muscles

It is postulated that an altered adrenergic response pattern may be associated with chronic muscle pain states. To evaluate this hypothesis, one must fully understand the effect of an adrenergic activation on masticatory muscle blood flow under various conditions. This study evaluated the effect of a 12 degrees C cold pressor stimulation (a mild adrenergic activator), applied to the hand-forearm area, on intramuscular hemodynamics in the human masseter and temporalis muscles following a sustained isometric contraction. We assessed hemodynamics by measuring intramuscular hemoglobin concentration repeatedly, using a non-invasive near-infrared spectroscopy device. Measurements were taken before, during, and after a 30-second sustained 50% maximum voluntary contraction task. Fourteen healthy subjects, seven males and seven females, with no history of muscle pain in the masticatory system participated in this study. This protocol was repeated three times, but in the second trial, the cold pressor stimulation was applied to the subject during and for 5 min after the sustained contraction task. Repeated-measure analysis of variance performed on these data revealed that the peak hemoglobin concentration levels in the post-contraction recovery period were significantly reduced (between 13 and 14%) with cold pressor stimulation, both in the masseter (p < 0.001) and in the temporalis (p < 0.001) muscles. The results suggest that cold pressor stimulation produced a reduced intramuscular vasodilative response in these muscles during the immediate post-contraction period. One explanation for these results is that altering the local chemical environment of the muscle affects the adrenergic response pattern typically induced by a cold pressor stimulation.

Near-infrared spectroscopy: a potential method for continuous, transcutaneous monitoring for compartmental syndrome in critically injured patients

BACKGROUND

Near-infrared spectroscopy (NIRS) noninvasively measures tissue O2 saturation (StO2), and has been proposed as a means of monitoring for compartmental syndrome (CS). However, its specificity in hypoxemic, hypotensive patients with severely reduced systemic oxygen delivery has not been tested. We hypothesized that NIRS can differentiate muscle ischemia caused by shock from ischemia caused by CS.

METHODS

Nine swine were anesthetized and an NIRS probe placed over the anterolateral compartment of the hind leg. Compartment pressure was also measured. A nerve stimulator was placed over the peroneal nerve, and CS was defined as loss of dorsiflexion twitch. At 30-minute sequential intervals, mean arterial blood pressure was reduced to 60% of baseline (phlebotomy), fraction of inspired oxygen was reduced to 0.15, and compartment pressure was increased in one limb by interstitial albumin infusion until CS occurred.

RESULTS

Hypotension combined with hypoxemia reduced StO2 from 82+/-4% to 66+/-10%. CS further reduced StO2 to 16+/-12% (p<0.0001). During hypotension + hypoxemia + CS, control limb StO2 was 70+/-15% (p = 0.0002 vs. experimental limb).

CONCLUSION

NIRS detects muscle ischemia caused by CS despite severe hypotension and hypoxemia, making it potentially useful in critically injured, unstable patients.

Cerebral desaturation during exercise reversed by O2 supplementation

The combined effects of hyperventilation and arterial desaturation on cerebral oxygenation (ScO2) were determined using near-infrared spectroscopy. Eleven competitive oarsmen were evaluated during a 6-min maximal ergometer row. The study was randomized in a double-blind fashion with an inspired O2 fraction of 0.21 or 0.30 in a crossover design. During exercise with an inspired O2 fraction of 0.21, the arterial CO2 pressure (35 +/- 1 mmHg; mean +/- SE) and O2 pressure (77 +/- 2 mmHg) as well as the hemoglobin saturation (91.9 +/- 0.7%) were reduced (P < 0.05). ScO2 was reduced from 80 +/- 2 to 63 +/- 2% (P < 0.05), and the near-infrared spectroscopy-determined concentration changes in deoxy- (DeltaHb) and oxyhemoglobin (DeltaHbO2) of the vastus lateralis muscle increased 22 +/- 3 microM and decreased 14 +/- 3 microM, respectively (P < 0.05). Increasing the inspired O2 fraction to 0.30 did not affect ventilation (174 +/- 4 l/min), but arterial CO2 pressure (37 +/- 2 mmHg), O2 pressure (165 +/- 5 mmHg), and hemoglobin O2 saturation (99 +/- 0.1%) increased (P < 0. 05). ScO2 remained close to the resting level during exercise (79 +/- 2 vs. 81 +/- 2%), and although the muscle DeltaHb (18 +/- 2 microM) and DeltaHbO2 (-12 +/- 3 microM) were similar to those established without O2 supplementation, work capacity increased from 389 +/- 11 to 413 +/- 10 W (P < 0.05). These results indicate that an elevated inspiratory O2 fraction increases exercise performance related to maintained cerebral oxygenation rather than to an effect on the working muscles.

Blood lactate accumulation and muscle deoxygenation during incremental exercise

Near-infrared spectroscopy (NIRS) could allow insights into controversial issues related to blood lactate concentration ([La](b)) increases at submaximal workloads (). We combined, on five well-trained subjects [mountain climbers; peak O(2) consumption (VO(2peak)), 51.0 +/- 4.2 (SD) ml. kg(-1). min(-1)] performing incremental exercise on a cycle ergometer (30 W added every 4 min up to voluntary exhaustion), measurements of pulmonary gas exchange and earlobe [La](b) with determinations of concentration changes of oxygenated Hb (Delta[O(2)Hb]) and deoxygenated Hb (Delta[HHb]) in the vastus lateralis muscle, by continuous-wave NIRS. A "point of inflection" of [La](b) vs. was arbitrarily identified at the lowest [La](b) value which was >0.5 mM lower than that obtained at the following. Total Hb volume (Delta[O(2)Hb + HHb]) in the muscle region of interest increased as a function of up to 60-65% of VO(2 peak), after which it remained unchanged. The oxygenation index (Delta[O(2)Hb - HHb]) showed an accelerated decrease from 60- 65% of VO(2 peak). In the presence of a constant total Hb volume, the observed Delta[O(2)Hb - HHb] decrease indicates muscle deoxygenation (i.e., mainly capillary-venular Hb desaturation). The onset of muscle deoxygenation was significantly correlated (r(2) = 0.95; P < 0.01) with the point of inflection of [La](b) vs., i.e., with the onset of blood lactate accumulation. Previous studies showed relatively constant femoral venous PO(2) levels at higher than approximately 60% of maximal O(2) consumption. Thus muscle deoxygenation observed in the present study from 60-65% of VO(2 peak) could be attributed to capillary-venular Hb desaturation in the presence of relatively constant capillary-venular PO(2) levels, as a consequence of a rightward shift of the O(2)Hb dissociation curve determined by the onset of lactic acidosis.

Near-infrared monitoring of tissue oxygenation during application of lower body pressure at rest and during dynamical exercise in humans

During the application of a wide range of graded lower body pressures (LBP) (-50 to 50 mmHg), we examined how (1) the tissue oxygenation in the lower and upper parts of the body changes at rest, and (2) how tissue oxygenation changes in the lower extremities during dynamical leg exercise. We used near-infrared spectroscopy (NIRS) to measure the changes induced by LBP in total Hb content and Hb oxygenation in seven subjects. At rest, total Hb increased and Hb oxygenation decreased in the thigh muscles during -25 and -50 mmHg LBP, while both decreased during +25 and +50 mmHg LBP. However, in the forearm muscles during graded LBP, the pattern of change in total Hb was the reverse of that in the thigh. Measurements from the forehead showed changes only during +50 mmHg LBP. These results demonstrated that the pattern of change in total Hb and Hb oxygenation differed between upper and lower parts with graded LBP at rest. During dynamical leg exercise, total Hb and Hb oxygenation in the thigh muscles decreased during stepwise increases in LBP above -25 mmHg, Hb oxygenation decreasing markedly during +50 mmHg LBP. These results suggest that during dynamical exercise (i) LBP at +25 mmHg or more causes a graded decline in blood volume and/or flow in the thigh muscles, and (ii) especially at +50 mmHg LBP, the O2 content may decrease markedly in active muscles. Our results suggest that NIRS can be used to monitor in a non-invasive and continuous fashion the changes in oxygenation occurring in human skeletal muscles and head during the graded changes in blood flow and/or volume caused by changes in external pressure and secondary reflexes both at rest and during dynamical exercise.

Age-associated alteration of muscle oxygenation measured by near infrared spectroscopy during exercise

The influence of ageing on the capacity to increase muscle oxygen delivery during exercise is unclear. This was investigated by comparing the evolution of Near InfraRed Spectroscopy (NIRS) in 10 old (67 +/- 5 years, Old group) and 13 young subjects (27 +/- 4 years, Young group), during a progressive maximal exercise. The NIRS probe was placed on the vastus lateralis; muscle oxygen saturation - IR-SmO(2) - values were expressed on a scale using an arterial occlusion as the lower reference point and the subsequent reactive hyperaemia as the upper reference point. Resting IR-SmO( 2) was found to be significantly lower in the Old as co mpared to the Young group. During exercise, VO(2) increased similarly as a function of the workload whereas IR-SmO(2) decreased faster in old subjects than in young ones. Conversely, when expressed at the same percentage of VO( 2max), IR-SmO(2) followed a similar evolution in both groups from rest to maximal exercise (27.3 +/- 16.7 vs 24.3 +/- 12.9% decrease, in Old and Young group, respectively, NS). Thus, the initial difference remained constant between the two groups. During recovery, the time to recover the signal variation was not different between the two groups. We concluded that Old subjects demonstrate a systematic lower muscle oxygen saturation than Young ones. This difference could be explained by an age related decrease in muscle blood flow limiting O(2) supply.

Monitoring for compartmental syndrome using near-infrared spectroscopy: a noninvasive, continuous, transcutaneous monitoring technique

BACKGROUND

The diagnosis of compartmental syndrome (CS) may be delayed because current monitoring techniques are invasive and intermittent and the compartment pressure (CP) that predicts ischemia is variable. Fiber-optic devices using near-infrared (NIR) wavelength reflection can determine the redox state of light-absorbing molecules and have been used to monitor venous hemoglobin saturation to detect ischemia during low-flow states. The purpose of this study was to determine if NIR spectroscopy can provide continuous, transcutaneous, noninvasive monitoring for muscle ischemia in an animal model of CS.

METHODS

Nine swine were anesthetized and a 20-mm NIR probe was placed over the anterolateral compartment of the hind leg to provide continuous determination of muscle oxyhemoglobin level. Needles were inserted into the compartment to measure CP. A nerve stimulator was placed over the peroneal nerve to induce dorsiflexion twitch. Albumin was infused into the muscle to incrementally increase CP until there was complete loss of dorsiflexion, then after 20 minutes fasciotomy was performed.

RESULTS

All animals lost dorsiflexion at CP of 43+/-14 mm Hg. There was a significant inverse correlation between CP and oxyhemoglobin level (r = -0.78; p < 0.001) and a correlation between oxyhemoglobin and perfusion pressure (mean arterial pressure minus CP) (r = 0.66; p < 0.001). Redox state was a more consistent predictor of twitch loss than perfusion pressure.

CONCLUSION

Muscle oxyhemoglobin level measured by NIR spectroscopy strongly reflected CP, perfusion pressure, and loss of dorsiflexion twitch. Currently available portable NIR devices may provide the benefit of continuous, noninvasive monitoring for CS. Further studies to determine the role of this technology in the detection of compartmental syndrome are warranted.

Comparison of femoral blood gases and muscle near-infrared spectroscopy at exercise onset in humans

We hypothesized that near-infrared spectroscopy (NIRS) measures of hemoglobin and/or myoglobin O2 saturation (IR-SO2) in the vascular bed of exercising muscle would parallel changes in femoral venous O2 saturation (SfvO2) at the onset of leg-kicking exercise in humans. Six healthy subjects performed transitions from rest to 48 +/- 3 (SE)-W two-legged kicking exercise while breathing 14, 21, or 70% inspired O2. IR-SO2 was measured over the vastus lateralis muscle continuously during all tests, and femoral venous and radial artery blood samples were drawn simultaneously during rest and during 5 min of exercise. In all gas-breathing conditions, there was a rapid decrease in both IR-SO2 and SfvO2 at the onset of moderate-intensity leg-kicking exercise. Although SfvO2 remained at low levels throughout exercise, IR-SO2 increased significantly after the first minute of exercise in both normoxia and hyperoxia. Contrary to the hypothesis, these data show that NIRS does not provide a reliable estimate of hemoglobin and/or O2 saturation as reflected by direct femoral vein sampling.

Continuous measurement of gut pH with near-infrared spectroscopy during hemorrhagic shock

BACKGROUND

The rate and magnitude of pH changes in the bowel during hemorrhagic shock are greater than those in the stomach, implying that gastric intramucosal pH may not be a reliable indicator of gut perfusion. Here, we evaluate near-infrared spectroscopy (NIRS) to assess bowel pH in a swine shock model.

METHODS

Laparotomy was performed to place flow probes, pH microelectrodes, and NIRS probes. Shock was maintained for 45 minutes at a blood pressure of 45 mm Hg, and resuscitation was achieved with shed blood and lactated Ringer's solution to baseline over 60 minutes.

RESULTS

Hemodynamic measurements were significantly reduced during shock. Lactic acid peaked during resuscitation and remained elevated. NIRS-measured pH was correlated to electrode-measured pH (R2 = 0.903 [ischemia] and R2 = 0.889 [reperfusion]). Estimated measurement accuracy after subject-specific offset correction was 0.083 pH units during ischemia and 0.076 pH units during reperfusion.

CONCLUSION

NIRS determination of small-bowel pH may be a good tool to monitor the adequacy of resuscitation.

Muscle oxygenation trends during constant work rate cycle exercise in men and women

PURPOSE

To examine the relationship between muscle oxygenation and arteriovenous oxygen difference [(a - v)O2diff)] at four constant rate workloads in healthy men and women and to compare these responses between the genders.

METHODS

Nineteen men and 14 women consented to perform an incremental test to identify the lactic acidosis threshold (LAT) and maximal aerobic power (VO2max) and an intermittent constant work rate test at an oxygen uptake corresponding to 40% LAT, 80% LAT, 25% LAT-VO2max, and 50% LAT-VO2max. Each exercise interval was 5 min long followed by 2 min of recovery. Cardiac output was measured by CO2 rebreathing at each workload from which (a - v)O2diff was computed. Tissue absorbency was measured from the vastus lateralis in both the test sessions using near infrared spectroscopy (NIRS). Muscle oxygenation during constant work rate exercise and recovery was expressed as a percentage (%Mox) of the maximum range observed during incremental exercise and recovery.

RESULTS

A systematic decrease was observed in %Mox with increasing intensity, followed by a proportional increase during recovery from each exercise bout. Significant inverse relationships were observed between %Mox and (a - v)O2diff in men (r = -0.34) and women (r = -0.31) across the four intensities. Mean %Mox was significantly higher (P < 0.05) in women compared with men, suggesting lesser deoxygenation at the same relative exercise intensity.

CONCLUSIONS

%Mox was not an accurate predictor of mixed (a - v)O2diff during exercise because of the low common variance between these two variables, and it is unclear whether the gender difference in %Mox is a true physiological phenomenon or whether it is an artifact of the NIRS technique.

Cold pressor stimulus temperature and resting masseter muscle haemodynamics in normal humans

Cold pressor stimulation reportedly increases sympathetic nerve activity in human skeletal muscles. This study examined the effect of cold pressor stimulation on the resting haemodynamics of the right masseter muscle in normal individuals, using near-infrared spectroscopy. Nine healthy non-smoking males with no history of chronic muscle pain or vascular headaches participated. Their right hand was immersed in a water bath (4, 10, 15 degrees C) for exactly 1 min. Each trial lasted 7 min (1 min before, 1 min during, 5 min after stimulation) and a strictly random order was utilized for the three test temperatures and the mock trial. Masseter muscle haemoglobin concentration and oxygen saturation, as well as heart rate and blood pressure, were continuously recorded in each trial. After completing the four trials, each participant produced and sustained a 30-s maximum voluntary clench in the intercuspal position. Data across the four trials were baseline-corrected and then magnitude-normalized to the individual's highest absolute haemoglobin and oxygen signal during the 30-s maximal clenching effort. Haemoglobin and oxygen saturation increased progressively during cold pressor stimulation as the water temperature decreased (Hb, p < 0.0001; O2, p = 0.0327); very little effect was seen during the mock trial. Heart rate and blood pressure also increased progressively during the stimulation as the temperature decreased (heart rate, p = 0.0013; systolic blood pressure, p = 0.0042; diastolic blood pressure, p = 0.0156). These data suggest that cold pressor, stimulation induces a strong increase in intramuscular blood volume which appears to be due to both a local vasodilative response and increased cardiac output.

Determination of blood flow in the finger using near-infrared spectroscopy

Wavelengths in the near-infrared range have much better penetrance in organic substances than visible light. We used near-infrared spectroscopy to determine non-invasively blood flow in the fingertip. We used laser Doppler technology to measure skin blood flow as a comparison procedure. We performed several manoeuvres to change blood flow. These included restriction of flow, thermal stimulation and post-occlusion hyperaemia. Near-infrared measurements had coefficients of variation of 10-15% at the various wavelengths, contrasting with variability of 30-40% with laser Doppler measurement. With restriction of blood flow, there was a downward shift in the absorbance curve. With thermal stimulation and with post-occlusion hyperaemia, there was a rise in the curve. The flow-induced shifts in the absorbance curve were particularly pronounced in the range of 850-970 nm. The correlation between absorbance values and laser Doppler-determined blood flow was also highest in this range, averaging about 0.69 (n = 625). Near-infrared spectroscopy can therefore be used to scan the fingertip. The absorbances obtained do reflect changes in blood flow. There is a correlation with skin blood flow, although near-infrared measurements are affected by blood flow in the full breadth of the finger, not just the skin. We can measure this blood flow with significant reproducibility. It may be possible to use near-infrared spectroscopy to measure the concentration of individual blood components.

Near infrared spectroscopy for non-invasive assessment of intracranial haemoglobin oxygenation in an in vitro model of the calf head

An in vitro model of the calf head was used to examine the ability of near infrared spectroscopy (NIRS) to non-invasively determine oxygenation events within the calf head. The brains were removed from 16 calf skulls and replaced with oxygenated dilutions of calf blood that had the oxygen progressively decreased from PO2 > 110 mmHg to < 10 mmHg. Appropriate placement of the lighting source and sensor (optodes) was examined, as were the influences of skull thickness and overlying skin of the skull (including colour). The changes in haemaglobin oxygenation in the model calf head, as observed by NIRS, were highly correlated to PO2 changes in all 16 calf skulls examined (mean r2=0.91, range 0.71 to 0.99). There was a trend for optode positioning to achieve optimal NIRS signals over the middle of the frontal bone in a longitudinal axis and with optodes spaced 4 cm apart, but with the large variation between calf heads this was not shown to be significantly different from other sites tested. The presence of skin over the skull had a significant damping effect on the NIRS signal when compared with the bare skull (P<0.01) but it was not possible to detect a difference in this damping effect between black and white coloured skin. All but the two thickest skulls (13 and 14 mm frontal bone thickness) appeared to allow sufficiently strong NIRS signals of changes in haemoglobin oxygenation. This study showed that NIRS can be used for non-invasive study of oxygenation events within the cranial cavity of calves, and established some guidelines and limitations for its use in this species.

Mitochondrial dysfunction of human muscle in chronic alcoholism detected by using 31P-magnetic resonance spectroscopy and near-infrared light absorption

We previously examined the effect of alcohol on muscle energy metabolism in chronic alcoholics by using 31P-magnetic resonance spectroscopy. Measurements of intracellular pH and PCr index [PCr/(PCr + Pi)] during resting, hand grasping, and recovery in the left flexor digitorum superficialis muscle of alcoholics with neurological signs showed a marked decrease and delayed recovery of pH, but rapid recovery of PCr index indicating that the muscle produces lactate during and after exercise to maintain the ATP level. To clarify the reason for this preference for anaerobic metabolism, we conducted simultaneous measurements of the muscle blood supply during and after exercise by using the near-infrared light method and energy metabolism by using 31P-magnetic resonance spectroscopy. In alcoholics with neurological signs, we observed a significant increase of oxyhemoglobin after exercise with a slight increase of total hemoglobin. In healthy volunteers and chronic alcoholics without neurological signs, such an overshoot of oxyhemoglobin was not observed. We conclude that chronic alcoholics with neurological signs have an abnormality of aerobic metabolism owing to muscle mitochondrial dysfunction.

Simultaneous determination of muscle perfusion and oxygenation by interleaved NMR plethysmography and deoxymyoglobin spectroscopy

A novel approach is presented that combines NMR-plethysmography and NMRS of deoxymyoglobin in real-time, using line-by-line interleaved acquisitions of both gradient echo images during venous occlusion and of the N-delta proton signal of myoglobin's proximal F8 histidine. This method allowed simultaneous measurement of peripheral regional perfusion and skeletal muscle oxygen content. During reactive hyperaemia, using our combined NMRI-NMRS protocol, we explored the relationship between muscle reoxygenation (myoglobin resaturation half-time, y in s) and reperfusion (x in ml/100 g tissue/min) and found it to be highly significant (y = 70.83x-0.94; r2 = 0.70; F = 64.40; p = 9.73 x 10(-9). We also demonstrated that at low flow, muscle perfusion was a rate-limiting factor to reoxygenation. Making certain hypotheses, muscle oxygen extraction was derived from perfusion and myoglobin resaturation rate. Muscle oxygen extraction during early post-ischemic recovery (0.78 +/- 0.11, 0.79 +/- 0.09 and 0.72 +/- 0.05 at 0, 60 and 100 Torr counter-pressure, respectively) was shown to be independent of perfusion and maximum at each step of the protocol in most volunteers but also to display significant variability among subjects in this supposedly normal population sample.

Fuzzy C-means clustering and principal component analysis of time series from near-infrared imaging of forearm ischemia

Fuzzy C-means clustering and principal components analysis were used to analyze a temporal series of near-IR images taken of a human forearm during periods of venous outflow restriction and complete forearm ischemia. The principal component eigen-time course analysis provided no useful information and the principal component eigen-image analysis gave results that correlated poorly with anatomical features. The fuzzy C-means clustering analysis, on the other hand, showed distinct regional differences in the hemodynamic response and scattering properties of the tissue, which correlated well with the anatomical features of the forearm.

Oxidative metabolism in muscle

Oxidative metabolism is the dominant source of energy for skeletal muscle. Near-infrared spectroscopy allows the non-invasive measurement of local oxygenation, blood flow and oxygen consumption. Although several muscle studies have been made using various near-infrared optical techniques, it is still difficult to interpret the local muscle metabolism properly. The main findings of near-infrared spectroscopy muscle studies in human physiology and clinical medicine are summarized. The advantages and problems of near-infrared spectroscopy measurements, in resting and exercising skeletal muscles studies, are discussed through some representative examples.

Internal and external carotid contributions to near-infrared spectroscopy during carotid endarterectomy

BACKGROUND AND PURPOSE

The internal carotid (ICA) and external carotid (ECA) contributions to changing concentrations of oxyhemoglobin (Hbo2) and deoxyhemoglobin (Hb) during carotid endarterectomy were assessed with the use of near-infrared spectroscopy (NIRS).

METHODS

NIRS optodes were placed on the forehead with an interoptode distance of 6 cm, and laser-Doppler flowmetry (LDF) was used to monitor the change in skin blood flow between the optodes. Hb, Hbo2, LDF, arterial blood pressure, and middle cerebral artery flow velocity were recorded continuously. The ECA was clamped 2 minutes before the ICA was clamped. Suitable multimodal recordings were achieved in 44 patients.

RESULTS

When the ECA was clamped, 76% of patients showed a fall in Hbo2 and 65% an increase in Hb. When corrected for changes in arterial blood pressure, an accompanying fall in cutaneous LDF predicted the fall in Hbo2 with high sensitivity (100%) and specificity (100%). Among those with no NIRS changes during ECA clamping, 56% had severe ECA stenosis or occlusion; none of these showed an accompanying fall in LDF. In contrast, when the ICA was clamped, substantial additional changes in NIRS occurred in 55% of cases, all of which were associated with a fall in flow velocity, but none with a change in LDF. Patients with a constant flow velocity after ICA clamping also showed no change in NIRS.

CONCLUSIONS

Both the ECA and ICA vascular territories contribute to NIRS changes during carotid endarterectomy. The external carotid contribution to NIRS can be monitored with cutaneous LDF.

Detection of ventilatory threshold using near infrared spectroscopy in men and women

The onset of anaerobic (lactate) metabolism during incremental exercise, which may be a result of an imbalance between tissue oxygen supply and demand, has been associated with the gas exchange ventilatory threshold (VT). This study was designed to examine whether near infrared spectroscopy (NIRS) could be used to detect the VT in healthy subjects. Twenty-one men and 19 women completed incremental cycle ergometry during which NIRS measurements were obtained from the right vastus lateralis and gas exchange measurements were monitored simultaneously using a metabolic cart. The VT was identified from the metabolic data by the V-slope method and from NIRS data as the intensity at which tissue absorbency crossed the resting baseline value observed immediately prior to the initiation of exercise. Pearson correlations for the relative oxygen uptake and power output observed for the two methods of detecting VT were 0.90 and 0.88, respectively, in men and 0.89 and 0.86, respectively, in women (P < 0.01). No significant differences were observed between the two methods of detecting VT for any of the physiological responses (P > 0.05). No significant (P > 0.05) gender differences were observed in muscle oxygenation values at the VT, 32% in men and 38% in women. These results validate the use of NIRS as an alternate noninvasive method for detecting VT during cycle exercise in healthy subjects.

Near-infrared spectroscopy: continuous measurement of cytochrome oxidation during hemorrhagic shock

OBJECTIVE

Mitochondrial cytochrome a,a3 redox shifts can be determined by near-infrared wavelength reflection. Since near-infrared wavelengths penetrate skin and bone, a potential exists to noninvasively measure mitochondrial oxidation using this phenomenon. The purpose of this study was to compare conventional parameters of resuscitation with regional measurements of spectroscopically derived cytochrome redox state in a hemorrhagic shock model.

DESIGN

Prospective, controlled laboratory investigation.

SETTING

Animal research laboratory of a university medical center.

SUBJECTS

New Zealand white rabbits (n = 23), weighing 2 to 3 kg.

INTERVENTIONS

After anesthesia and instrumentation, the subjects underwent laparotomy with placement of near-infrared spectroscopy probes on the stomach, liver, kidney, and hamstring muscle. Baseline measurements were obtained, and phlebotomy was used to reduce cardiac output by 60% for 30 mins. Animals were resuscitated with shed autologous blood and crystalloid to reach baseline cardiac output (0.9%), and were monitored for an additional 60 mins.

MEASUREMENTS AND MAIN RESULTS

Significant correlations between mitochondrial cytochrome a,a3 redox state, cardiac output, and oxygen delivery were observed throughout shock and resuscitation. However, gastric cytochrome oxidation did not recover after shock, despite systemic evidence of adequate resuscitation (p < .05).

CONCLUSIONS

Resuscitation from severe hemorrhagic shock may not uniformly restore cellular oxygenation, despite normalization of traditional parameters of resuscitation. Direct monitoring of cytochrome oxidation may be useful in identifying regional areas of dysoxia.

Coupling of hemodynamic measurements with oxygen consumption during exercise does not improve risk stratification in patients with heart failure

BACKGROUND

Measurement of peak Vo2 has become an accepted method to select patients for cardiac transplantation. Some investigators have suggested that the addition of exercise hemodynamic measurements can further enhance risk stratification because these measurements may identify patients with a noncardiac limitation to exercise.

METHODS AND RESULTS

Accordingly, we performed maximal bicycle exercise with respiratory gas analysis and hemodynamic measurements in 65 patients (47 men, 18 women) 53 +/- 10 years old (mean +/- SD) who underwent a transplant evaluation at Columbia Presbyterian Medical Center. Skeletal muscle oxygenation of the vastus lateralis during exercise was assessed with near-infrared spectroscopy. Exercise hemodynamic, ventilatory, and muscle oxygenation measurements were obtained in all patients. For each subject, a linear correlation was derived between Vo2 and pulmonary artery saturation (PA Sao2). The slope of this relationship and a theoretical Vo2max at a PA Sao2 of 0% (Vo2 intercept) was derived. Baseline measurements were left ventricular ejection fraction, 22 +/- 9%; pulmonary capillary wedge pressure (PCWP), 16 +/- 10 mm Hg; cardiac index (CI), 2.1 +/- 0.5 L. min-1. m-2; and PA Sao2, 53 +/- 8%. The cardiac output response to exercise was categorized as normal or abnormal by comparison to the linear equation of peak Vo2 versus peak cardiac output as described by Higginbotham. Exercise measurements were peak Vo2, 12.1 +/- 3.0 mL.kg-1.min-1; Vo2 intercept, 19.1 +/- 5.5 mL. kg-1.min-1; PCWP, 31 +/- 11 mm Hg; CI, 3.8 +/- 1.3 L.min-1.m-2; and PA Sao2, 27 +/- 9%. Only 6% of patients exhibited a normal cardiac output response to exercise. Multivariate analysis was performed with peak Vo2, Vo2 intercept, skeletal muscle oxygenation at end exercise, and peak exercise hemodynamic variables. Only left ventricular stroke work and left ventricular stroke work index were shown to be predictive of survival.

CONCLUSIONS

Addition of exercise hemodynamic measurements to noninvasive metabolic stress testing minimally improves risk prognostication in patients with severe heart failure.

The sensation of dyspnea during exercise is not determined by the work of breathing in patients with heart failure

OBJECTIVES

The present study sought to investigate whether the work of breathing was reduced after heart transplantation. Accordingly, the tension time index of the diaphragm was measured in patients with heart failure and in transplant recipients.

BACKGROUND

Patients with heart failure are frequently limited by exertional dyspnea that may be due to the increased work of breathing. After heart transplantation, exertional dyspnea is markedly diminished. Whether work of breathing is reduced in posttransplant recipients is unknown.

METHODS

Nine patients with heart failure, six normal subjects and six heart transplant recipients were studied. Transdiaphragmatic pressure was measured throughout exercise. Accessory respiratory muscle oxygenation was assessed using near-infrared spectroscopy. Peak oxygen consumption, time in inspiration, time per breath and maximal inspiratory and expiratory pressures were measured in all subjects.

RESULTS

The tension time index remained markedly abnormal after heart transplantation both at rest ([mean +/- SD] normal group 0.01 +/- 0.006, heart failure group 0.026 +/- 0.018, transplant group 0.058 +/- 0.015, p < 0.004) and at peak exercise (normal group 0.03 +/- 0.02, heart failure group 0.10 +/- 0.03, transplant group 0.10 +/- 0.04, p < 0.0001). Accessory respiratory muscle deoxygenation was present only in patients with heart failure (near-infrared absorbency changes [arbitrary units]: normal group -3 +/- 6, heart failure group 28 +/- 5, transplant group -3.5 +/- 4.4, p < 0.0001).

CONCLUSIONS

Although heart transplantation alleviates dyspnea in patients with heart failure, the work of breathing as assessed by the tension time index of the diaphragm is not decreased. Amelioration of exertional dyspnea is achieved by other mechanisms, such as improved respiratory muscle perfusion.

Differential sympathetic neural control of oxygenation in resting and exercising human skeletal muscle

Metabolic products of skeletal muscle contraction activate metaboreceptor muscle afferents that reflexively increase sympathetic nerve activity (SNA) targeted to both resting and exercising skeletal muscle. To determine effects of the increased sympathetic vasoconstrictor drive on muscle oxygenation, we measured changes in tissue oxygen stores and mitochondrial cytochrome a,a3 redox state in rhythmically contracting human forearm muscles with near infrared spectroscopy while simultaneously measuring muscle SNA with microelectrodes. The major new finding is that the ability of reflex-sympathetic activation to decrease muscle oxygenation is abolished when the muscle is exercised at an intensity > 10% of maximal voluntary contraction (MVC). During high intensity handgrip, (45% MVC), contraction-induced decreases in muscle oxygenation remained stable despite progressive metaboreceptor-mediated reflex increases in SNA. During mild to moderate handgrips (20-33% MVC) that do not evoke reflex-sympathetic activation, experimentally induced increases in muscle SNA had no effect on oxygenation in exercising muscles but produced robust decreases in oxygenation in resting muscles. The latter decreases were evident even during maximal metabolic vasodilation accompanying reactive hyperemia. We conclude that in humans sympathetic neural control of skeletal muscle oxygenation is sensitive to modulation by metabolic events in the contracting muscles. These events are different from those involved in either metaboreceptor muscle afferent activation or reactive hyperemia.

Brain and muscle oxygen saturation during head-up-tilt-induced central hypovolaemia in humans

Near-infrared spectrophotometry-determined cerebral (ScO2) and muscle oxygen saturations (SmO2) were followed in 15 volunteers during passive 50 degrees head-up-tilt-induced central hypovolaemia, and in nine volunteers during ventilatory manoeuvres affecting arterial carbon dioxide tension. During head-up tilt, mean arterial pressure [MAP, 88 (77-118) to 97 (80-136) mmHg, median and range] and heart rate [HR; 66 (49-77) to 87 (42-132) beats min-1 P < 0.01] increased, but after 22 (1-45) min they declined [to 61 (40-91) mmHg and 69 (38-109) beats min-1, respectively, P = 0.001] and pre-syncopal symptoms developed. Central hypovolaemia was indicated by an increased thoracic electrical impedance, and a decreased cardiac output and central venous oxygen saturation. The arterial oxygen saturation, pulmonal oxygen uptake and skin temperatures remained constant. The ScO2 remained stable at 72 (62-77)% until the pre-syncopal incidence, when it decreased to 62 (31-73)% (P = 0.001), and tilt down made it increase to 75 (36-87)% (P < 0.05) before the recovery value was established. In contrast, SmO2 decreased during tilting [75(70-87) to 65 (53-70)%], and recovered to 70 (53-83)%, P < 0.01) during the hypotensive episode. The end-tidal CO2 tension decreased only during tilt-up. The ScO2 decreased, and SmO2 increased during hyperventilation, and ScO2 increased during breathing of 5% carbon dioxide. Rebreathing from a bag made SmO2 decrease and resulted in a biphasic ScO2 response: it first increased and subsequently decreased. Cardiovascular changes during tilt were not reflected in skin temperature. The ScO2 reflected the maintained autoregulation of cerebral blood flow until the perfusion pressure decreased markedly. In contrast, SmO2 mirrored muscle vasoconstriction early during tilt, and vasodilatation when pre-syncopal symptoms appeared.