Dual role of diffusion in tissue gas exchange: blood-tissue equilibration and diffusion shunt

A revision of maximal oxygen consumption and exercise capacity at altitude 70 years after the first climb of Mount Everest

On the 70th anniversary of the first climb of Mount Everest by Edmund Hillary and Tensing Norgay, we discuss the physiological bases of climbing Everest with or without supplementary oxygen. After summarizing the data of the 1953 expedition and the effects of oxygen administration, we analyse the reasons why Reinhold Messner and Peter Habeler succeeded without supplementary oxygen in 1978. The consequences of this climb for physiology are briefly discussed. An overall analysis of maximal oxygen consumption (V ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ ) at altitude follows. In this section, we discuss the reasons for the non-linear fall ofV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ at altitude, we support the statement that it is a mirror image of the oxygen equilibrium curve, and we propose an analogue of Hill's model of the oxygen equilibrium curve to analyse theV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ fall. In the following section, we discuss the role of the ventilatory and pulmonary resistances to oxygen flow in limitingV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ , which becomes progressively greater while moving toward higher altitudes. On top of Everest, these resistances provide most of theV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ limitation, and the oxygen equilibrium curve and the respiratory system provide linear responses. This phenomenon is more accentuated in athletes with elevatedV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ , due to exercise-induced arterial hypoxaemia. The large differences inV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ that we observe at sea level disappear at altitude. There is no need for a very highV ̇ O 2 max ${\dot V_{{{\mathrm{O}}_{\mathrm{2}}}{\mathrm{max}}}}$ at sea level to climb the highest peaks on Earth.

A century of exercise physiology: key concepts on coupling respiratory oxygen flow to muscle energy demand during exercise

After a short historical account, and a discussion of Hill and Meyerhof's theory of the energetics of muscular exercise, we analyse steady-state rest and exercise as the condition wherein coupling of respiration to metabolism is most perfect. The quantitative relationships show that the homeostatic equilibrium, centred around arterial pH of 7.4 and arterial carbon dioxide partial pressure of 40 mmHg, is attained when the ratio of alveolar ventilation to carbon dioxide flow ([Formula: see text]) is - 21.6. Several combinations, exploited during exercise, of pertinent respiratory variables are compatible with this equilibrium, allowing adjustment of oxygen flow to oxygen demand without its alteration. During exercise transients, the balance is broken, but the coupling of respiration to metabolism is preserved when, as during moderate exercise, the respiratory system responds faster than the metabolic pathways. At higher exercise intensities, early blood lactate accumulation suggests that the coupling of respiration to metabolism is transiently broken, to be re-established when, at steady state, blood lactate stabilizes at higher levels than resting. In the severe exercise domain, coupling cannot be re-established, so that anaerobic lactic metabolism also contributes to sustain energy demand, lactate concentration goes up and arterial pH falls continuously. The [Formula: see text] decreases below - 21.6, because of ensuing hyperventilation, while lactate keeps being accumulated, so that exercise is rapidly interrupted. The most extreme rupture of the homeostatic equilibrium occurs during breath-holding, because oxygen flow from ambient air to mitochondria is interrupted. No coupling at all is possible between respiration and metabolism in this case.

Computational modeling of the interactions between the maternal and fetal circulations in human pregnancy

In pregnancy, fetal growth is supported by its placenta. In turn, the placenta is nourished by maternal blood, delivered from the uterus, in which the vasculature is dramatically transformed to deliver this blood an ever increasing volume throughout gestation. A healthy pregnancy is thus dependent on the development of both the placental and maternal circulations, but also the interface where these physically separate circulations come in close proximity to exchange gases and nutrients between mum and baby. As the system continually evolves during pregnancy, our understanding of normal vascular anatomy, and how this impacts placental exchange function is limited. Understanding this is key to improve our ability to understand, predict, and detect pregnancy pathologies, but presents a number of challenges, due to the inaccessibility of the pregnant uterus to invasive measurements, and limitations in the resolution of imaging modalities safe for use in pregnancy. Computational approaches provide an opportunity to gain new insights into normal and abnormal pregnancy, by connecting observed anatomical changes from high-resolution imaging to function, and providing metrics that can be observed by routine clinical ultrasound. Such advanced modeling brings with it challenges to scale detailed anatomical models to reflect organ level function. This suggests pathways for future research to provide models that provide both physiological insights into pregnancy health, but also are simple enough to guide clinical focus. We the review evolution of computational approaches to understanding the physiology and pathophysiology of pregnancy in the uterus, placenta, and beyond focusing on both opportunities and challenges. This article is categorized under: Reproductive System Diseases >Computational Models.

Altering blood flow does not reveal differences between nitrogen and helium kinetics in brain or in skeletal miracle in sheep

In underwater diving, decompression schedules are based on compartmental models of nitrogen and helium tissue kinetics. However, these models are not based on direct measurements of nitrogen and helium kinetics. In isoflurane-anesthetized sheep, nitrogen and helium kinetics in the hind limb (n = 5) and brain (n = 5) were determined during helium-oxygen breathing and after return to nitrogen-oxygen breathing. Nitrogen and helium concentrations in arterial, femoral vein, and sagittal sinus blood samples were determined using headspace gas chromatography, and venous blood flows were monitored continuously using ultrasonic Doppler. The experiment was repeated at different states of hind limb blood flow and cerebral blood flow. Using arterial blood gas concentrations and blood flows as input, parameters and model selection criteria of various compartmental models of hind limb and brain were estimated by fitting to the observed venous gas concentrations. In both the hind limb and brain, nitrogen and helium kinetics were best fit by models with multiexponential kinetics. In the brain, there were no differences in nitrogen and helium kinetics. Hind limb models fit separately to the two gases indicated that nitrogen kinetics were slightly faster than helium, but models with the same kinetics for both gases fit the data well. In the hind limb and brain, the blood:tissue exchange of nitrogen is similar to that of helium. On the basis of these results, it is inappropriate to assign substantially different time constants for nitrogen and helium in all compartments in decompression algorithms.

Maximal oxygen consumption in healthy humans: theories and facts

This article reviews the concept of maximal oxygen consumption ([Formula: see text]) from the perspective of multifactorial models of [Formula: see text] limitation. First, I discuss procedural aspects of [Formula: see text] measurement: the implications of ramp protocols are analysed within the theoretical work of Morton. Then I analyse the descriptive physiology of [Formula: see text], evidencing the path that led to the view of monofactorial cardiovascular or muscular [Formula: see text] limitation. Multifactorial models, generated by the theoretical work of di Prampero and Wagner around the oxygen conductance equation, represented a radical change of perspective. These models are presented in detail and criticized with respect to the ensuing experimental work. A synthesis between them is proposed, demonstrating how much these models coincide and converge on the same conclusions. Finally, I discuss the cases of hypoxia and bed rest, the former as an example of the pervasive effects of the shape of the oxygen equilibrium curve, the latter as a neat example of adaptive changes concerning the entire respiratory system. The conclusion is that the concept of cardiovascular [Formula: see text] limitation is reinforced by multifactorial models, since cardiovascular oxygen transport provides most of the [Formula: see text] limitation, at least in normoxia. However, the same models show that the role of peripheral resistances is significant and cannot be neglected. The role of peripheral factors is greater the smaller is the active muscle mass. In hypoxia, the intervention of lung resistances as limiting factors restricts the role played by cardiovascular and peripheral factors.

Inert gas clearance from tissue by co-currently and counter-currently arranged microvessels

To elucidate the clearance of dissolved inert gas from tissues, we have developed numerical models of gas transport in a cylindrical block of tissue supplied by one or two capillaries. With two capillaries, attention is given to the effects of co-current and counter-current flow on tissue gas clearance. Clearance by counter-current flow is compared with clearance by a single capillary or by two co-currently arranged capillaries. Effects of the blood velocity, solubility, and diffusivity of the gas in the tissue are investigated using parameters with physiological values. It is found that under the conditions investigated, almost identical clearances are achieved by a single capillary as by a co-current pair when the total flow per tissue volume in each unit is the same (i.e., flow velocity in the single capillary is twice that in each co-current vessel). For both co-current and counter-current arrangements, approximate linear relations exist between the tissue gas clearance rate and tissue blood perfusion rate. However, the counter-current arrangement of capillaries results in less-efficient clearance of the inert gas from tissues. Furthermore, this difference in efficiency increases at higher blood flow rates. At a given blood flow, the simple conduction-capacitance model, which has been used to estimate tissue blood perfusion rate from inert gas clearance, underestimates gas clearance rates predicted by the numerical models for single vessel or for two vessels with co-current flow. This difference is accounted for in discussion, which also considers the choice of parameters and possible effects of microvascular architecture on the interpretation of tissue inert gas clearance.

A mathematical model of diffusional shunting of oxygen from arteries to veins in the kidney

To understand how arterial-to-venous (AV) oxygen shunting influences kidney oxygenation, a mathematical model of oxygen transport in the renal cortex was created. The model consists of a multiscale hierarchy of 11 countercurrent systems representing the various branch levels of the cortical vasculature. At each level, equations describing the reactive-advection-diffusion of oxygen are solved. Factors critical in renal oxygen transport incorporated into the model include the parallel geometry of arteries and veins and their respective sizes, variation in blood velocity in each vessel, oxygen transport (along the vessels, between the vessels and between vessel and parenchyma), nonlinear binding of oxygen to hemoglobin, and the consumption of oxygen by renal tissue. The model is calibrated using published measurements of cortical vascular geometry and microvascular Po2. The model predicts that AV oxygen shunting is quantitatively significant and estimates how much kidney V̇o2 must change, in the face of altered renal blood flow, to maintain cortical tissue Po2 at a stable level. It is demonstrated that oxygen shunting increases as renal V̇o2 or arterial Po2 increases. Oxygen shunting also increases as renal blood flow is reduced within the physiological range or during mild hemodilution. In severe ischemia or anemia, or when kidney V̇o2 increases, AV oxygen shunting in proximal vascular elements may reduce the oxygen content of blood destined for the medullary circulation, thereby exacerbating the development of tissue hypoxia. That is, cortical ischemia could cause medullary hypoxia even when medullary perfusion is maintained. Cortical AV oxygen shunting limits the change in oxygen delivery to cortical tissue and stabilizes tissue Po2 when arterial Po2 changes, but renders the cortex and perhaps also the medulla susceptible to hypoxia when oxygen delivery falls or consumption increases.

Oxygenating the microcirculation: the perspective from blood transfusion and blood storage

Tissue oxygen delivery depends on red blood cell (RBC) content and RBC flow regulation in the microcirculation. The important role of the RBC in tissue oxygenation is clear from anaemia and the use of RBC transfusion which has saved many lives. Whether RBC transfusion actually restores tissue oxygenation is difficult to determine due to the lack of appropriate clinical monitoring techniques. Some patients with restored haemoglobin levels and stable haemodynamics still develop tissue hypoxia, emphasizing that, in addition to global parameters, local microcirculatory control mechanisms are also important in the restoration of tissue oxygenation. Both clinical and animal experimental studies have indicated that storage of RBC diminishes their ability to oxygenate the tissue. Several intrinsic RBC parameters that change during storage and might influence tissue oxygenation will be mentioned. The release of vasodilators from RBC that will alter blood flow during hypoxia, mediated by haemoglobin in the RBC that functions as an oxygen sensor, could be impaired during storage. A better understanding of hypoxia-induced vasodilator release from RBC might become a potential target for drug development and improve tissue oxygenation after transfusion.

Effect of acetazolamide on pulmonary and muscle gas exchange during normoxic and hypoxic exercise

Acetazolamide (ACZ) is used to prevent acute mountain sickness at altitude. Because it could affect O2 transport in several different and potentially conflicting ways, we examined its effects on pulmonary and muscle gas exchange and acid-base status during cycle exercise at approximately 30, 50 and 90% VO2max in normoxia (F(IO2) = 0.2093) and acute hypoxia (F(IO2) = 0.125). In a double-blind, order-balanced, crossover design, six healthy, trained men (normoxic VO2max= 59 ml kg(-1) min(-1)) exercised at both F(IO2) values after ACZ (3 doses of 250 mg, 8 h apart) and placebo. One week later this protocol was repeated using the other drug (placebo or ACZ). We measured cardiac output (QT), leg blood flow (LBF), and muscle and pulmonary gas exchange, the latter using the multiple inert gas elimination technique. ACZ did not significantly affect VO2, QT, LBF or muscle gas exchange. As expected, ACZ led to lower arterial and venous blood [HCO3-], pH and lactate levels (P < 0.05), and increased ventilation (P < 0.05). In both normoxia and hypoxia, ACZ resulted in higher arterial P(O2) and saturation and a lower alveolar-arterial P(O2) difference (AaD(O2)) due to both less VA/Q mismatch and less diffusion limitation (P < 0.05). In summary, ACZ improved arterial oxygenation during exercise, due to both greater ventilation and more efficient pulmonary gas exchange. However, muscle gas exchange was unaffected.

Countercurrent compartmental models describe hind limb skeletal muscle helium kinetics at resting and low blood flows in sheep

AIMS

This study evaluated the relative importance of perfusion and diffusion mechanisms in compartmental models of blood : tissue helium exchange in a predominantly skeletal muscle tissue bed in the sheep hind limb. Helium has different physiochemical properties from previously studied gases and is a common diluent gas in underwater diving where decompression schedules are based on theoretical models of inert gas kinetics.

METHODS

Helium kinetics across skeletal muscle were determined during and after 20 min of helium inhalation, at separate resting and low steady-states of femoral vein blood flow in six sheep under isoflurane anaesthesia. Helium concentrations in arterial and femoral vein blood were determined using gas chromatographic analysis and femoral vein blood flow was monitored continuously. Parameters and model selection criteria of various perfusion-limited or perfusion-diffusion compartmental models of skeletal muscle were estimated by simultaneous fitting of the models to the femoral vein helium concentrations for both blood flow states.

RESULTS

A model comprising two parallel perfusion-limited compartment models fitted the data well but required a 51-fold difference in relative compartment perfusion that did not seem physiologically plausible. Models that allowed a countercurrent diffusion exchange of helium between arterial and venous vessels outside of the tissue compartments provided better overall fit of the data and credible parameter estimates.

CONCLUSIONS

These results suggest a role of arterial-venous diffusion in blood : tissue helium equilibration in skeletal muscle.

Vascular and metabolic response to cycle exercise in sedentary humans: effect of age

We measured leg blood flow (LBF), drew arterial-venous (A-V) blood samples, and calculated muscle O(2) consumption (VO(2)) during incremental cycle ergometry exercise [15, 30, and 99 W and maximal effort (maximal work rate, WR(max))] in nine sedentary young (20 +/- 1 yr) and nine sedentary old (70 +/- 2 yr) males. LBF was preserved in the old subjects at 15 and 30 W. However, at 99 W and at WR(max), leg vascular conductance was attenuated because of a reduced LBF (young: 4.1 +/- 0.2 l/min and old: 3.1 +/- 0.3 l/min) and an elevated mean arterial blood pressure (young: 112 +/- 3 mmHg and old: 132 +/- 3 mmHg) in the old subjects. Leg A-V O(2) difference changed little with increasing WR in the old group but was elevated compared with the young subjects. Muscle maximal VO(2) and cycle WR(max) were significantly lower in the old subjects (young: 0.8 +/- 0.05 l/min and 193 +/- 7 W; old: 0.5 +/- 0.03 l/min and 117 +/- 10 W). The submaximally unchanged and maximally reduced cardiac output associated with aging coupled with its potential maldistribution are candidates for the limited LBF during moderate to heavy exercise in older sedentary subjects.

Numerical studies on the effect of lowering temperature on the oxygen transport during brain hypothermia resuscitation

There have been arguments about the advantage and shortcoming of hypothermia on the brain resuscitation during circulation arrest. People usually accepted that hypothermia may decrease the cerebral oxygen demands, which is beneficial for the patient to sustain longer time when subjected to a hypoxia. However, there are also quite a few disputes claiming that the blood viscosity would increase with the reduction of temperature, which may lead to an increase of cerebral vascular resistance and thus worsen the hypoxia state. To resolve this critical issue, a heat transfer model was established to characterize the thermal response of brain tissue during hypothermia resuscitation. Combined with this model, a compartmental model taking account of the temperature effect was further developed to analyze the transient oxygen partial pressure (PO(2)) distribution over the successive branches of the vascular network during circulation arrest. Using the morphological and physiological data of a sheep brain, effects of lowering temperature on the oxygen consumption dynamics were studied. Calculations indicated that the lower the temperature, the slower the decreasing rate for the PO(2). Although immediately lowering the brain temperature may induce an evident increase in blood viscosity and subsequently a decrease in blood flow rate, which is responsible for oxygen delivery, it seems to always result in a monotonic increase of PO(2). The results show a good qualitative accord with the experimental data. They also present better understanding on the transient oxygen transport in brain hypothermia during circulation arrest.

A critical parameter for transcapillary exchange of small solutes in countercurrent systems

Small solute transport by a countercurrent capillary loop was studied using a theoretical model. In the model, the afferent and the efferent limbs of the loop share a common interstitial space, with which exchange of solute occurs. Sources of solute, epithelial cells, exist near capillaries and secret solute into the interstitial fluid. Parameters based on experimental measurements on young Sprague-Dawley rats were used in the model, and asymptotic solutions were derived. Comparison of the solute distribution in the interstitium between a capillary loop and a single capillary reveals that the ratio of the product of permeability (P(1)) and surface area (A(1)) to flow (F(1)) of the afferent limb, gamma(1)=P(1)A(1)/F(1) is a critical parameter for the countercurrent exchange system. It alone determines whether the countercurrent arrangement of capillaries facilitates clearance of solute from the interstitial fluid, a greater axial gradient of solute in the interstitium from the base to the tip of the capillary loop and a greater effect of flow, F, upon this gradient. The properties of the efferent limb affect the results, but it is gamma(1) that determines the characteristic difference between a capillary loop and a single capillary.

Increase in O(2) delivery with hyperoxia does not increase O(2) uptake in tetanically contracting dog muscle

We investigated the influence of hyperoxia on O(2) uptake in tetanically contracting canine gastrocnemius. Hyperoxia showed neither increase in O(2) uptake nor decrease in lactate release, irrespective of increased O(2) supply, venous Po(2) and vascular resistance, as compared to normoxia, suggesting that hyperoxia decreases O(2) diffusion conductance and/or effective O(2) supply probably due to arteriovenous O(2) diffusion shunt.

Microcirculatory oxygenation and shunting in sepsis and shock

OBJECTIVE

To review optical spectroscopic techniques for assessment of the determinants of tissue oxygenation and to evaluate the notion that the disturbances in oxygen pathways in sepsis can be accounted for by enhanced functional shunting of parts of the microcirculation.

DATA RESOURCES

Experimental data from previous research and the literature were analyzed.

STUDY SELECTION

The data selected pertained to a) whether cellular distress in sepsis is caused by tissue hypoxia or disturbed metabolic pathways, b) optical spectroscopic techniques used to study microcirculatory oxygenation, and c) possible mechanisms underlying shunting of the microcirculation in hypoxemia and sepsis. STUDY SYNTHESIS: Despite resuscitation of oxygen-derived variables, signs of regional tissue hypoxia persist in sepsis. The mechanisms underlying this condition are expected to be associated with oxygen pathways in the microcirculation. Optical spectroscopic techniques are providing new insights into these mechanisms. These include absorption spectroscopy for hemoglobin saturation of erythrocytes, reduced nicotinamide adenine dinucleotide fluorescence for tissue mitochondrial bioenergetics, and palladium-porphyrin phosphorescence for microvascular PO2. Reduced nicotinamide adenine dinucleotide videofluorescence studies have shown the heterogeneous nature of hypoxia. Measurement of gut microvascular PO2 in pigs has shown the development of a PO2 gap between microvascular PO2 and venous PO2 during hemorrhage and endotoxemia, with a larger gap occurring in sepsis than in hemorrhage. It is hypothesized that this difference is caused by the enhanced shunting of the microcirculation present in sepsis.

CONCLUSIONS

Microcirculatory distress may form one of the earliest stages in the progress of sepsis to multiple organ failure, and shunting of the microcirculation may be an important contributing factor to this development. To evaluate the severity of microcirculatory distress and the effectiveness of resuscitation strategies, new clinical technologies aimed at the microcirculation will need to be developed. It is anticipated that optical spectroscopy will play a major role in the development of such tools.

Evidence of O2 supply-dependent VO2 max in the exercise-trained human quadriceps

Maximal O2 delivery and O2 uptake (VO2) per 100 g of active muscle mass are far greater during knee extensor (KE) than during cycle exercise: 73 and 60 ml. min-1. 100 g-1 (2.4 kg of muscle) (R. S. Richardson, D. R. Knight, D. C. Poole, S. S. Kurdak, M. C. Hogan, B. Grassi, and P. D. Wagner. Am. J. Physiol. 268 (Heart Circ. Physiol. 37): H1453-H1461, 1995) and 28 and 25 ml. min-1. 100 g-1 (7.5 kg of muscle) (D. R. Knight, W. Schaffartzik, H. J. Guy, R. Predilleto, M. C. Hogan, and P. D. Wagner. J. Appl. Physiol. 75: 2586-2593, 1993), respectively. Although this is evidence of muscle O2 supply dependence in itself, it raises the following question: With such high O2 delivery in KE, are the quadriceps still O2 supply dependent at maximal exercise? To answer this question, seven trained subjects performed maximum KE exercise in hypoxia [0.12 inspired O2 fraction (FIO2)], normoxia (0.21 FIO2), and hyperoxia (1.0 FIO2) in a balanced order. The protocol (after warm-up) was a square wave to a previously determined maximum work rate followed by incremental stages to ensure that a true maximum was achieved under each condition. Direct measures of arterial and venous blood O2 concentration in combination with a thermodilution blood flow technique allowed the determination of O2 delivery and muscle VO2. Maximal O2 delivery increased with inspired O2: 1.3 +/- 0.1, 1.6 +/- 0.2, and 1.9 +/- 0.2 l/min at 0.12, 0.21, and 1.0 FIO2, respectively (P < 0.05). Maximal work rate was affected by variations in inspired O2 (-25 and +14% at 0.12 and 1.0 FIO2, respectively, compared with normoxia, P < 0.05) as was maximal VO2 (VO2 max): 1.04 +/- 0.13, 1. 24 +/- 0.16, and 1.45 +/- 0.19 l/min at 0.12, 0.21, and 1.0 FIO2, respectively (P < 0.05). Calculated mean capillary PO2 also varied with FIO2 (28.3 +/- 1.0, 34.8 +/- 2.0, and 40.7 +/- 1.9 Torr at 0.12, 0.21, and 1.0 FIO2, respectively, P < 0.05) and was proportionally related to changes in VO2 max, supporting our previous finding that a decrease in O2 supply will proportionately decrease muscle VO2 max. As even in the isolated quadriceps (where normoxic O2 delivery is the highest recorded in humans) an increase in O2 supply by hyperoxia allows the achievement of a greater VO2 max, we conclude that, in normoxic conditions of isolated KE exercise, KE VO2 max in trained subjects is not limited by mitochondrial metabolic rate but, rather, by O2 supply.

Factors limiting maximal O2 consumption: effects of acute changes in ventilation

The response of the O2 transport system to acute changes in alveolar ventilation (VA) was analysed. The fractional limitations to maximal O2 consumption (VO2max) imposed by the lungs (ventilation, FV, and lung-blood transfer, FL), the cardiovascular system (FQ), and peripheral O2 diffusion (Fp) were calculated according to a multifactorial model. A reference set of data, describing the status of O2 transport at maximal exercise in normoxia was used. The effects of VA on VO2max were assessed on the assumption of a constant reference O2 flow in mixed venous blood (QVO2). The changes in reference data after given independent changes in VA were calculated by an iterative procedure, until the VO2max value compatible with the constant reference QVO2 was found, at PIO2 values of 150 (normoxia), 130, 110 and 90 Torr. The VO2max changes in normoxia were less than expected assuming a linear O2 transport system, because of the flatness of the O2 dissociation curve around normoxic PO2. This affected the cardiovascular resistance to O2 flow, and its changes counterbalanced the effects on VO2max of induced changes in VA. This phenomenon was reversed in hypoxia, as the steep part of the O2 dissociation curve was approached. The fractional limitations to VO2max in normoxia resulted as follows: FV and FL provided between 5 and 12%, FQ between 59 and 78%, and Fp between 13 and 19% of the overall VO2max limitation. In hypoxia, FV and FL increased and FQ decreased. At PIO2 = 90 Torr, when VA was halved, FV, FL, FQ and Fp amounted to 0.35, 0.31, 0.20 and 0.14, respectively.

Oxygen exchange in the isolated, arrested guinea pig heart: theoretical and experimental observations

A model of oxygen transport in perfused myocardial tissue is presented. Steady-state conditions are assumed in order to mimic the metabolic rate of the arrested heart. The model incorporates Michaelis-Menten dependence of mitochondrial oxygen consumption, oxymyoglobin saturation and oxyhemoglobin saturation on oxygen partial pressure (PO2). The transport equations model both the advective supply of oxygen via the coronary circulation and the diffusive exchange of oxygen between tissues and environment across the epicardial and endocardial surfaces. The left ventricle is approximated by an axisymmetric prolate spheroid and the transport equations solved numerically using finite element techniques. Solution yields the PO2 profile across the heart wall. Integration of this profile yields the simulated rate of metabolic oxygen uptake determined according to the Fick principle. Correction for the diffusive flux of oxygen across the surfaces yields the simulated true metabolic rate of oxygen consumption. Simulated values of oxygen uptake are compared with those measured experimentally according to the Fick principle, using saline-perfused, Langendorff-circulated, K(+)-arrested, guinea pig hearts. Four perfusion variables were manipulated: arterial PO2, environmental PO2, coronary flow and perfusion pressure. In each case agreement between simulated and experimentally determined rates of oxygen consumption gives confidence that the model adequately describes the advective and diffusive transport of oxygen in the isolated, arrested, saline-perfused heart.

The oxygen consumption/oxygen delivery curve in severe preeclampsia: evidence for a fixed oxygen extraction state

OBJECTIVE

Increased total body oxygen consumption requirements are usually met by increased oxygen delivery and increased oxygen extraction. In certain conditions (e.g., adult respiratory distress syndrome) the ability to increase oxygen extraction is lost, and any increase in oxygen consumption depends on increased oxygen delivery. The objective of this study was to investigate the oxygen delivery/oxygen consumption relationship in severe preeclampsia.

STUDY DESIGN

Thirty-two patients with severe preeclampsia (blood pressure > 160/110 mm Hg; 3 to 4+ proteinuria) were monitored with a pulmonary artery catheter. Baseline oxygen consumption and delivery in a group without volume expansion or pharmacologic vasodilatation were compared with those in a group who had received a magnesium sulfate infusion.

RESULTS

Oxygen consumption, oxygen delivery, arterial-venous-oxygen difference, and the oxygen extraction ratio were low when compared to that for normal 32 to 38 week pregnancy. The oxygen extraction ratio, defined as the ratio of oxygen consumption to oxygen delivery, was abnormally low for pregnancy, especially considering the low oxygen delivery levels in these patients. Oxygen consumption was dependent on oxygen delivery over the entire range of values seen.

CONCLUSIONS

Severe preeclampsia is associated with an abnormality of tissue oxygen extraction, as evidenced by a low and unresponsive oxygen extraction ratio. Oxygen consumption increases proportionately with increases in oxygen delivery without reaching an oxygen delivery-independent state. Even at high oxygen delivery levels the oxygen consumption in preeclamptic patients is still abnormally low for pregnancy.

Algebraic analysis of the determinants of VO2,max

Considerable evidence exists to support the idea that maximum oxygen consumption in exercising mammals is determined by the quantitative interaction between diffusive and convective factors involved in the transport of oxygen between the environment and the muscle mitochondria. To complement experimental tests of this hypothesis as well as numerical modeling of the interaction between diffusion and convection, both in the lungs and tissues, this paper reports an analytical (algebraic) model of diffusive/convective interaction made possible by replacing oxygen by a hypothetical gas of similar effective solubility, obeying Henry's law. The model describes a homogeneous but potentially diffusion-limited lung arranged in series via the circulation with a homogeneous but potentially diffusion-limited muscle. Steady-state transport of gas through this system and its subsequent tissue utilization are described by three equations: (1) mass balance across the lungs, (2) diffusive transport across the lungs, and (3) diffusive transport in the tissues. The latter two equations involve interaction between diffusive and perfusive (convective) elements of gas transport. Independent variables in this analysis are inspired partial pressure, alveolar ventilation, cardiac output, effective solubility of the gas, and diffusing capacities of the lungs and of the tissues. Dependent variables are alveolar, arterial, and venous partial pressures and hence maximum O2 uptake by the tissues (VO2,max). Evaluation of this model in both normoxia and severe hypoxia is described. In normoxia, VO2,max is shown to be affected by all independent variables, but mostly by blood flow. However, in severe hypoxia, VO2,max, based on data from Operation Everest II, becomes more sensitive to muscle diffusing capacity and less so to blood flow. In normoxia, normal sea level values of the independent variables set VO2,max at a point where little further gain in VO2 would be seen without large increases in diffusive or convective properties. On the other hand, there is relatively little reserve, such that decreases in transport parameters would result in significant reductions in VO2,max.

Adaptation of O2 transport and utilization at altitude in man

All stages of the O2 transport pathway are affected in some way by both acute and chronic altitude exposure. At any one stage, the effects are multiple, sometimes subtle, and frequently opposing. Clear-cut differences in responses to acute and to chronic altitude exposure are detectable but not in every case explainable, leaving important and perplexing problems still to be solved. Perhaps the most interesting of these relate to control of cardiac output and to determinants of O2 diffusion from muscle capillary red cells to the muscle mitochondria.

Rabbit skeletal muscle PO2 during hypodynamic sepsis

We measured skeletal muscle tissue PO2 (PtO2) in anesthetized rabbits (n = 7) following infusion of an intravenous bolus of E coli endotoxin. An array of surface PO2 microelectrodes was placed over the hindlimb biceps femoris muscle and sufficient readings were obtained to construct a PtO2 histogram. Changes in the histogram standard deviation were used to characterize micro-circulatory maldistribution. Systemic O2 consumption (VO2) was measured by the expired gas method. Cardiac output (Q) and systemic O2 transport (TO2) were calculated. Samples of arterial, right atrial (ra), and hindlimb venous blood, from a catheter placed in the infrarenal portion of the vena cava, were simultaneously obtained for measurement of blood gases and saturations. Following the administration of endotoxin, there were decreases in Q and TO2 of approximately 50 percent. The VO2 initially decreased 23 percent, but returned to baseline levels 30 minutes after endotoxin administration. Systemic O2 extraction ratio (ERO2 = VO2/TO2) increased from 0.32 +/- .03 to 0.54 +/- .07 (p less than 0.01), whereas hindlimb ERO2 increased from 0.42 +/- .03 to 0.60 +/- .02 (p less than 0.01). The arithmetic mean of the PtO2 histograms decreased after endotoxin infusion (43 +/- 4 to 7 +/- 2 mm Hg; p less than 0.01), but PLO2 remained at baseline levels (35 +/- 2 vs. 33 +/- 2 mm Hg; p = NS). The standard deviation of the PtO2 histograms remained constant during the experiment. This finding supports the notion that skeletal muscle microcirculatory heterogeneity does not increase during endotoxin induced hypodynamic sepsis.

Counter-current blood flow in tissues: protection against adverse effects

In hypoxia, the tissue counter-current can thus, by virtue of the Bohr effect, increase tissue Po2 and thus tissue oxygenation. In hyperoxia, on the other hand, the counter-current system, acting as a diffusion shunt, can protect the tissue against adverse O2-toxic effects. It thus appears, that the counter-current system is advantageous for O2 supply to tissues.

Gas exchange in the fish swimbladder

The fish swimbladder acts as a device to adjust for neutral buoyancy at various depths. High gas pressures, corresponding to the ambient hydrostatic pressure, are encountered, most of which is made up by O2 and N2. To prevent gas loss, the swimbladder wall is made impermeable by guanine crystals in its wall. Gas deposition is made possible by lactic acid production in the swimbladder epithelium, which increases blood gas partial pressures of inert gases (salting-out effect), O2 (Bohr and Root effects) and CO2 (conversion from HCO3-). The hairpin counter-current blood flow in the rete mirabile enhances this partial pressure increase to the tremendous values, up to several 100 atm, encountered in deep sea dwellers. Flow balance in the rete capillaries is found to be crucial, and salt back-diffusion to be advantageous, for the concentrating efficiency in the rete mirabile.

Significance of the Bohr effect for tissue oxygenation in a model with counter-current blood flow

Counter-current arrangement of afferent and efferent blood flow in tissues is commonly considered to be detrimental to tissue oxygenation, since O2 diffusion would shunt O2 away from the tissue. We have investigated the combined effects of counter-current CO2 and O2 exchange in a simple model, paying particular attention to the Bohr effect. We have obtained the following main results. (1) Back-diffusion of CO2 leads to increasing CO2 partial pressure (PCO2) and CO2 content along the afferent vessel. This is enhanced when fixed acid is released by the tissue into the venous blood, e.g. during hypoxia, which leads to a further PCO2 increase therein. (2) The increasing PCO2, with concomitant decrease in pH, in the afferent blood leads to a decrease in blood O2 affinity (Bohr effect) and thus results in increased PO2. (3) The resulting O2 diffusion shunt diminishes the O2 content in afferent blood, but for most conditions its PO2 remains higher than without the Bohr effect. (4) During hypoxia, both the PO2 in blood reaching the tissue (Pta) as well as in that leaving it (Ptv) are significantly elevated above the level without the Bohr effect. Moreover, with fixed acid release both Pta and Ptv for O2 can be higher than the arterial PO2 value. (5) During hyperoxia, O2 diffusion shunt prevents the tissue PO2 levels from increasing to levels that might be regarded as toxic. It is concluded that a diffusion shunt in tissues stabilizes the O2 partial pressure at the tissue when it varies in arterial blood (hypoxia or hyperoxia).

Precapillary O2 loss and arteriovenous O2 diffusion shunt are below limit of detection in myocardium

1. Mean intracellular PO2 is much lower than mean venous PO2 in subepicardium. 2. The drop in Hb saturation between aorta and terminal arterioles is within the 5% error of our method. 3. Arteriolar O2 has no effect on saturation in paired countercurrent venules in myocardium. 4. Saturation in coronary venules is independent of venule diameter and indistinguishable from saturation in macroscopic epicardial veins. 5. Since diffusive O2 shunting is negligible and PO2 is approximately linearly related to saturations over the observed range, mean coronary venous PO2 should closely approximate mean-end capillary PO2. 6. O2 mass transport from blood to tissue requires a steep PO2 gradient between the capillary and the surface of a tissue cell.

A Mathematical Model of Countercurrent Exchange of Oxygen Between Paired Arterioles and Venules

A mathematical model is formulated for diffusive countercurrent exchange of oxygen between paired arterioles and venules. A closed form solution of the problem is obtained by linearizing the nonlinear oxyhemoglobin dissociation curve at the inlet P_O2 in the vessel. The closed form solution is compared with the corresponding numerical solution of the nonlinear problem. Under normal conditions, longitudinal gradients of venular P_O2 are found to be small. Examples are presented where the model predicts significant gradients of venular P_O2 when the blood flow rate in the venule is several times smaller than that in the arteriole.

Role of diffusion shunt in transfer of inert gases and O2 in muscle

Diffusion shunt is diffusive gas exchange between arterial and venous vessels. Evidence for diffusion shunt had been obtained in washout studies in the gastrocnemius muscle of the dog. According to models, diffusion shunt is expected to be enhanced at low blood flow, and for gases of high diffusivity. Shunting of O2 should be reduced in comparison to inert gases because of chemical binding in blood.

Diffusional shunting of oxygen in saline-perfused isolated rabbit heart is negligible

Diffusional shunting of oxygen in the saline-perfused heart was studied by comparing the time course of the coronary venous concentrations of oxygen and an intravascular indicator following a simultaneous step-like change in their arterial concentrations. To this end 7 rabbit hearts were perfused according to Langendorff with Tyrode solution at a perfusion flow rate of 3.8 +/- 1.4 ml.min-1.g-1 (wet weight) at 37 degrees C. In the reference situation arterial (Pao2) and venous oxygen tensions (Pvo2) were about 610 and 290 mmHg, respectively. Step changes in Pao2 were made to a 60 mmHg lower level and back. Simultaneously the arterial concentration of albumin-bound indocyanine green, an intravascular indicator, was changed. No deflection in PvO2 was detected before the venous dye concentration changed. The venous dye concentration crossed 5% of its step amplitude 4 s after the arterial change, on average 2.3 s before Pvo2 crossed its 5% level. We conclude that shunt diffusion of oxygen from arterioles to venules and from arterial to venous ends of the capillary bed is negligible in saline-perfused hearts and thus cannot explain the high value of Pvo2 in these preparations.

The concept of a critical oxygen delivery

In healthy tissues, decreases in oxygen delivery (QO2 = cardiac output X arterial O2 content) do not lower oxygen consumption (VO2) because tissue O2 extraction increases proportionately. When delivery is reduced below a critical threshold, VO2 falls because tissue extraction exceeds a critical threshold, and cannot compensate for the reduction in delivery. In the adult respiratory distress syndrome and perhaps in septicemia, tissue extraction capacity is impaired, leading to O2 supply dependency despite normal or increased overall delivery. This pathologic supply dependency could be caused by a loss in autoregulatory capacity, by disrupted blood flow distribution secondary to peripheral microembolization, or to other factors interfering with efficient tissue distribution of QO2 with respect to VO2. Alternatively, the increased VO2 may be consumed in biochemical pathways not associated with ATP production, or in the production of oxygen radicals or hydrogen peroxide. To the extent this abnormal dependence of VO2 on QO2 reflects tissue hypoxia, clinical interventions which decrease systemic delivery should be evaluated with regard to possible deleterious effects on organ system function.

A new method to determine Giardia cyst viability: correlation of fluorescein diacetate and propidium iodide staining with animal infectivity

The viability of Giardia muris cysts was studied with the fluorogenic dyes fluorescein diacetate (FDA) and propidium iodide (PI). G. muris cysts were seen to fluoresce intensely green with FDA at an excitation wavelength of 450 to 490 nm. Cysts stained with PI fluoresced bright orange at an excitation wavelength of 450 to 490 nm and bright red at 545 to 546 nm. Examination of isolated G. muris cyst preparations stained with FDA-PI revealed that greater than 85% of the cysts stained green with FDA and less than 15% stained orange-red with PI. Using the mouse model for giardiasis, we inoculated FDA- or PI-stained cysts into neonatal mice. Feces were examined at days 3, 5, 8, and 11 postinoculation for the presence of cysts. Using 1,000 FDA-stained cysts as the inoculum, we detected cysts at days 5, 8, and 11 postinoculation in 19 of 19 mice, whereas a 50-fold greater dose of cysts produced infection in 27 of 27 mice at day 3 as well as at days 5, 8, and 11 postinoculation. Inoculation of mice with either 5,000 or 50,000 PI-stained G. muris cysts did not produce infection in any of the animals. Necropsy of mice infected with FDA-stained cysts showed trophozoites within the intestines. No trophozoites were detected within animals inoculated with PI-stained cysts. These results demonstrate that FDA-positive cysts are viable, as determined by infectivity, while PI-positive cysts are nonviable and incapable of producing G. muris infections in vivo.(ABSTRACT TRUNCATED AT 250 WORDS)

A microcomputer program of pulmonary and tissue gas exchange

A microcomputer program written in BASIC for the IBM-PC and compatibles has been developed to analyze the effects of many parameters on the gas exchange and transport phenomena in the lungs and the tissues. The program is designed for use by medical students and residents concerned with gas exchange (anesthesiology, pulmonary diseases, critical care, etc.) to study the steady state effects on blood and tissue oxygen and carbon dioxide levels. The present program consists of two main subroutines: Pulmonary Gas Exchange and Tissue Gas Exchange. Steady state gas exchange at the lungs can be studied using either a three-compartment model or V/Q relationships. The V/Q subroutine uses single or multiple populations of V/Q distributions to determine gas exchange using a log-normal distribution of V/Q ratios. Other variables can be adjusted which determine the arterial and mixed-venous blood gases. These values are then fed into the second part of the program to analyze factors which determine tissue O2 tension. The Tissue Oxygen Tension subroutine is also subdivided into a modified Krogh-Erlang model, which provides a three-dimensional plot of theoretical capillary and tissue O2 tensions, and a Piiper model which includes the effect of diffusion shunt on O2 tensions and treats the tissue as a well-stirred compartment. Minimal and maximal tissue O2 tensions are calculated using the Piiper model since the intercapillary distance is allowed to vary depending on the O2 delivery by diffusion. Estimates of blood and tissue O2 tensions, diffusion/perfusion coefficients, amount of O2 delivered and the size of the active capillary bed are summarized in a table.

Inert gas wash-out from tissue: model analysis

Model simulations on variously arranged two-compartment models are performed to provide a basis for interpreting the observed non-monoexponential (or non-linear logarithmic) wash-out time courses of inert gases from tissue. The variables considered are: blood flow, tissue volume, solubility of gas in tissue and blood, and diffusive conductances (diffusing capacities) for tissue/blood gas transfer and for gas transfer between tissue compartments. The wash-out is studied in terms of both mean tissue partial pressure and effluent venous blood partial pressure. Diffusion limitation within a tissue-blood capillary unit is shown to produce logarithmic wash-out rates which increase or decrease during wash-out, depending on the functional structure of the unit. On the other hand, in a system consisting of dissimilar tissue-blood capillary units arranged in parallel, the logarithmic wash-out rate decreases with wash-out time. It is shown that the conventional analysis of nonlinear logarithmic wash-out may overestimate or underestimate tissue perfusion or the extent of its inhomogeneity.