Respiratory Muscle Deoxygenation and Ventilatory Threshold Assessments Using Near Infrared Spectroscopy in Children

Effect of Inspiratory Muscle-Loaded Exercise Training on Ventilatory Response and Intercostal Muscle Deoxygenation During Incremental Cycling Exercise

Purpose: This study evaluated the effects of exercise training (ET) and inspiratory muscle-loaded exercise training (IMLET) on ventilatory response and intercostal muscle deoxygenation levels during incremental cycling exercise. Methods: Twenty-one male participants were randomly divided into IMLET (n = 10) or ET (n = 11) groups. All participants underwent a 4-week cycling exercise training at 60% peak oxygen uptake. IMLET loaded 50% of maximal inspiratory pressure (PImax). Respiratory muscle strength test, respiratory muscle endurance test (RMET), resting hypoxic ventilatory responsiveness (HVR) test, and incremental cycling test were performed pre- and post-training. Results: The extent of improvement in the PImax was significantly greater in the IMLET group (24%) than in the ET group (8%) (p = .018), and an extended RMET time was observed in the IMLET group (p < .001). Minute ventilation (V ˙ E ) during exercise was unchanged in both groups before and after training, but tidal volume during exercise increased in the IMLET group. The increase in the exercise intensity threshold for muscle deoxygenation was similar in both groups (p < .001). HVR remained unchanged in both groups post-training. The exercise duration for the incremental exercise until reaching fatigue increased by 7.9% after ET and 6.9% after IMLET (p < .001). Conclusion: The 4-week IMLET improved respiratory muscle strength and endurance but did not alter HVR. Respiratory muscle deoxygenation was alleviated by exercise training, with a limited impact of inspiratory load training.

Assessment of Intercostal Muscle Near-Infrared Spectroscopy for Estimating Respiratory Compensation Point in Trained Endurance Athletes

This study aimed to assess the reliability and validity of estimating the respiratory compensation point (RCP) in trained endurance athletes by analyzing intercostal muscles' NIRS-derived tissue oxygenation dynamics. Seventeen experienced trail runners underwent an incremental treadmill protocol on two separate occasions, with a 7-day gap between assessments. Gas exchange and muscle oxygenation data were collected, and the oxygen saturation breakpoint (SmO2BP) measured in the intercostal muscles was compared to the RCP, which was identified by the increase in the VE/V.CO2 slope and the point at which the PetCO2 started to decrease. No statistically significant differences were observed between the two methods for any of the variables analyzed. Bland-Altman analysis showed significant agreement between the NIRS and gas analyzer methods for speed (r = 0.96, p < 0.05), HR (r = 0.98, p < 0.05), V.O2 relative to body mass (r = 0.99, p < 0.05), and %SmO2 (r = 0.98, p < 0.05). The interclass correlation coefficient values showed moderate to good reliability (0.60 to 0.86), and test-retest analysis revealed mean differences within the confidence intervals for all variables. These findings suggest that the SmO2BP measured using a portable NIRS device in the intercostal muscles is a reliable and valid tool for estimating the RCP for experienced trail runners and might be useful for coaches and athletes to monitor endurance training.

Determination of the Respiratory Compensation Point by Detecting Changes in Intercostal Muscles Oxygenation by Using Near-Infrared Spectroscopy

This study aimed to evaluate if the changes in oxygen saturation levels at intercostal muscles (SmO2-m.intercostales) assessed by near-infrared spectroscopy (NIRS) using a wearable device could determine the respiratory compensation point (RCP) during exercise. Fifteen healthy competitive triathletes (eight males; 29 ± 6 years; height 167.6 ± 25.6 cm; weight 69.2 ± 9.4 kg; V˙O2-máx 58.4 ± 8.1 mL·kg−1·min−1) were evaluated in a cycle ergometer during the maximal oxygen-uptake test (V˙O2-máx), while lung ventilation (V˙E), power output (watts, W) and SmO2-m.intercostales were measured. RCP was determined by visual method (RCPvisual: changes at ventilatory equivalents (V˙E·V˙CO2−1, V˙E·V˙O2−1) and end-tidal respiratory pressure (PetO2, PetCO2) and NIRS method (RCPNIRS: breakpoint of fall in SmO2-m.intercostales). During exercise, SmO2-m.intercostales decreased continuously showing a higher decrease when V˙E increased abruptly. A good agreement between methods used to determine RCP was found (visual vs NIRS) at %V˙O2-máx, V˙O2, V˙E, and W (Bland-Altman test). Correlations were found to each parameters analyzed (r = 0.854; r = 0.865; r = 0.981; and r = 0,968; respectively. p < 0.001 in all variables, Pearson test), with no differences (p < 0.001 in all variables, Student’s t-test) between methods used (RCPvisual and RCPNIRS). We concluded that changes at SmO2-m.intercostales measured by NIRS could adequately determine RCP in triathletes.

Detection of ventilatory thresholds using near-infrared spectroscopy with a polynomial regression model

Whether near-infrared spectroscopy (NIRS) is a convenient and accurate method of determining first and second ventilatory thresholds (VT₁ and VT₂) using raw data remains unknown. This study investigated the reliability and validity of VT₁ and VT₂ determined by NIRS skeletal muscle hemodynamic raw data via a polynomial regression model. A total of 100 male students were recruited and performed maximal cycling exercises while their cardiopulmonary and NIRS muscle hemodynamic data were measured. The criterion validity of VT_1VET and VT_2VET were determined using a traditional V-slope and ventilatory efficiency. Statistical significance was set at α = . 05. There was high reproducibility of VT_1NIRS and VT_2NIRS determined by a NIRS polynomial regression model during exercise (VT_1NIRS, r = 0.94; VT_2NIRS, r = 0.93). There were high correlations of VT_1VET vs VT_1NIRS (r = 0.93, p < .05) and VT_2VET vs VT_2NIRS (r = 0.94, p < .05). The oxygen consumption (VO₂) between VT_1VET and VT_1NIRS or VT_2VET and VT_2NIRS was not significantly different. NIRS raw data are reliable and valid for determining VT₁ and VT₂ in healthy males using a polynomial regression model. Skeletal muscle raw oxygenation and deoxygenation status reflects more realistic causes and timing of VT₁ and VT₂.

Reliability of NIRS portable device for measuring intercostal muscles oxygenation during exercise

This study assessed the intra-individual reliability of oxygen saturation in intercostal muscles (SmO₂-m.intercostales) during an incremental maximal treadmill exercise by using portable NIRS devices in a test-retest study. Fifteen marathon runners (age, 24.9 ± 2.0 years; body mass index, 21.6 ± 2.3 kg·m^-2; V̇O₂-peak, 63.7 ± 5.9 mL·kg^-1·min^-1) were tested on two separate days, with a 7-day interval between the two measurements. Oxygen consumption (V̇O₂) was assessed using the breath-by-breath method during the V̇O₂-test, while SmO₂ was determined using a portable commercial device, based in the near-infrared spectroscopy (NIRS) principle. The minute ventilation (VE), respiratory rate (RR), and tidal volume (Vt) were also monitored during the cardiopulmonary exercise test. For the SmO₂-m.intercostales, the intraclass correlation coefficient (ICC) at rest, first (VT1) and second ventilatory (VT2) thresholds, and maximal stages were 0.90, 0.84, 0.92, and 0.93, respectively; the confidence intervals ranged from -10.8% - +9.5% to -15.3% - +12.5%. The reliability was good at low intensity (rest and VT1) and excellent at high intensity (VT2 and max). The Spearman correlation test revealed (p ≤ 0.001) an inverse association of SmO₂-m.intercostales with V̇O₂ (ρ = -0.64), VE (ρ = -0.73), RR (ρ = -0.70), and Vt (ρ = -0.63). The relationship with the ventilatory variables showed that increased breathing effort during exercise could be registered adequately using a NIRS portable device.

Oxygen Availability in Respiratory Muscles During Exercise in Children Following Fontan Operation

Introduction: As survival of previously considered as lethal congenital heart disease forms is the case in our days, issues regarding quality of life including sport and daily activities emerge. In patients with Fontan circulation, there is no pump to propel blood into the pulmonary arteries since the systemic veins are directly connected to the pulmonary arteries. The complex hemodynamics of Fontan circulation include atrial function, peripheral muscle pump, integrity of the atrioventricular valve, absence of restrictive, or obstructive pulmonary lung function. Therefore, thoracic mechanics are of particular importance within the complex hemodynamics of Fontan circulation. Methods: To understand the physiology of respiratory muscles, the aim of this study was to examine the matching of auxiliary respiratory muscle oxygen delivery and utilization during incremental exercise in young male Fontan patients (n = 22, age = 12.04 ± 2.51) and healthy Controls (n = 10, age = 14.90 ± 2.23). All subjects underwent a cardiopulmonary exercise test (CPET) to exhaustion whereas respiratory muscle oxygenation was measured non-invasively using a near-infrared spectrometer (NIRS). Results: CPET revealed significantly lower peak power output, oxygen uptake and breath activity in Fontan patients. The onset of respiratory muscle deoxygenation was significantly earlier. The matching of local muscle perfusion to oxygen demand was significantly worse in Fontans between 50 and 90% V . O 2 peak . Findings: The results indicate that (a) there is high strain on respiratory muscles during incremental cycling exercise and (b) auxiliary respiratory muscles are worse perfused in patients who underwent a Fontan procedure compared to healthy Controls. This might be indicative of a more general skeletal muscle strain and worse perfusion in Fontan patients rather than a localized-limited to thoracic muscles phenomenon.

An integrated view on the oxygenation responses to incremental exercise at the brain, the locomotor and respiratory muscles

In the past two decades oxygenation responses to incremental ramp exercise, measured non-invasively by means of near-infrared spectroscopy at different locations in the body, have advanced the insights on the underpinning mechanisms of the whole-body pulmonary oxygen uptake ([Formula: see text]) response. In healthy subjects the complex oxygenation responses at the level of locomotor and respiratory muscles, and brain were simplified and quantified by the detection of breakpoints as a deviation in the ongoing response pattern as work rate increases. These breakpoints were located in a narrow intensity range between 75 and 90 % of the maximal [Formula: see text] and were closely related to traditionally determined thresholds in pulmonary gas exchange (respiratory compensation point), blood lactate measurements (maximal lactate steady state), and critical power. Therefore, it has been assumed that these breakpoints in the oxygenation patterns at different sites in the body might be equivalent and could, therefore, be used interchangeably. In the present review the typical oxygenation responses (at locomotor and respiratory muscle level, and cerebral level) are described and a possible framework is provided showing the physiological events that might link the breakpoints at different body sites with the thresholds determined from pulmonary gas exchange and blood lactate measurements. However, despite a possible physiological association, several arguments prevent the current practical application of these breakpoints measured at a single site as markers of exercise intensity making it highly questionable whether measurements of the oxygenation response at one single site can be used as a reflection of whole-body responses to different exercise intensities.

Determination of maximal lactate steady state in healthy adults: can NIRS help?

PURPOSE

We tested the hypothesis that the maximal lactate steady state (MLSS) can be accurately determined in healthy subjects based on measures of deoxygenated hemoglobin (deoxyHb), an index of oxygen extraction measured noninvasively by near-infrared spectroscopy (NIRS).

METHODS

Thirty-two healthy men (mean ± SD age = 48 ± 17 yr, range = 23-74 yr) performed an incremental cycling test to exhaustion and square wave tests for MLSS determination. Cardiorespiratory variables were measured bbb and deoxyHb was monitored noninvasively on the right vastus lateralis with a quantitative NIRS device. The individual values of V˙O2 and HR corresponding to the MLSS were calculated and compared to the NIRS-derived MLSS (NIRSMLSS) that was, in turn, determined by double linear function fitting of deoxyHb during the incremental exercise.

RESULTS

V˙O2 and HR at MLSS were 2.25 ± 0.54 L·min (76% ± 9% V˙O2max) and 133 ± 14 bpm (81% ± 7% HRmax), respectively. Muscle O2 extraction increased as a function of exercise intensity up to a deflection point, NIRSMLSS, at which V˙O2 and HR were 2.23 ± 0.59 L·min (76% ± 9% V˙O2max) and 136 ± 17 bpm (82% ± 8% HRmax), respectively. For both V˙O2 and HR, the difference of NIRSMLSS from MLSS values was not significant and the measures were highly correlated (r = 0.81 and r = 0.76). The Bland-Altman analysis confirmed a nonsignificant bias for V˙O2 and HR (-0.015 L·min and 3 bpm, respectively) and a small imprecision of 0.26 L·min and 8 bpm.

CONCLUSIONS

A plateau in muscle O2 extraction was demonstrated in coincidence with MLSS during an incremental cycling exercise, confirming the hypothesis that this functional parameter can be accurately estimated with a quantitative NIRS device. The main advantages of NIRSMLSS over lactate-based techniques are the noninvasiveness and the time/cost efficiency.

Exercise testing in children: comparison in ventilatory thresholds changes with interval-training

The aim of this investigation was, first, to examine comparatively the changes in first and second ventilatory thresholds (VT1 and VT2 ) and, secondly, to compare with peak oxygen uptake (${\dot {\rm {V}}}_{{\rm O}_{{\rm 2}} {\rm peak}} $) changes following high-intensity interval training (HIT) in prepubescent children. Eighteen prepubescent children (aged 10.1 ± 0.7 years) performed an incremental exhaustive exercise on a cycle ergometer with pulmonary gas exchange measurements before and after an 8-week period. During this period, nine children (five girls and four boys; initial ${\dot {\rm {V}}}_{{\rm O}_{{\rm 2}} {\rm peak}} $: 39.6 ± 6.0 ml O2  · min(-1)  · kg(-1) ) took part in a HIT and nine other children (three girls and six boys; initial ${\dot {\rm {V}}}_{{\rm O}_{{\rm 2}} {\rm peak}} $: 39.8 ± 7.8 ml O2  · min(-1)  · kg(-1) ), considered as controls, were not trained. After the training period, VT1 , VT2 , and ${\dot {\rm {V}}}_{{\rm O}_{{\rm 2}} {\rm peak}} $ were significantly (P < 0.01) improved (21%, 24%, and 14%, respectively) without significant changes in the control group. However, the changes in VT1 (ΔVT1 = +4.35 ± 4.36 ml O2  · min(-1)  · kg(-1) ), VT2 (ΔVT1 = +7.17 ± 5.17 ml O2  · min(-1)  · kg(-1) ), ${\dot {\rm {V}}}_{{\rm O}_{{\rm 2}} {\rm peak}} $ ($\Delta {\dot {\rm {V}}}_{{\rm O}_{{\rm 2}} {\rm peak}} $ = +5.51 ± 4.17 ml O2  · min(-1)  · kg(-1) ) induced by HIT in trained children were not related. In conclusion, for prepubescent children, in addition to VT1 and ${\dot {\rm {V}}}_{{\rm O}_{{\rm 2}} {\rm peak}} $, VT2 can also be significantly improved by training. Therefore, HIT represents a good way to obtain great improvement in these parameters in only 8 weeks. However, the time courses of these aerobic fitness parameters are dissociated, which implies the need to differentiate among them during aerobic fitness exercise testing.

Hemodynamic and oxidative mechanisms of tourniquet-induced muscle injury: near-infrared spectroscopy for the orthopedics setting

During orthopedic procedures, the tourniquets used to maintain bloodless surgical fields cause ischemia and then reperfusion (I/R), leading to oxidative muscle injury. Established methods exist neither for monitoring orthopedic I/R nor for predicting the extent of tourniquet-associated oxidative injury. To develop a predictive model for tourniquet-associated oxidative muscle injury, this study combined real-time near-infrared spectroscopy (NIRS) monitoring of I/R with Western blotting (WB) for oxidized proteins. We hypothesized strong correlations between NIRS-derived I/R indices and muscle protein oxidation. In 17 patients undergoing ankle fracture repair, a thigh tourniquet was inflated on the injured limb (300 mmHg). Using a continuous-wave (CW) NIRS setup, oxygenated (O2Hb), deoxygenated (HHb), and total (tHb) hemoglobin were monitored bilaterally (tourniquet versus control) in leg muscles. Leg muscle biopsies were collected unilaterally (tourniquet side) immediately after tourniquet inflation (pre) and before deflation (post). Average ischemia duration was 43.2 ± 14.6 min. In post-compared to pre-biopsies, muscle protein oxidation (quantified using WB) increased 172.3%± 145.7% (P<0.0005). Changes in O2Hb and tHb were negatively correlated with protein oxidation (respectively: P=0.040, R2=0.25 and P=0.003, R2=0.58). Reoxygenation rate was positively correlated with protein oxidation (P=0.041, R2=0.25). These data indicate that using CW NIRS, it is possible to predict orthopedic tourniquet-associated muscle oxidative injury noninvasively.

Measurement of regional tissue bed venous weighted oximetric trends during exercise by near infrared spectroscopy

BACKGROUND

Cardiopulmonary exercise testing (CPET) is limited to children able to tolerate the equipment. Modification of instrumentation to reduce invasiveness will open CPET to a wider population. Near Infrared Spectroscopy (NIRS) devices measure regional oxyhemoglobin saturation (rSO2). We aim to predict anaerobic threshold (AT) during CPET using multiorgan NIRS monitoring.

METHODS AND RESULTS

Nineteen subjects were recruited. NIRS probes were placed on the forehead, para vertebral space, vastus lateralis, and deltoid muscle (rSO2 C, rSO2 R, rSO2 L and rSO2 A). rSO2 was recorded at six second intervals at rest, exercise, and through a five minute recovery period. The AT was computed using the v-slope method. AT was also predicted using NIRS data by identifying the inflection point of the rSO2 trends for all the four sites. AT can be estimated by the point of slope change of rSO2 R, rSO2 C and the four-site composite measure.

CONCLUSIONS

Multisite NIRS monitoring of visceral organs is a potential predictor of AT. This allows for monitoring in all forms of exercise over a wide age range.

Assessment of exercise capacity and respiratory muscle oxygenation in healthy children and children with congenital heart diseases

Muscular and cardiorespiratory dysfunction contributes to exercise intolerance. Therefore, the aim of the present study was to characterize the cardiopulmonary response andrespiratory muscle oxygenation of children with congenital heart diseases (CHD) when compared with those of healthy children. Twelve children with CHD in New York Heart Association (NYHA) class II or III, and 14 healthy children participated in the study. All subjects performed conventional spirographic measurements and a cardiopulmonary exercise test on a cycle ergometer. Oxygen uptake (VO2), carbon dioxide production (VCO2), minute ventilation (VE), heart rate (HR), and power output were measured. Oxygenation of respiratory muscles was assessed by near-infrared spectroscopy (NIRS) during exercise and recovery. Pulmonary function was normal and no significant difference was found between groups. At rest, CHD patients had cardiorespiratory variables comparable with those of the healthy group. At submaximal intensity (ventilatory threshold) and at peak exercise, power output, HR, VO2, VCO2, and VE were significantly reduced (p < 0.01) in CHD patients. Respiratory muscles deoxygenated during exercise in both groups. However, deoxygenation was more pronounced in the CHD group than in the healthy children from an intensity of 40% up to exhaustion. Likewise, children with CHD showed a slower recovery of oxygenation than healthy children (113.4 ± 17.5 vs. 74.6 ± 13.0 s; p < 0.001). Compared with healthy children, these results demonstrated that children with CHD have reduced performance and present a defected exercise capacity. Children with CHD showed a more pronounced decrease of respiratory muscle oxygenation and slower recovery of oxygen kinetics.

Near-infrared spectroscopy/imaging for monitoring muscle oxygenation and oxidative metabolism in healthy and diseased humans

Near-infrared spectroscopy (NIRS) was initiated in 1977 by Jobsis as a simple, noninvasive method for measuring the presence of oxygen in muscle and other tissues in vivo. This review honoring Jobsis highlights the progress that has been made in developing and adapting NIRS and NIR imaging (NIRI) technologies for evaluating skeletal muscle O(2) dynamics and oxidative energy metabolism. Development of NIRS/NIRI technologies has included novel approaches to quantification of the signal, as well as the addition of multiple source detector pairs for imaging. Adaptation of NIRS technology has focused on the validity and reliability of NIRS measurements. NIRS measurements have been extended to resting, ischemic, localized exercise, and whole body exercise conditions. In addition, NIRS technology has been applied to the study of a number of chronic health conditions, including patients with chronic heart failure, peripheral vascular disease, chronic obstructive pulmonary disease, varying muscle diseases, spinal cord injury, and renal failure. As NIRS technology continues to evolve, the study of skeletal muscle function with NIRS first illuminated by Jobsis continues to be bright.

Recruitment of the Serratus Anterior as an Accessory Muscle of Ventilation during Graded Exercise

The role of the serratus anterior (SA) as an accessory muscle of ventilation and its physiologic significance under exercising conditions remains unclear. Recent investigations have utilized the measurement of SA as an analog for respiratory muscle oxygenation. The purpose of this investigation was to examine the action of the serratus anterior via surface electromyography (EMG) and near infrared spectroscopy (NIRS) during exercise while controlling for muscular effort not related to ventilation. Nine healthy volunteers (age = 24.4 +/- 0.5 years, VO2max = 3.416 +/- 0.35 l min(-1); VEpeak = 127.5 +/- 13.1 l min(-1); TVpeak = 2.844 +/- 0.226 l) completed a graded exercise test to volitional exhaustion on a cycle ergometer. The subjects' arms were folded and relaxed at the abdomen to minimize muscular effort resulting from scapular stabilization during pushing/forward flexion of the arms associated with cycle ergometry. VO2 and V were monitored breath-by-breath throughout exercise. EMG was recorded over the right SA, and a near infrared probe was placed over the left SA. No significant differences were observed throughout the graded exercise test for tissue oxygenation (StO2) (n = 6, F[1.532, 7.661] = 0.895, P > 0.05, eta2 = 0.15) or EMG (n = 9, F[1.594, 12.75] = 3.067, P > 0.05, eta2 = 0.27). Although the recruitment of the SA has been postulated to aid in ventilation in various postures and disease states, it is concluded that it shows little muscular effort in healthy subjects during upright cycling. Additional research is needed to conclude the pertinence of utilizing StO2 of the SA as an analog for respiratory muscle oxygenation.