Spiroergometric measurements under increased inspiratory oxygen concentration (FIO2)-Putting the Haldane transformation to the test

Indirect Calorimetry in Spontaneously Breathing, Mechanically Ventilated and Extracorporeally Oxygenated Patients: An Engineering Review

Indirect calorimetry (IC) is considered the gold standard for measuring resting energy expenditure (REE). This review presents an overview of the different techniques to assess REE with special regard to the use of IC in critically ill patients on extracorporeal membrane oxygenation (ECMO), as well as to the sensors used in commercially available indirect calorimeters. The theoretical and technical aspects of IC in spontaneously breathing subjects and critically ill patients on mechanical ventilation and/or ECMO are covered and a critical review and comparison of the different techniques and sensors is provided. This review also aims to accurately present the physical quantities and mathematical concepts regarding IC to reduce errors and promote consistency in further research. By studying IC on ECMO from an engineering point of view rather than a medical point of view, new problem definitions come into play to further advance these techniques.

Hypoxia equally reduces the respiratory compensation point and the NIRS-derived [HHb] breakpoint during a ramp-incremental test in young active males

This study investigated the effect of reduced inspired fraction of O₂ (FiO₂) in the correspondence between the respiratory compensation point (RCP) and the breakpoint in the near‐infrared spectroscopy‐derived deoxygenated hemoglobin signal ([HHb]_bp) during a ramp‐incremental (RI) test to exhaustion. Eleven young males performed, on two separated occasions, a RI test either in normoxia (NORM, FiO₂ = 20.9%) or hypoxia (HYPO, FiO₂ = 16%). Oxygen uptake ( V˙O₂), and [HHb] signal from the vastus lateralis muscle were continuously measured. Peak V˙O₂ (2.98 ± 0.36 vs. 3.39 ± 0.26 L min⁻¹) and PO (282 ± 29 vs. 310 ± 19 W) were lower in HYPO compared to NORM condition, respectively. The V˙O₂ and PO associated with RCP and [HHb]_bp were lower in HYPO (2.35 ± 0.24 and 2.34 ± 0.26 L min⁻¹; 198 ± 37 and 197 ± 30 W, respectively) when compared to NORM (2.75 ± 0.26 and 2.75 ± 0.28 L min⁻¹; 244 ± 29 and 241 ± 28 W, respectively) (p < .05). Within the same condition, the V˙O₂ and PO associated with RCP and [HHb]_bp were not different (p > .05). Bland–Altman plots mean average errors between RCP and [HHb]_bp were not different from zero in HYPO (0.01 L min⁻¹ and 1.1 W) and NORM (0.00 L min⁻¹ and 3.6 W) conditions. The intra‐individual changes between thresholds associated with V˙O₂ and PO in HYPO from NORM were strongly correlated (r = .626 and 0.752, p < .05). Therefore, breathing a lower FiO₂ during a RI test resulted in proportional reduction in the RCP and the [HHb]_bp in terms of V˙O₂ and PO, which further supports the notion that these physiological responses may arise from similar metabolic changes reflecting a common phenomenon.

The effect of the fraction of inspired oxygen on the NIRS-derived deoxygenated hemoglobin "breakpoint" during ramp-incremental test

During ramp-incremental (RI) exercise to exhaustion, the near-infrared spectroscopy-derived deoxygenated hemoglobin ([HHb]) signal in the vastus lateralis muscle shows a linear increase up to a point at which a plateau-like response is manifested ([HHb]_bp). This study investigated if 1) the [HHb]_bp is affected by different fractions of inspired O₂ (FIO2) [hypoxia (16%; HYPO); normoxia (21%; NORM); hyperoxia (30%; HYPER)]; and 2) an abrupt change to hyperoxic-inspired gas just before the occurrence of the [HHb]_bp (HYPER_SWITCH) would affect the [HHb] plateau-like response. Ten physically active male participants reported to the laboratory on four separate occasions to perform an RI test to exhaustion in NORM, HYPO, and HYPER and an RI test to exhaustion with an abrupt increase in FIO2 (30%; HYPER_SWITCH) 15 W before the power output (PO) associated with [HHb]_bp in normoxia. PO, [HHb], tissue O₂ (StO2), and pulse O₂ saturation (SpO2) were recorded continuously. Peak PO was significantly lower in HYPO (290 ± 21 W) and higher in HYPER (321 ± 22 W) and HYPER_SWITCH (320 ± 19 W) compared with NORM (311 ± 18 W). The PO associated with [HHb]_bp was not different between NORM and HYPER (246 ± 23 vs. 247 ± 24 W), but it was lower in HYPO (198 ± 31 W) than NORM and HYPER. The PO associated with the [HHb]_bp in HYPER_SWITCH (240 ± 23) was not different compared with NORM. HYPER and HYPER_SWITCH resulted in greater StO2 and SpO2 compared with NORM. These results suggest that the [HHb]_bp response is not dependent of O₂ driving pressure and that other physiological mechanisms might determine its occurrence.