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de Jong FJM, Lilien TA, Fenn DW, Wingelaar TT, van Ooij PJAM, Maitland-van der Zee AH, Hollmann MW, van Hulst RA, Brinkman P. Volatile Organic Compounds in Cellular Headspace after Hyperbaric Oxygen Exposure: An In Vitro Pilot Study. Metabolites 2024; 14:281. [PMID: 38786758 PMCID: PMC11123173 DOI: 10.3390/metabo14050281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/01/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Volatile organic compounds (VOCs) might be associated with pulmonary oxygen toxicity (POT). This pilot study aims to identify VOCs linked to oxidative stress employing an in vitro model of alveolar basal epithelial cells exposed to hyperbaric and hyperoxic conditions. In addition, the feasibility of this in vitro model for POT biomarker research was evaluated. The hyperbaric exposure protocol, similar to the U.S. Navy Treatment Table 6, was conducted on human alveolar basal epithelial cells, and the headspace VOCs were analyzed using gas chromatography-mass spectrometry. Three compounds (nonane [p = 0.005], octanal [p = 0.009], and decane [p = 0.018]), of which nonane and decane were also identified in a previous in vivo study with similar hyperbaric exposure, varied significantly between the intervention group which was exposed to 100% oxygen and the control group which was exposed to compressed air. VOC signal intensities were lower in the intervention group, but cellular stress markers (IL8 and LDH) confirmed increased stress and injury in the intervention group. Despite the observed reductions in compound expression, the model holds promise for POT biomarker exploration, emphasizing the need for further investigation into the complex relationship between VOCs and oxidative stress.
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Affiliation(s)
- Feiko J. M. de Jong
- Royal Netherlands Navy Diving and Submarine Medical Centre, 1780 CA Den Helder, The Netherlands
- Department of Anesthesiology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
| | - Thijs A. Lilien
- Department of Pediatric Intensive Care, Amsterdam UMC, Location Emma Children’s Hospital, 1100 DD Amsterdam, The Netherlands
| | - Dominic W. Fenn
- Department of Pulmonology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
| | - Thijs T. Wingelaar
- Royal Netherlands Navy Diving and Submarine Medical Centre, 1780 CA Den Helder, The Netherlands
- Department of Anesthesiology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
| | - Pieter-Jan A. M. van Ooij
- Royal Netherlands Navy Diving and Submarine Medical Centre, 1780 CA Den Helder, The Netherlands
- Department of Pulmonology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
| | | | - Markus W. Hollmann
- Department of Anesthesiology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
| | - Rob A. van Hulst
- Department of Anesthesiology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
| | - Paul Brinkman
- Department of Pulmonology, Amsterdam UMC, Location AMC, 1100 DD Amsterdam, The Netherlands
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Arieli R. Pulmonary oxygen toxicity index during linear change in PO 2: HBO treatment tables and dive planning. Respir Physiol Neurobiol 2024; 319:104172. [PMID: 37838230 DOI: 10.1016/j.resp.2023.104172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023]
Affiliation(s)
- R Arieli
- Israel Naval Medical Institute, Haifa, Israel; Eliachar Research Laboratory, Western Galilee Medical Center, Nahariya, Israel.
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de Jong FJ, Brinkman P, Wingelaar TT, van Ooij PJA, van Hulst RA. Pulmonary oxygen toxicity breath markers after heliox diving to 81 metres. Diving Hyperb Med 2023; 53:340-344. [PMID: 38091594 PMCID: PMC10944665 DOI: 10.28920/dhm53.4.340-344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/08/2023] [Indexed: 12/18/2023]
Abstract
Pulmonary oxygen toxicity (POT), an adverse reaction to an elevated partial pressure of oxygen in the lungs, can develop as a result of prolonged hyperbaric hyperoxic conditions. Initially starting with tracheal discomfort, it results in pulmonary symptoms and ultimately lung fibrosis. Previous studies identified several volatile organic compounds (VOCs) in exhaled breath indicative of POT after various wet and dry hyperbaric hypoxic exposures, predominantly in laboratory settings. This study examined VOCs after exposures to 81 metres of seawater by three navy divers during operational heliox diving. Univariate testing did not yield significant results. However, targeted multivariate analysis of POT-associated VOCs identified significant (P = 0.004) changes of dodecane, tetradecane, octane, methylcyclohexane, and butyl acetate during the 4 h post-dive sampling period. No airway symptoms or discomfort were reported. This study demonstrates that breath sampling can be performed in the field, and VOCs indicative of oxygen toxicity are exhaled without clinical symptoms of POT, strengthening the belief that POT develops on a subclinical-to-symptomatic spectrum. However, this study was performed during an actual diving operation and therefore various confounders were introduced, which were excluded in previous laboratory studies. Future studies could focus on optimising sampling protocols for field use to ensure uniformity and reproducibility, and on establishing dose-response relationships.
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Affiliation(s)
- Feiko Jm de Jong
- Royal Netherlands Navy Diving and Submarine Medical Centre, 1780 CA, Den Helder, The Netherlands
- Department of Anesthesiology, Amsterdam University Medical Center, location AMC, 1100 DD, Amsterdam, The Netherlands
- Corresponding author: Feiko JM de Jong, Royal Netherlands Navy Diving and Submarine Medical Centre, Rijkszee-en Marinehaven, Postbus 10.000, 1780 CA, Den Helder, The Netherlands, ORCiD: 0009-0008-9804-8307,
| | - Paul Brinkman
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, 1100 DD, Amsterdam, The Netherlands
| | - Thijs T Wingelaar
- Royal Netherlands Navy Diving and Submarine Medical Centre, 1780 CA, Den Helder, The Netherlands
- Department of Anesthesiology, Amsterdam University Medical Center, location AMC, 1100 DD, Amsterdam, The Netherlands
| | - Pieter-Jan Am van Ooij
- Royal Netherlands Navy Diving and Submarine Medical Centre, 1780 CA, Den Helder, The Netherlands
- Department of Pulmonology, Amsterdam University Medical Center, location AMC, 1100 DD, Amsterdam, The Netherlands
| | - Robert A van Hulst
- Department of Anesthesiology, Amsterdam University Medical Center, location AMC, 1100 DD, Amsterdam, The Netherlands
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Fothergill DM, Gertner JW. Exhaled Nitric Oxide and Pulmonary Oxygen Toxicity Susceptibility. Metabolites 2023; 13:930. [PMID: 37623874 PMCID: PMC10456729 DOI: 10.3390/metabo13080930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/26/2023] Open
Abstract
Individual susceptibility to pulmonary oxygen toxicity (PO2tox) is highly variable and currently lacks a reliable biomarker for predicting pulmonary hyperoxic stress. As nitric oxide (NO) is involved in many respiratory system processes and functions, we aimed to determine if expired nitric oxide (FENO) levels can provide an indication of PO2tox susceptibility in humans. Eight U.S. Navy-trained divers volunteered as subjects. The hyperoxic exposures consisted of six- and eight-hour hyperbaric chamber dives conducted on consecutive days in which subjects breathed 100% oxygen at 202.65 kPa. Subjects' individual variability in pulmonary function and FENO was measured twice daily over five days and compared with their post-dive values to assess susceptibility to PO2tox. Only subjects who showed no decrements in pulmonary function following the six-hour exposure conducted the eight-hour dive. FENO decreased by 55% immediately following the six-hour oxygen exposure (n = 8, p < 0.0001) and by 63% following the eight-hour exposure (n = 4, p < 0.0001). Four subjects showed significant decreases in pulmonary function immediately following the six-hour exposure. These subjects had the lowest baseline FENO, had the lowest post-dive FENO, and had clinical symptoms of PO2tox. Individuals with low FENO were the first to develop PO2tox symptoms and deficits in pulmonary function from the hyperoxic exposures. These data suggest that endogenous levels of NO in the lungs may protect against the development of PO2tox.
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Arieli R. The pulmonary oxygen toxicity index. Respir Physiol Neurobiol 2023; 315:104114. [PMID: 37460079 DOI: 10.1016/j.resp.2023.104114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/03/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
Pulmonary oxygen toxicity (POT) is a major risk in diving while breathing hyperoxic gas and is also considered in clinical hyperbaric oxygen treatment. The POTindex calculated by the power equation K = t2 × PO24.57 with the recovery form Ktr = Ke × e - [- 0.42 + 0.384 × (PO2)ex] × tr which are based on chemical and physiological principles, have a better prediction power than other suggested approaches. Reduction of vital capacity as well as incidence of POT are well predicted by the POTindex. Both the cumulative pulmonary toxic effect and concomitant recovery were suggested to operate at the lower toxic range of PO2 used in saturation diving K = t2 × PO24.57 × e-0.0135 × t, and further experimental support is supplied. The recovery time constant for the full range of PO2 is presented. POTindex is suggested to replace the old method of UPTD for safe diving. Many diving clubs and diving institutes already adopted the POTindex.
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Affiliation(s)
- R Arieli
- Israel Naval Medical Institute, Haifa, Israel; Eliachar Research Laboratory, Western Galilee Medical Center, Nahariya, Israel.
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Qin H, Zhuang W, Liu X, Wu J, Li S, Wang Y, Liu X, Chen C, Zhang H. Targeting CXCR1 alleviates hyperoxia-induced lung injury through promoting glutamine metabolism. Cell Rep 2023; 42:112745. [PMID: 37405911 DOI: 10.1016/j.celrep.2023.112745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/22/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023] Open
Abstract
Although increasing evidence suggests potential iatrogenic injury from supplemental oxygen therapy, significant exposure to hyperoxia in critically ill patients is inevitable. This study shows that hyperoxia causes lung injury in a time- and dose-dependent manner. In addition, prolonged inspiration of oxygen at concentrations higher than 80% is found to cause redox imbalance and impair alveolar microvascular structure. Knockout of C-X-C motif chemokine receptor 1 (Cxcr1) inhibits the release of reactive oxygen species (ROS) from neutrophils and synergistically enhances the ability of endothelial cells to eliminate ROS. We also combine transcriptome, proteome, and metabolome analysis and find that CXCR1 knockdown promotes glutamine metabolism and leads to reduced glutathione by upregulating the expression of malic enzyme 1. This preclinical evidence suggests that a conservative oxygen strategy should be recommended and indicates that targeting CXCR1 has the potential to restore redox homeostasis by reducing oxygen toxicity when inspiratory hyperoxia treatment is necessary.
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Affiliation(s)
- Hao Qin
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, Jiangsu 221006, China; Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou 221006, Jiangsu, China
| | - Wei Zhuang
- Shanghai Key Laboratory of Signaling and Disease Research, School of Life Sciences and Technology, Tongji University, Shanghai 200092, China
| | - Xiucheng Liu
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, Jiangsu 221006, China; Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Junqi Wu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China; Shanghai Engineering Research Center of Lung Transplantation, Shanghai 200433, China
| | - Shenghui Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Yang Wang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China
| | - Xiangming Liu
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, Jiangsu 221006, China; Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou 221006, Jiangsu, China
| | - Chang Chen
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai 200433, China; Shanghai Engineering Research Center of Lung Transplantation, Shanghai 200433, China
| | - Hao Zhang
- Thoracic Surgery Laboratory, Xuzhou Medical University, Xuzhou, Jiangsu 221006, China; Department of Thoracic Surgery, Affiliated Hospital of Xuzhou Medical University, 99 West Huaihai Road, Xuzhou 221006, Jiangsu, China.
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Fothergill DM, Borras E, McCartney MM, Schelegle E, Davis CE. Exhaled breath condensate profiles of U.S. Navy divers following prolonged hyperbaric oxygen (HBO) and nitrogen-oxygen (Nitrox) chamber exposures. J Breath Res 2023; 17:10.1088/1752-7163/acd715. [PMID: 37207635 PMCID: PMC11057948 DOI: 10.1088/1752-7163/acd715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/19/2023] [Indexed: 05/21/2023]
Abstract
Prolonged exposure to hyperbaric hyperoxia can lead to pulmonary oxygen toxicity (PO2tox). PO2tox is a mission limiting factor for special operations forces divers using closed-circuit rebreathing apparatus and a potential side effect for patients undergoing hyperbaric oxygen (HBO) treatment. In this study, we aim to determine if there is a specific breath profile of compounds in exhaled breath condensate (EBC) that is indicative of the early stages of pulmonary hyperoxic stress/PO2tox. Using a double-blind, randomized 'sham' controlled, cross-over design 14 U.S. Navy trained diver volunteers breathed two different gas mixtures at an ambient pressure of 2 ATA (33 fsw, 10 msw) for 6.5 h. One test gas consisted of 100% O2(HBO) and the other was a gas mixture containing 30.6% O2with the balance N2(Nitrox). The high O2stress dive (HBO) and low O2stress dive (Nitrox) were separated by at least seven days and were conducted dry and at rest inside a hyperbaric chamber. EBC samples were taken immediately before and after each dive and subsequently underwent a targeted and untargeted metabolomics analysis using liquid chromatography coupled to mass spectrometry (LC-MS). Following the HBO dive, 10 out of 14 subjects reported symptoms of the early stages of PO2tox and one subject terminated the dive early due to severe symptoms of PO2tox. No symptoms of PO2tox were reported following the nitrox dive. A partial least-squares discriminant analysis of the normalized (relative to pre-dive) untargeted data gave good classification abilities between the HBO and nitrox EBC with an AUC of 0.99 (±2%) and sensitivity and specificity of 0.93 (±10%) and 0.94 (±10%), respectively. The resulting classifications identified specific biomarkers that included human metabolites and lipids and their derivatives from different metabolic pathways that may explain metabolomic changes resulting from prolonged HBO exposure.
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Affiliation(s)
| | - Eva Borras
- Mechanical and Aerospace Engineering, One Shields Avenue, University of California, Davis, Davis, California, USA
- UC Davis Lung Center, One Shields Avenue, University of California, Davis, Davis, California, USA
| | - Mitchell M. McCartney
- Mechanical and Aerospace Engineering, One Shields Avenue, University of California, Davis, Davis, California, USA
- UC Davis Lung Center, One Shields Avenue, University of California, Davis, Davis, California, USA
- VA Northern California Health Care System, Mather, California, USA
| | - Edward Schelegle
- Department of Anatomy, Physiology, and Cell Biology, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Cristina E. Davis
- Mechanical and Aerospace Engineering, One Shields Avenue, University of California, Davis, Davis, California, USA
- UC Davis Lung Center, One Shields Avenue, University of California, Davis, Davis, California, USA
- VA Northern California Health Care System, Mather, California, USA
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Analysis of Volatile Organic Compounds in Exhaled Breath Following a COMEX-30 Treatment Table. Metabolites 2023; 13:metabo13030316. [PMID: 36984755 PMCID: PMC10056109 DOI: 10.3390/metabo13030316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/24/2023] Open
Abstract
The COMEX-30 hyperbaric treatment table is used to manage decompression sickness in divers but may result in pulmonary oxygen toxicity (POT). Volatile organic compounds (VOCs) in exhaled breath are early markers of hyperoxic stress that may be linked to POT. The present study assessed whether VOCs following COMEX-30 treatment are early markers of hyperoxic stress and/or POT in ten healthy, nonsmoking volunteers. Because more oxygen is inhaled during COMEX-30 treatment than with other treatment tables, this study hypothesized that VOCs exhaled following COMEX-30 treatment are indicators of POT. Breath samples were collected before and 0.5, 2, and 4 h after COMEX-30 treatment. All subjects were followed-up for signs of POT or other symptoms. Nine compounds were identified, with four (nonanal, decanal, ethyl acetate, and tridecane) increasing 33–500% in intensity from before to after COMEX-30 treatment. Seven subjects reported pulmonary symptoms, five reported out-of-proportion tiredness and transient ear fullness, and four had signs of mild dehydration. All VOCs identified following COMEX-30 treatment have been associated with inflammatory responses or pulmonary diseases, such as asthma or lung cancer. Because most subjects reported transient pulmonary symptoms reflecting early-stage POT, the identified VOCs are likely markers of POT, not just hyperbaric hyperoxic exposure.
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Tang Y, Huang P, Chai D, Zhang X, Zhang X, Chen S, Su D, Huang Y. High-flow nasal oxygen reduces the incidence of hypoxia in sedated hysteroscopy for assisted reproduction. Front Med (Lausanne) 2022; 9:929096. [PMID: 36004375 PMCID: PMC9394211 DOI: 10.3389/fmed.2022.929096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/07/2022] [Indexed: 12/02/2022] Open
Abstract
Backgrounds and aims Pain is the main reason for hysteroscopy failure. In day-surgical settings, hysteroscopy procedures are commonly performed with the patient under sedation. Hypoxia is the most common adverse event during sedation and can lead to severe adverse events. This study aimed to compare the incidence of hypoxia when using high-flow nasal oxygen (HFNO) with that when using regular nasal oxygen in patients undergoing hysteroscopy with sedation. Materials and methods In this single-center, prospective, randomized, single-blinded study, 960 female patients undergoing elective diagnostic or operative hysteroscopy were randomly enrolled into the following two groups: the regular nasal group [O2 (3–6 L/min) covered by an HFNO] and the HFNO group [O2 (30–60 L/min)] from September 2021 to December 2021. All women were sedated with propofol (1.5 mg/kg) and remifentanil (1.5 μg/kg) in the operating room. The primary outcome was the incidence of hypoxia (75% ≤ SpO2 < 90%, < 60 s). Results HFNO decreased the incidence of hypoxia (75% ≤ SpO2 < 90%, < 60 s), subclinical respiratory depression (90% ≤ SpO2 < 95%) and severe hypoxia (SpO2 < 75% for any duration or 75% ≤ SpO2 < 90% for ≥ 60 s) from 24.38 to 0.83%, from 11.25 to 1.46% and from 3.75 to 0%, respectively (P < 0.001). Conclusion In procedures conducted to treat female infertility, HFNO can reduce hypoxia during hysteroscopy in patients sedated with propofol, and it can prevent the occurrence of subclinical respiratory depression and severe hypoxia.
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Volatile Organic Compounds Frequently Identified after Hyperbaric Hyperoxic Exposure: The VAPOR Library. Metabolites 2022; 12:metabo12050470. [PMID: 35629974 PMCID: PMC9142890 DOI: 10.3390/metabo12050470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/06/2022] [Accepted: 05/13/2022] [Indexed: 01/31/2023] Open
Abstract
Diving or hyperbaric oxygen therapy with increased partial pressures of oxygen (pO2) can have adverse effects such as central nervous system oxygen toxicity or pulmonary oxygen toxicity (POT). Prevention of POT has been a topic of interest for several decades. One of the most promising techniques to determine early signs of POT is the analysis of volatile organic compounds (VOCs) in exhaled breath. We reanalyzed the data of five studies to compose a library of potential exhaled markers for the early detection of POT. GC-MS data from five hyperbaric hyperoxic studies were collected. Wilcoxon signed-rank tests were used to compare baseline- and postexposure measurements; all ion fragments that significantly varied were compared by similarity using the National Institute of Standards and Technology (NIST) library. All identified molecules were cross-referenced with open-source databases and other scientific publications on VOCs to exclude compounds that occurred as a result of contamination, and to identify the compounds most likely to occur due to hyperbaric hyperoxic exposure. After identification and removal of contaminants, 29 compounds were included in the library. This library of hyperbaric hyperoxic-related VOCs can help to advance the development of an early noninvasive marker of POT. It enables validation by others who use more targeted MS-related techniques, instead of full-scale GC-MS, for their exhaled VOC research.
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