1
|
Woorons X, Billaut F, Lamberto C. Running exercise with end-expiratory breath holding up to the breaking point induces large and early fall in muscle oxygenation. Eur J Appl Physiol 2021; 121:3515-3525. [PMID: 34532775 DOI: 10.1007/s00421-021-04813-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The goal of this study was to assess the effects of repeated running bouts with end-expiratory breath holding (EEBH) up to the breaking point on muscle oxygenation. METHODS Eight male runners participated in three randomised sessions each including two exercises on a motorised treadmill. The first exercise consisted in performing 10-12 running bouts with EEBH of maximum duration either (separate sessions) at 60% (active recovery), 80% (passive recovery) or 100% (passive recovery) of the maximal aerobic velocity (MAV). Each repetition started at the onset of EEBH and ended at its release. In the second exercise of the session, subjects replicated the same procedure but with normal breathing (NB). Arterial oxygen saturation (SpO2), heart rate (HR) and the change in vastus lateralis muscle deoxy-haemoglobin/myoglobin (Δ[HHb/Mb]) and total haemoglobin/myoglobin (Δ[THb/Mb]) were continuously monitored throughout exercises. RESULTS On average, the EEBHs were maintained for 10.1 ± 1.1 s, 13.2 ± 1.8 s and 12.2 ± 1.7 s during exercise at 60%, 80% and 100% of MAV, respectively. In the three exercise intensities, SpO2 (mean nadir values: 76.3 ± 2.5 vs 94.5 ± 2.5%) and HR were lower with EEBH than with NB at the end of the repetitions; whereas, the mean Δ[HHb/Mb] (12.6 ± 5.2 vs 7.7 ± 4.4 µm) and Δ[THb/Mb] (- 0.6 ± 2.3 vs 3.8 ± 2.6 µm) were, respectively, higher and lower with EEBH (p < 0.05). CONCLUSION This study showed that performing repeated bouts of running exercises with EEBH up to the breaking point induced a large and early drop in muscle oxygenation compared with the same exercise with NB. This phenomenon was probably the consequence of the strong arterial oxygen desaturation induced by the maximal EEBHs.
Collapse
Affiliation(s)
- Xavier Woorons
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, EA 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, 59000, Lille, France. .,ARPEH, Association for Research and Promotion of Hypoventilation Training, 18 rue Saint Gabriel, 59800, Lille, France.
| | - François Billaut
- Département de Kinésiologie, Faculté de Médecine, Université Laval, Québec, QC, G1V 0S6, Canada
| | - Christine Lamberto
- UFR de Santé, Médecine et Biologie Humaine, Université Paris 13, Bobigny, France
| |
Collapse
|
2
|
Gille T, Boubaya M, Moya L, Lamberto C, Brillet P, Valeyre D, Planès C, Nunes H. Impact pronostique des composantes de la DLCO (Dm et Vc) dans la fibrose pulmonaire idiopathique. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
3
|
Moya L, Gille T, Boubaya M, Bertrand G, Planès C, Valeyre D, Lamberto C, Nunes H, Brillet P. Impact pronostique des mesures tomodensitométriques dans la fibrose pulmonaire idiopathique. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
4
|
Poirier E, Soued I, Alexandre M, Boussoura S, Lamberto C, Uzunhan Y, Gharbi N, Pascal F, Doan S, Brillet PY, Caux F, Laroche L, Prost-Squarcioni C. Pemphigoïde des muqueuses avec sténoses laryngées ou trachéales : série de 11 cas. Ann Dermatol Venereol 2014. [DOI: 10.1016/j.annder.2014.09.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
5
|
Alexandre V, Davila AM, Bouchoucha M, Bertin C, Even P, Lamberto C, Tomé D, Benamouzig R. Agreement between indirect calorimetry and traditional tests of lactose malabsorption. Dig Liver Dis 2013; 45:727-32. [PMID: 23816697 DOI: 10.1016/j.dld.2013.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 01/25/2013] [Accepted: 03/05/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Lactose malabsorption occurs frequently and the variable consequent intolerance may seriously impair quality of life. No reliable and convenient test method is in routine clinical practice. A recent animal study showed that the respiratory quotient changed significantly after ingestion of sucrose and lactose in naturally lactase-deficient rats. AIMS This exploratory study evaluated the relevance of monitoring the respiratory quotient after lactose ingestion to detect malabsorption. METHODS Healthy volunteers were identified and classified lactose absorbers and malabsorbers by a lactose tolerance test (25 g). After an overnight fast, a second lactose challenge was performed to monitor hydrogen excretion and respiratory quotient kinetics over 4h. Participants also completed questionnaires to score and localise their gastrointestinal symptoms. RESULTS 20 subjects were enrolled (10 per group, 60% males, mean age 34 ± 4 years). Respiratory quotient kinetics were different between absorbers and malabsorbers during the first 100 min after lactose ingestion (p<0.01) and during the initial 30-50 min period. Respiratory quotient was significantly, positively correlated to peak glycaemia (R=0.74) and negatively correlated to hydrogen excretion (R=-0.51) and symptoms score (R=-0.46). CONCLUSIONS Indirect calorimetry could improve the reliability of lactose malabsorption diagnosis. Studies on larger populations are needed to confirm the validity of this test and propose a simplified measurement.
Collapse
Affiliation(s)
- Virginie Alexandre
- AgroParisTech, Nutrition Physiology and Ingestion Behavior, Paris, France; Vivatech, Paris, France
| | | | | | | | | | | | | | | |
Collapse
|
6
|
Kelaidi C, Beyne-Rauzy O, Braun T, Sapena R, Cougoul P, Adès L, Pillard F, Lamberto C, Charniot JC, Guerci A, Choufi B, Stamatoullas A, Slama B, De Renzis B, Ame S, Damaj G, Boyer F, Chaury MP, Legros L, Cheze S, Testu A, Gyan E, Béné MC, Rose C, Dreyfus F, Fenaux P. Erratum to: High response rate and improved exercise capacity and quality of life with a new regimen of darbepoetin alfa with or without filgrastim in lower-risk myelodysplastic syndromes: a phase II study by the GFM. Ann Hematol 2013. [DOI: 10.1007/s00277-013-1713-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
Kelaidi C, Beyne-Rauzy O, Braun T, Sapena R, Cougoul P, Adès L, Pillard F, Lamberto C, Lambert C, Charniot JC, Guerci A, Choufi B, Stamatoullas A, Slama B, De Renzis B, Ame S, Damaj G, Boyer F, Chaury MP, Legros L, Cheze S, Testu A, Gyan E, Béné MC, Rose C, Dreyfus F, Fenaux P. High response rate and improved exercise capacity and quality of life with a new regimen of darbepoetin alfa with or without filgrastim in lower-risk myelodysplastic syndromes: a phase II study by the GFM. Ann Hematol 2013; 92:621-31. [PMID: 23358617 DOI: 10.1007/s00277-013-1686-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/17/2013] [Indexed: 11/24/2022]
Abstract
Darbepoetin (DAR), with or without granulocyte colony-stimulating factor (G-CSF), has proved effective in treating anemia in patients with lower-risk myelodysplastic syndrome (MDS), but its effects on quality of life (QoL) and exercise functioning are less well established. In this phase II study (no. NCT00443339), lower-risk MDS patients with anemia and endogenous erythropoietin (EPO) level <500 IU/L received DAR 500 μg once every 2 weeks for 12 weeks, with G-CSF added at week 12 in non-responders. Physical performance was assessed with the 6-min walking test and, for fit patients, maximal oxygen consumption (VO2max). QoL was evaluated using SF-36 and FACT-An tests. In 99 patients, erythroid response rate according to IWG 2006 criteria was 48 and 56 % at 12 and 24 weeks, respectively. Addition of G-CSF rescued 22 % of non-responders. In 48 % of the responders, interval between darbepoetin injections could be increased for maintenance treatment. Serum EPO level was the only independent predictive factor of response at 12 weeks, and its most discriminant cutoff value was 100 IU/L. QoL and VO2max showed improvement over time in responders, compared with non-responders. With a median follow-up of 52 months, median response duration was not reached, and 3-year cumulative incidence of acute myeloid leukemia and overall survival (OS) was 14.5 and 70 %, respectively. Baseline transfusion dependence, International Prognostic Score System (IPSS), and Revised IPSS accurately predicted OS from treatment onset. Tolerance of darbepoetin was good. In conclusion, this regimen of darbepoetin every 2 weeks yielded high response rates and prolonged response duration. Objective improvement in exercise testing and in patient-reported QoL confirms the clinical relevance of anemia correction with erythropoiesis-stimulating agents.
Collapse
Affiliation(s)
- C Kelaidi
- GFM Service d'Hématogie Clinique, Hôpital Avicenne, Assistance Publique des Hôpitaux de Paris, Université Paris 13, 125 rue de Stalingrad, Bobigny, France
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Salvator H, Gille T, Herve A, Bron C, Lamberto C, Valeyre D. Chronic beryllium disease: azathioprine as a possible alternative to corticosteroid treatment. Eur Respir J 2012; 41:234-6. [DOI: 10.1183/09031936.00095712] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
9
|
Nunes H, Uzunhan Y, Gille T, Lamberto C, Valeyre D, Brillet PY. Imaging of sarcoidosis of the airways and lung parenchyma and correlation with lung function. Eur Respir J 2012; 40:750-65. [PMID: 22790910 DOI: 10.1183/09031936.00025212] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Imaging has a prominent role in the assessment of sarcoidosis diagnosis and outcome, which are extremely variable. Chest radiography staging helps predict the probability of spontaneous remission, and stage IV is associated with higher mortality. However, the reproducibility of reading is poor and changes in radiography and lung function are inconsistently correlated, which may be problematic for the monitoring of disease and treatment response. Chest computed tomography (CT) makes a great diagnostic contribution in difficult cases. Bilateral hilar lymphadenopathy with peri-lymphatic micronodular pattern is highly specific for sarcoidosis. CT is important for the investigation of pulmonary complications, including aspergilloma and pulmonary hypertension. CT improves the yield of bronchoscopy for obtaining a positive endobronchial or transbronchial biopsy. CT findings may also discriminate between active inflammation and irreversible fibrosis, with occasional influence on therapeutic decisions. Three CT patterns of fibrotic sarcoidosis are identified, with different functional profiles: predominant bronchial distortion is associated with obstruction; honeycombing is associated with restriction and lower diffusing capacity of the lung for carbon monoxide; whereas functional impairment is relatively minor with linear pattern. The clinical impact of correlations between CT severity scores and functional impairment is uncertain, except for its utility elucidating the mechanisms of airflow limitation, which include bronchial distortion, peribronchovascular thickening, air-trapping and bronchial compression by lymphadenopathy.
Collapse
Affiliation(s)
- Hilario Nunes
- Department of Pneumology, University of Paris 13, UPRES EA 2363, Assistance Publique-Hôpitaux de Paris, Avicenne Hospital, Bobigny, France.
| | | | | | | | | | | |
Collapse
|
10
|
Woorons X, Bourdillon N, Lamberto C, Vandewalle H, Richalet JP, Mollard P, Pichon A. Cardiovascular Responses During Hypoventilation at Exercise. Int J Sports Med 2011; 32:438-45. [DOI: 10.1055/s-0031-1271788] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
11
|
Marchand-Adam S, El Khatib A, Guillon F, Brauner MW, Lamberto C, Lepage V, Naccache JM, Valeyre D. Short- and long-term response to corticosteroid therapy in chronic beryllium disease. Eur Respir J 2008; 32:687-93. [DOI: 10.1183/09031936.00149607] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
12
|
Abstract
Although the thrombotic risk of heparin-induced thrombocytopaenia (HIT) is well recognized and may affect any vascular bed, the involvement of adrenal veins has been less commonly described. We report the case of a 86-year-old woman who developed bilateral massive adrenal haematoma associated with HIT, resulting in acute adrenal insufficiency. After immediate discontinuation of heparin and starting therapy with danaparoid and hydrocortisone, the clinical evolution was favourable, although adrenal failure was irreversible. When abdominal pain, hypotension and fever occur during heparin therapy, associated with a drop in platelet count, acute adrenal insufficiency secondary to HIT should be considered, as early diagnosis is essential for the treatment of this life-threatening complication.
Collapse
Affiliation(s)
- G Poulain
- Division of general internal medicine, Saint-Luc University Hospital, Brussels, Belgium
| | | | | | | | | |
Collapse
|
13
|
Mollard P, Woorons X, Letournel M, Lamberto C, Favret F, Pichon A, Beaudry M, Richalet JP. Determinant factors of the decrease in aerobic performance in moderate acute hypoxia in women endurance athletes. Respir Physiol Neurobiol 2007; 159:178-86. [PMID: 17766196 DOI: 10.1016/j.resp.2007.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2007] [Revised: 06/23/2007] [Accepted: 06/23/2007] [Indexed: 11/28/2022]
Abstract
The purpose of this study was to evaluate the limiting factors of maximal aerobic performance in endurance trained (TW) and sedentary (UW) women. Subjects performed four incremental tests on a cycle ergometer at sea level and in normobaric hypoxia corresponding to 1000, 2500 and 4500 m. Maximal oxygen uptake decrement (Delta VO2 max) was larger in TW at each altitude. Maximal heart rate and ventilation decreased at 4500 m in TW. Maximal cardiac output remained unchanged. In both groups, arterialized oxygen saturation (Sa'O2 max) decreased at and above 2500 m and maximal O2 transport (QaO2 max) decreased from 1000 m. At 4500 m, there was no more difference in QaO2 max between TW and UW. Mixed venous O2 pressure (PvO2 max) was lower and O2 extraction (O2ERmax) greater in TW at each altitude. The primary determinant factor of VO2 max decrement in moderate acute hypoxia in trained and untrained women is a reduced maximal O2 transport that cannot be compensate by tissue O2 extraction.
Collapse
Affiliation(s)
- Pascal Mollard
- Université Paris 13, Laboratoire Réponses cellulaires et fonctionnelles à l'hypoxie, EA2363, ARPE, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Mollard P, Woorons X, Letournel M, Lamberto C, Favret F, Pichon A, Beaudry M, Richalet JP. Determinants of maximal oxygen uptake in moderate acute hypoxia in endurance athletes. Eur J Appl Physiol 2007; 100:663-73. [PMID: 17534646 DOI: 10.1007/s00421-007-0457-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2007] [Indexed: 10/23/2022]
Abstract
The factors determining maximal oxygen consumption were explored in eight endurance trained subjects (TS) and eight untrained subjects (US) exposed to moderate acute normobaric hypoxia. Subjects performed maximal incremental tests at sea level and simulated altitudes (1,000, 2,500, 4,500 m). Heart rate (HR), stroke volume (SV), cardiac output (.Q), arterialized oxygen saturation (Sa'O2), oxygen uptake (.VO2max), ventilation (.VE, expressed in normobaric conditions) were measured. At maximal exercise, ventilatory equivalent (.VE/.VO2max), O2 transport (.QaO2max) and O2 extraction (O2ERmax) were calculated. In TS, .Qmax remained unchanged despite a significant reduction in HRmax at 4,500 m. SVmax remained unchanged. .VEmax decreased in TS at 4,500 m, .VE/.VO2max was lower in TS and greater at 4,500 m vs. sea level in both groups. Sa'O2max decreased at and above 1,000 m in TS and 2,500 m in US, O2ERmax increased at 4,500 m in both groups. .QaO2max decreased with altitude and was greater in TS than US up to 2,500 m but not at 4,500 m. .VO2max decreased with altitude but the decrement (Delta.VO2max) was larger in TS at 4,500 m. In both groups Delta.VO2max in moderate hypoxia was correlated with Delta.QaO2max. Several differences between the two groups are probably responsible for the greater Delta.VO2max in TS at 4,500 m : (1) the relative hypoventilation in TS as shown by the decrement in .VEmax at 4,500 m (2) the greater.QaO2max decrement in TS due to a lower Sa'O2max and unchanged .Qmax 3) the smaller increase in O2ERmax in TS, insufficient to compensate the decrease in .QaO2max.
Collapse
Affiliation(s)
- Pascal Mollard
- Laboratoire Réponses cellulaires et fonctionnelles à l'hypoxie, Université Paris 13, 74 rue Marcel Cachin, EA2363, ARPE, 93017 Bobigny Cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
15
|
Woorons X, Mollard P, Pichon A, Duvallet A, Richalet JP, Lamberto C. Prolonged expiration down to residual volume leads to severe arterial hypoxemia in athletes during submaximal exercise. Respir Physiol Neurobiol 2007; 158:75-82. [PMID: 17434347 DOI: 10.1016/j.resp.2007.02.017] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Revised: 02/08/2007] [Accepted: 02/24/2007] [Indexed: 11/27/2022]
Abstract
The goal of this study was to assess the effects of a prolonged expiration (PE) carried out down to the residual volume (RV) during a submaximal exercise and consider whether it would be worth including this respiratory technique in a training programme to evaluate its effects on performance. Ten male triathletes performed a 5-min exercise at 70% of maximal oxygen consumption in normal breathing (NB(70)) and in PE (PE(70)) down to RV. Cardiorespiratory parameters were measured continuously and an arterialized blood sampling at the earlobe was performed in the last 15s of exercise. Oxygen consumption, cardiac frequency, end-tidal and arterial carbon dioxide pressure, alveolar-arterial difference for O(2) (PA(O2) - Pa(O2)) and P(50) were significantly higher, and arterial oxygen saturation (87.4+/-3.4% versus 95.0+/-0.9%, p<0.001), alveolar (PA(O2)) or arterial oxygen pressure, pH and ventilatory equivalent were significantly lower in PE(70) than NB(70). There was no difference in blood lactate between exercise modalities. These results demonstrate that during submaximal exercise, a prolonged expiration down to RV can lead to a severe hypoxemia caused by a PA(O2) decrement (r=0.56; p<0.05), a widened PA(O2) - Pa(O2) (r=-0.85; p<0.001) and a right shift of the oxygen dissociation curve (r=-0.73; p<0.001).
Collapse
Affiliation(s)
- Xavier Woorons
- Université Paris 13, Laboratoire Réponses cellulaires et fonctionnelles à l'hypoxie, EA2363, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France.
| | | | | | | | | | | |
Collapse
|
16
|
Mollard P, Woorons X, Letournel M, Cornolo J, Lamberto C, Beaudry M, Richalet JP. Role of maximal heart rate and arterial O2 saturation on the decrement of VO2max in moderate acute hypoxia in trained and untrained men. Int J Sports Med 2006; 28:186-92. [PMID: 17024632 DOI: 10.1055/s-2006-924215] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We aimed to evaluate 1) the altitude where maximal heart rate (HR (max)) decreases significantly in both trained and untrained subjects in moderate acute hypoxia, and 2) if the HR (max) decrease could partly explain the drop of V.O (2max). Seventeen healthy males, nine trained endurance athletes (TS) and eight untrained individuals (US) were studied. Subjects performed incremental exercise tests at sea level and at 5 simulated altitudes (1000, 1500, 2500, 3500, 4500 meters). Power output (PO), heart rate (HR), arterial oxygen saturation (SaO (2)), oxygen uptake (V.O (2)), arterialized blood pH and lactate were measured. Both groups showed a progressive reduction in V.O (2max). The decrement in HR (max) (DeltaHR (max)) was significant from 1000 m for TS and 2500 m for US and more important in TS than US (at 1500 m and 3500 m). At maximal exercise, TS had a greater reduction in SaO (2) (DeltaSaO (2)) at each altitude. DeltaHR (max) observed in TS was correlated with DeltaSaO (2). When the two groups were pooled, simple regressions showed that DeltaV.O (2max) was correlated with both DeltaSaO (2) and DeltaHR (max). However, a multiple regression analysis demonstrated that DeltaSaO (2) alone may account for DeltaV.O (2max). Furthermore, in spite of a greater reduction in SaO (2) and HR (max) in TS, no difference was evidenced in relative DeltaV.O (2max) between groups. Thus, in moderate acute hypoxia, the reduction in SaO (2) is the primary factor to explain the drop of V.O (2max) in trained and untrained subjects.
Collapse
Affiliation(s)
- P Mollard
- Université Paris 13, Laboratoire Réponses cellulaires et fonctionnelles à l'hypoxie, EA2363, ARPE, Bobigny, France.
| | | | | | | | | | | | | |
Collapse
|
17
|
Woorons X, Mollard P, Pichon A, Lamberto C, Duvallet A, Richalet JP. Moderate exercise in hypoxia induces a greater arterial desaturation in trained than untrained men. Scand J Med Sci Sports 2006; 17:431-6. [PMID: 16805783 DOI: 10.1111/j.1600-0838.2006.00577.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
During moderate exercise breathing a low inspired O(2) fraction (F(I)O(2)), arterial O(2) desaturation may depend on the fitness level. Seven trained (TM) and seven untrained men (UTM) cycled in normoxia and in hypoxia (F(I)O(2)=0.187, 0.173, 0.154, 0.13 and 0.117). We compared TM and UTM at submaximal intensities below the ventilatory threshold. Ventilatory variables were monitored and arterial oxygen saturation was measured by pulse oximetry. O(2) saturation was not different between groups at sea level. In hypoxia, O(2) saturation was lower in TM than in UTM at F(I)O(2)=0.154 (87.3 +/- 2.9% vs 90.4 +/- 1.5% at 90 W) and below. Both the ventilatory-equivalent and the end-tidal O(2) pressure were lower in TM at sea level and at every F(I)O(2), with the differences between TM and UTM becoming apparent at lower exercise intensity and increasing in magnitude as the severity of hypoxia increased. O(2) saturation was correlated with the ventilatory parameters at every F(I)O(2) and the correlations were stronger in severe hypoxia. These results demonstrate that a moderate exercise carried out in hypoxia, contrary to normoxic conditions, can lead to a greater arterial desaturation in TM compared with UTM. This phenomenon could be partly attributed to a relative hypoventilation in trained subjects.
Collapse
Affiliation(s)
- X Woorons
- Université Paris 13, Laboratoire Réponses cellulaires et fonctionnelles à l'hypoxie, Bobigny, France.
| | | | | | | | | | | |
Collapse
|
18
|
Abstract
PURPOSE The purpose of this study was to determine the physiological responses of sedentary and endurance-trained female subjects during maximal exercise at different levels of acute hypoxia. METHODS Fourteen women who were sea level residents were divided into two groups according to their level of fitness: 1) endurance-trained women (TW) (N = 7), VO(2max) = 56.3 +/- 4.7 mL.kg(-1).min(-1); and 2) sedentary women (SW) (N = 7), VO(2max) = 34.8 +/- 5.6 mL.kg(-1).min(-1). Subjects performed four maximal cycle ergometer tests in normoxia and under hypoxic conditions (F(I)O(2) = 0.187, 0.154, and 0.117, corresponding to altitudes of 1000, 2500, and 4500 m, respectively). RESULTS VO(2max) decreased significantly by 3.6 +/- 2.1, 14 +/- 2.5, and 27.4 +/- 3.6% in TW, and by 5 +/- 4, 9.4 +/- 6.4, and 18.7 +/- 7% in SW at 1000, 2500, and 4500 m, respectively. The drop of VO(2max) (DeltaVO(2max)) was greater in TW at and above 2500 m. Arterial O2 saturation (SpO(2)) at maximal exercise was lower in TW at every altitude (1000 m: 90.9 +/- 1.9 vs 94.6 +/- 1.4%; 2500 m: 82.8 +/- 2.8 vs 90.0 +/- 2.1%; 4500 m: 65.0 +/- 4.7 vs 73.6 +/- 4.5%). Maximal heart rate decreased significantly from 1000 m in the two groups. SpO(2) was correlated to DeltaVO(2max) at 4500 m (r = -0.81, P < 0.01) and 2500 m (r = -0.81, P < 0.01), but not below. Furthermore, we noted a relationship between SpO(2) and O2 pulse (VO(2)/HR) at every F(I)O(2). CONCLUSION These results demonstrate that endurance-trained women show a greater decrement in VO(2max) at high altitudes. This could be explained mainly by a higher arterial desaturation, which is largely caused, according to our results, by diffusion limitation.
Collapse
Affiliation(s)
- Xavier Woorons
- Laboratory of Functional and Cellular Responses to Hypoxia, UFR-SMBH Universite Paris, 74 rue Marcel Cachin, 93017 Bobigny Cedex, France.
| | | | | | | | | |
Collapse
|
19
|
Duperron F, Velea V, Ioos V, Brauner M, Lamberto C, Valeyre D. [Pathophysiology of interstitial lung disease]. Rev Pneumol Clin 2005; 61:159-63. [PMID: 16142188 DOI: 10.1016/s0761-8417(05)84807-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Chronic interstitial lung disease (ILD) groups a number of diseases with the common feature of radiological pulmonary infiltration, typical functional syndrome, and diffuse involvement of the deep pulmonary parenchyma identified histologically. Correlations between histological and radiological findings have enabled progress in both fields, leading to better interpretation of the radiological findings and optimizing the etiological diagnosis. Besides the signs themselves, their distribution in relation to the normal lung structures is highly contributive. Function tests can be used to quantify the impact on the respiratory system and assess the effect of treatment. Evidence-based criteria will progressively replace the consensual criteria enabling more effective evaluation of treatment in difficult pathological conditions such as idiopathic pulmonary fibrosis.
Collapse
Affiliation(s)
- Florence Duperron
- Service de Pneumologie, Hôpital Avicenne, 125, route de Stalingrad, 93009 Bobigny, et UFR SMBH, Université Paris 13, Bobigny
| | | | | | | | | | | |
Collapse
|
20
|
Lamberto C, Nunes H, Le Toumelin P, Duperron F, Valeyre D, Clerici C. Membrane and Capillary Blood Components of Diffusion Capacity of the Lung for Carbon Monoxide in Pulmonary Sarcoidosis. Chest 2004; 125:2061-8. [PMID: 15189922 DOI: 10.1378/chest.125.6.2061] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Resting pulmonary diffusing capacity of the lung for carbon monoxide (DLCO) is known to be the best predictor of arterial desaturation during exercise in patients with sarcoidosis. However, the relative contribution of each of the two components of DLCO-alveolar membrane diffusing capacity (Dm) and pulmonary capillary blood volume (Vc)-remains unclear. STUDY OBJECTIVES To evaluate which component is responsible for the decrease of resting DLCO in patients with sarcoidosis, and to determine which resting pulmonary function test, including Dm and Vc, is the best predictor of gas exchange abnormalities during submaximal exercise. DESIGN Prospective analysis of patients referred to our department of respiratory medicine. PATIENTS Twenty four patients with pulmonary sarcoidosis were separated into two groups according to chest radiographic findings: group 1, stages 2 and 3 (n = 15); group 2, stage 4 (n = 9). All the patients completed pulmonary function tests (flows, volumes, single-breath DLCO, transfer coefficient [Ka], Dm, Vc) and submaximal exercise (two steady-state levels of mild and moderate exercise corresponding respectively to a target oxygen consumption of approximately 10 to 15 mL/min/kg). RESULTS DLCO was reduced in the two groups (group 1, 63 +/- 16% of predicted; group 2, 64 +/- 16% of predicted). Dm was severely decreased (group 1, 58 +/- 24% of predicted; group 2, 51 +/- 15% of predicted), whereas Vc was unchanged or only mildly decreased (group 1, 81 +/- 18% of predicted; group 2, 85 +/- 28% of predicted). Whatever the group of patients and the exercise level, Dm and DLCO were the strongest predictors (p < 0.001) of gas exchange abnormalities. Ka or volumes were weak predictors, and Vc or flows were not related with exercise gas exchange. CONCLUSIONS This study demonstrates that a decrease in Dm mostly accounts for resting DLCO reduction, and that Dm as well as DLCO are highly predictive of gas exchange abnormalities at exercise in patients with sarcoidosis.
Collapse
Affiliation(s)
- Christine Lamberto
- Department of Physiology, Assistance Publique/Hôpitaux de Paris, Hôpital Avicenne, Bobigny, France.
| | | | | | | | | | | |
Collapse
|
21
|
Pourriat JL, Baud M, Lamberto C, Fournier JL, Cupa M. Measurement of CO2 response with the breath-by-breath automatic acquisition of the breathing pattern and occlusion pressure. J Clin Monit Comput 1994; 10:26-34. [PMID: 8126535 DOI: 10.1007/bf01651463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Our objective is to present a methodology for the automated acquisition and storage of BP and P0.1 during a CO2 rebreathing test. METHODS The system consists of a microcomputer with additional circuits and an automatic electronically controlled valve to occlude the inspiratory airway. Data collection and data processing are separate programs. Airway pressure and flow are digitized at a 100-Hz rate, while PETCO2 is determined and P0.1 is measured on a breath-by-breath basis. Off-line processing calculates the BP variables, generates a correlation matrix (VE/PETCO2, TTOT/PETCO2, TI/PETCO2, TE/PETCO2, [VT/TI]/PETCO2, [TI/TTOT]/PETCO2, P0.1/PETCO2), and edits graphic data. The accuracy of the volume and pressure measurements was tested by comparing known volumes provided by a syringe (n = 100) and a series of pressures controlled by a water manometer (n = 41) on the one hand, with volumes and pressures measured by the device. The accuracy of the time intervals and P0.1 was assessed by comparing in 10 healthy subjects the values measured manually on a graphic recording with those provided by the device (n = 170). RESULTS Volumes:Vmeasured = 0.99 x Vcontrolled, r = 0.99, p < 0.001. Pressures:Pmeasured = 0.97 x Pcontrolled + 0.09, r = 0.98, p < 0.001. Inspiratory time:TIautomatic = 0.91 x TIgraphic + 0.22, r = 0.93, p < 0.001. Expiratory time:TEautomatic = 0.93 x TEgraphic + 0.34, r = 0.95, p < 0.001. Occlusion pressure:P0.1automatic = 0.95 x P0.1graphic + 0.62, r = 0.94, p < 0.001. Reproducibility was assumed to be represented by the intraindividual coefficient of variation of the CO2 response. The comparison of an automatic breath-to-breath method with a graphic manual recording revealed significantly less variability with the former (VE/PETCO2: 15.2 +/- 4.5% vs 22.5 +/- 6.3%, p < 0.01; P0.1/PETCO2:8.3 +/- 4.3% vs 19.7 +/- 7.2%, p < 0.001; [VT/TI]/PETCO2:9.1 +/- 3.5% vs 14.5 +/- 5.3%, p < 0.05). CONCLUSION Our automated acquisition and storage of waveforms and breath-by-breath determination of BP and P0.1 provide an easy and thorough analysis of the respiratory response to CO2 and decrease the variability of the results.
Collapse
Affiliation(s)
- J L Pourriat
- Département d'Anesthésie-Réanimation, CHU Jean Verdier, Bondy, France
| | | | | | | | | |
Collapse
|
22
|
Pourriat JL, Baud M, Lamberto C, Fosse JP, Cupa M. Effects of doxapram on hypercapnic response during weaning from mechanical ventilation in COPD patients. Chest 1992; 101:1639-43. [PMID: 1600786 DOI: 10.1378/chest.101.6.1639] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Failure of weaning from mechanical ventilation in COPD patients is often related to diaphragmatic fatigue. Whether there is a central respiratory drive fatigue and a reserve of excitability is still debated. The purpose of this study was to analyze the following in 13 COPD patients weaned from mechanical ventilation: (1) ventilatory (VE/PETCO2) and neuromuscular (P0.1/PETCO2) response to hypercapnia; (2) the maximum reserve capacity measured through changes in the VE/PETCO2 and P0.1/PETCO2 slopes after doxapram (DXP) infusion, which, given during the test, allows measurement of the maximum response capacity to overstimulation; and (3) analyze the influence of these changes on the outcome of weaning. The results show a variable P0.1/PETCO2 response and a low VE/PETCO2. DXP infusion does not change the slopes of these relations but increases the end-expiratory volume (delta FRCd); (p less than 0.02). Since there was no change in the VE/PETCO2, P0.1/PETCO2, and delta FRC values with or without DXP, there was no excitability reserve in patients who were successfully weaned. When weaning failed, DXP did not change VE/PETCO2 and P0.1/PETCO2 slope, but delta FRCd was greater the delta FRC (p less than 0.001). The excitability reserve in these patients leads to an increase in end-expiratory volume, probably worsening the diaphragm dysfunction.
Collapse
Affiliation(s)
- J L Pourriat
- Department of Anesthesiology/Critical Care Unit, Université Paris XIII, Bondy, France
| | | | | | | | | |
Collapse
|
23
|
Pourriat JL, Lamberto C, Baud M, Fosse JP, Hoang PH, Cupa M. [Hyperoxia test during attempts to withdraw artificial ventilation]. Agressologie 1989; 30:217-21. [PMID: 2782551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A 30 minute test of hyperoxia (10 l.min-1) was conducted in patients (n = 21) with chronic obstructive lung disease during the weaning trials from mechanical ventilation. Two groups were formed according to whether the occlusion pressure at 100 ms (PO.1), index of central stimulation, decreased or not during the test. The first group lowered PO.1 and increased PaCO2 by decreasing VE (minute-ventilation), VA (alveolar ventilation) and increasing the VD/VT ratio; the others had a lower PO.1 and did not modify it after administration of 02 despite a lowered PaO2 initially identical to that in the first group. They held PaCO2 constant by increasing VE and by maintaining VA in relationship with an improvement in diaphragm contractility and/or a better response to hypercapnia stimulus. All the patients is this group were successfully weaned eight days after the study period.
Collapse
|
24
|
Pourriat JL, Lamberto C, Fosse JP, Vasseur B, Cupa M. Steady-state breathing pattern responses to small inspiratory resistive loads in COPD patients. Application to weaning from mechanical ventilation. Chest 1989; 95:364-9. [PMID: 2492464 DOI: 10.1378/chest.95.2.364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We investigated the effect of small inspiratory resistive loads on the breathing patterns of patients with COPD admitted to the ICU for acute respiratory failure. Patients were in stable clinical condition three days after weaning from the acute-phase ventilation. Healthy nonsmokers served as controls. Breathing patterns were recorded for 20-min periods during unloaded breathing (R0), then with small inspiratory resistive loads (R1 = 2.5 cmH2O L/s and R2 = 5.2 cmH2O L/s) applied in random order. Respiratory parameters were memorized in real time and blood gases measured continuously with a transcutaneous PO2/PCO2 monitor and compared periodically with arterial blood gases. Minute volume (VE) and respiratory rate decreased with no modification in blood gas values. In the COPD patients, R1 was too small to be perceived; when R2 was applied, no increase in TI was observed, and VT and VT/TI decreased. The VE could not be maintained despite a shortening of expiratory time. The COPD patients did not have significant increase of occlusion pressure (P0.1). Mean blood gas values did not change during the testing, but the coefficient of variation of tcPCO2 increased. During the critical period following weaning from artificial ventilation, COPD patients did not respond in the same manner as normal subjects to inspiratory resistive loads, but did not have modified gas exchange during the 20-min period.
Collapse
Affiliation(s)
- J L Pourriat
- Département d'Anesthésie-Réanimation, Hôpital Avicenne, Paris, France
| | | | | | | | | |
Collapse
|
25
|
Pourriat JL, Lamberto C, Hoang PH, Fournier JL, Vasseur B. Diaphragmatic fatigue and breathing pattern during weaning from mechanical ventilation in COPD patients. Chest 1986; 90:703-7. [PMID: 3769572 DOI: 10.1378/chest.90.5.703] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
The medium-term outcome of weaning from mechanical ventilation in COPD patients is not easy to anticipate because a respiratory fatigue may eventually develop. We evaluated the diaphragmatic function and the breathing pattern during 40 weaning trials on 15 patients ventilated after acute respiratory failure. We formed two groups according to the success (group B, n = 18) or failure (group A, n = 19) of the medium-term attempt (group A/less than 10 hours; group B/more than 12 hours). Provided the patients showed the classic weaning criteria (tidal volume greater than 5 ml/kg, respiratory frequency less than 30 breaths per minute, PaO2 greater than 50 mm Hg), the study of the breathing pattern did not allow differentiation between the groups. However, the transdiaphragmatic pressure (Pdi) and the Pdimax, which gave an indication of the power of diaphragm contraction, dropped early in the group that could not stand weaning, with an increase in the Pdi/Pdimax ratio. In addition, this same group showed a diaphragmatic dysfunction attested for by a frequent negative gastric pressure associated with or shortly preceded by an abdominal paradoxic motion.
Collapse
|
26
|
Lamberto C, Saumon G, Loiseau P, Battesti JP, Georges R. Respiratory function in recent pulmonary sarcoidosis with special reference to small airways. Bull Eur Physiopathol Respir 1985; 21:309-15. [PMID: 4041656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study was designed to evaluate airway dysfunction in relation to duration of disease in patients with pulmonary sarcoidosis for less than two years. Twenty four subjects with recent disease were compared with nine subjects with disease of more than two years' duration. They underwent lung function testing (lung volumes, lung transfer factor for CO and pulmonary mechanics). Small airway function was assessed using frequency dependence of compliance, closing volume, nitrogen single breath test and flow-volume curves breathing air and helium-oxygen mixture. Airway dysfunction was seen in pulmonary sarcoidosis even in some patients with recent disease and it became more evident in disease of longer duration. The results suggest small airway involvement. The frequency of airway dysfunction is difficult to evaluate, varying from estimates of 0% using flow-volume curves to 79% with frequency dependence of compliance. This apparent discrepancy could be explained by the consequences of parenchymal involvement leading to inhomogeneities in distribution of compliance, and of elastic lung recoil. We conclude that patients with recent sarcoidosis are probably affected by intrinsic small airway disease, but an increase in elastic recoil often conceals its consequences. The airway disease may not be apparent using conventional function tests and published predicted values.
Collapse
|
27
|
Pourriat JL, Lamberto JF, Lamberto C, Gabry AL, Cupa M. [Ventilatory profile and occlusion pressure in patients with chronic respiratory insufficiency during weaning from mechanical ventilation]. Ann Fr Anesth Reanim 1982; 1:639-46. [PMID: 7185289 DOI: 10.1016/s0750-7658(82)80108-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
28
|
Lamberto C, Kleinknecht D. [Long-term course of arterial hypertension treated with beta-blockers. 1. Comparison with the results obtained with non-beta-blocking antihypertensive agents]. Rev Med Interne 1981; 2:207-19. [PMID: 6114526 DOI: 10.1016/s0248-8663(81)80068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
29
|
Lamberto C, Kleinknecht D. [Long-term course of arterial hypertension treated with beta-blockers. Study of factors in resistance to treatment]. Rev Med Interne 1981; 2:221-8. [PMID: 6114527 DOI: 10.1016/s0248-8663(81)80069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|