Hyperoxic Ventilatory Response Research Articles

Hyperoxic ventilatory response in infants is related to nocturnal hypoxaemia

BackgroundThe carotid bodies primarily serve as oxaemia sensors that affect tidal breathing. Their function has not yet been studied in infants with nocturnal hypoxaemia. This cross-sectional study aimed to characterise the hyperoxic ventilatory response (HVR) in infants and its relationship to nocturnal hypoxaemia.MethodsThe HVR was analysed in term infants aged <24 months with childhood interstitial lung disease (chILD), those with severe recurrent wheezing (wheeze), and nonrespiratory controls. The HVR timing was characterised using hyperoxia response time (HRT1), and HVR magnitude was characterised by the relative change in minute volume between normoxia and 30-s hyperoxia (VE_dH30). Time spent with an arterial haemoglobin oxygen saturation (SpO2) <90% during overnight monitoring (t90) was estimated.ResultsHVR data were available for 23 infants with chILD, 24 wheeze and 14 control infants. A significant decrease in minute volume under 30 s of hyperoxia was observed in all patients. HRT1 was shorter in chILD (5.6±1.2 s) and wheeze (5.9±1.5 s) groups than in the controls (12.6±5.5 s) (ANOVA p<0.001).VE_dH30 was increased in the chILD group (24.3±8.0%) compared with that in the controls (14.7±9.2%) (p=0.003).t90was abnormal in the wheeze (8.0±5.0%) and chILD (32.7±25.8%) groups and higher in the chILD group than in the controls (p<0.001). HRT1 negatively correlated witht90in all groups.ConclusionSignificant differences in HVR timing and magnitude were noted in the chILD, wheeze and control groups. A relationship between nocturnal hypoxaemia and HRT1 was proposed. HVR characterisation may help identify patients with abnormal nocturnalSpO2.

The effects of P2Y12 adenosine receptors' inhibitors on central and peripheral chemoreflexes.

Introduction: The most common side effect of ticagrelor is dyspnea, which leads to premature withdrawal of this life-saving medication in 6.5% of patients. Increased chemoreceptors' sensitivity was suggested as a possible pathophysiological explanation of this phenomenon; however, the link between oversensitization of peripheral and/or central chemosensory areas and ticagrelor intake has not been conclusively proved. Methods: We measured peripheral chemoreceptors' sensitivity using hypoxic ventilatory response (HVR), central chemoreceptors' sensitivity using hypercapnic hyperoxic ventilatory response (HCVR), and dyspnea severity before and 4 ± 1 weeks following ticagrelor initiation in 11 subjects with chronic coronary syndrome undergoing percutaneous coronary intervention (PCI). The same tests were performed in 11 age-, sex-, and BMI-matched patients treated with clopidogrel. The study is registered at ClinicalTrials.com at NCT05080478. Results: Ticagrelor significantly increased both HVR (0.52 ± 0.46 vs. 0.84 ± 0.69 L min-1%-1; p < 0.01) and HCVR (1.05 ± 0.64 vs. 1.75 ± 1.04Lmin-1mmHg-1; p < 0.01). The absolute change in HVR correlated with the change in HCVR. Clopidogrel administration did not significantly influence HVR (0.63 ± 0.32 vs. 0.58 ± 0.33 L min-1%-1; p = 0.53) and HCVR (1.22 ± 0.67 vs. 1.2 ± 0.64Lmin-1mmHg-1; p = 0.79). Drug-related dyspnea was reported by three subjects in the ticagrelor group and by none in the clopidogrel group. These patients were characterized by either high baseline HVR and HCVR or excessive increase in HVR following ticagrelor initiation. Discussion: Ticagrelor, contrary to clopidogrel, sensitizes both peripheral and central facets of chemodetection. Two potential mechanisms of ticagrelor-induced dyspnea have been identified: 1) high baseline HVR and HCVR or 2) excessive increase in HVR or HVR and HCVR. Whether other patterns of changes in chemosensitivities play a role in the pathogenesis of this phenomenon needs to be further investigated.

Effect of Facemask in Congenital Central Hypoventilation Syndrome

Introduction: Congenital central hypoventilation syndrome (CCHS) is a rare genetic disorder with a mutation in the PHOX2B gene. Patients need ventilatory support by noninvasive ventilation or tracheostomy to treat alveolar hypoventilation. Patients with CCHS have a defect in chemosensitivity signal integration. Recently, due to the COVID-19 pandemic, the entire world has had to get used to wearing medical masks (MM). Objectives: The aim of the study was to evaluate the effect of an MM on gas exchange and to determine the role of central and peripheral chemoresponsiveness on the partial pressure of transcutaneous carbon dioxide (PtcCO₂) in patients with CCHS wearing an MM. Methods: This study was based on the analysis of recordings obtained without and with an MM during hospitalization and was conducted to assess the impact of MM on PtcCO₂ and SpO₂ recordings with the SenTec Digital Monitor and their relationships with peripheral CO₂ chemosensitivity obtained during tidal breathing measurement and with the hypercapnic hyperoxic ventilatory response. Results: Sixteen patients were included (13 boys) and were 10.2 (7.5; 18.5) years old. The use of an MM had a negative impact on gas exchange in patients with CCHS. The median PtcCO₂ increased significantly. Peripheral chemosensitivity correlated with MM-induced PtcCO₂ changes (R = −0.72, p = 0.005), but central chemosensitivity (the hypercapnic ventilator response slope) did not (R = −0.22, p = 0.510). Conclusion: The use of an MM had a negative impact on gas exchange in patients with CCHS.

Identifying Predictive Markers of CNS Oxygen Toxicity and Ketone Ester Effects on Latency to Seizure and Antioxidant Capacity

Hyperbaric oxygen (HBO2) is used in hyperbaric oxygen therapy and in undersea and aerospace medicine. What limits the use of HBO2 is the risk of seizures, i.e. central nervous system oxygen toxicity (CNS‐OT). In undersea medicine, the threat of CNS‐OT is what limits the time that the warfighter remains at depth while breathing HBO2. In addition, when breathing HBO2, various non‐convulsive signs and symptoms often precede onset of seizures, including bradycardia followed by tachycardia, hypothermia, and hyperventilation. We hypothesized that the early cardiorespiratory responses to HBO2 during the safe latent period could be used as predictive physiological markers (or physio‐markers) prior to the onset of CNS‐OT. Furthermore, using a ketone ester (KE) supplement, R,S‐1,3‐butanediol diacetoacetate ester, we posited that the KE would increase the antioxidant capacity and the latency time to seizure (LSz) when exposed to HBO2. Accordingly, 18 male, Sprague Dawley (SD) rats were implanted with DSI 4‐ET radio telemetry to record EEG, ECG, and respiratory EMG for offline analyses of physio‐markers. At least 1 week following surgery, each rat was placed in a hyperbaric chamber and “dived” to 5 ATA O2 (1 ATG/min) after oral gavage of either water (control group) or KE (treatment group). An additional 9 SD rats were also dived to 5 ATA O2, but not implanted with telemetry, to collect blood samples to measure antioxidant capacity with the RedoxSys® device before and after HBO2 exposure. HBO2 caused a 3‐phase hyperoxic ventilatory response: decreased respiration, transient hyperventilation, and a secondary later hyperventilation prior to seizures. Results showed that LSz increased in the KE group by 307% (controls: 6.42 ± 0.44 (n=15); KE: 22.16 ± 5.10 (n=18)). Additionally, minute ventilation and RR‐Interval (1/heart rate) were significantly different beginning ~15 minutes prior to onset of seizures. Receiver operating characteristic (ROC) analyses indicated that both hyperoxic hyperpnea and bradycardia were reliable physio‐markers for seizure prediction; that is, ROC for minute ventilation in both control and KE group, and for RR‐Interval in controls, was 1 (excellent predictor), and in the KE group was 0.84 (good predictor). However, core body temperature did not decrease significantly during HBO2 exposure and thus was not a physio‐marker for CNS‐OT. In addition, KE increased antioxidant capacity of blood from animals that were exposed to HBO2 with (p=0.0399) or without (p=0.0018) the development of CNS‐OT. In conclusion, hyperoxic hyperpnea and bradycardia can be used as predictive physio‐markers in conjunction with ketone therapy to reliably predict and delay CNS‐OT in rodents, and KE delays seizures in part by increasing overall antioxidant capacity during exposure to HBO2. Together this may enable safer and longer exposures for applications in undersea/aerospace medicine as well as hyperbaric oxygen therapies.

Peripheral chemoresponsiveness during exercise in male athletes with exercise‐induced arterial hypoxaemia

What is the central question of this study? Do highly trained male endurance athletes who develop exercise-induced arterial hypoxaemia (EIAH) demonstrate reduced peripheral chemoresponsiveness during exercise? What is the main finding and its importance? Those with the lowest arterial saturation during exercise have a smaller ventilatory response to hypercapnia during exercise. There was no significant relationship between the hyperoxic ventilatory response and EIAH. The findings suggest that peripheral chemoresponsiveness to hypercapnia during exercise could play a role in the development of EIAH. The findings improve our understanding of the mechanisms that contribute to EIAH. Exercise-induced arterial hypoxaemia (EIAH) is characterized by a decrease in arterial oxygen tension and/or saturation during whole-body exercise, which may in part result from inadequate alveolar ventilation. However, the role of peripheral chemoresponsiveness in the development of EIAH is not well established. We hypothesized that those with the most severe EIAH would have an attenuated ventilatory response to hyperoxia and hypercapnia during exercise. To evaluate this, on separate days, we measured ventilatory sensitivity to hyperoxia and separately hypercapnia at rest and during three different exercise intensities (25, 50% of and ventilatory threshold (∼67% of )) in 12 males cyclists ( =66.6±4.7mlkg-1 min-1 ). Subjects were divided into two groups based on their end-exercise arterial oxygen saturation (ear oximetry, ): a normal oxyhaemoglobin saturation group (NOS, =93.4±0.4%,n=5) and a low oxyhaemoglobin saturation group (LOS, =89.9±0.9%, n=7). There was no difference in (66.4±2.9vs.66.8±6.0mlkg-1 min-1 , respectively, P=0.9), peak ventilation during maximal exercise (182±15vs.197±32lmin-1 , respectively, P=0.36) or ventilatory response to hyperoxia (P=0.98) at any exercise intensity between NOS and LOS groups. However, those in the LOS group had a significantly lower ventilatory response to hypercapnia (P=0.004, (η2 =0.18). There was also a significant relationship between the mean hypercapnic response and end-exercise (r=0.75, P=0.009) but not between the mean hyperoxic response and end-exercise (r=0.21, P=0.51). A blunted hypercapnic ventilatory response may contribute to EIAH in highly trained men due to a failure to increase ventilation sufficiently to offset exercise-induced gas exchange impairments.

Heme oxygenase-1 (HO-1) mediated respiratory responses to hypoxia in the goldfish, Carassius auratus

In this study we investigated the role of heme oxygenase-1 (HO-1) in modulating the hypoxic and hyperoxic ventilatory responses of goldfish (Carassius auratus) acclimated to 7 and 25°C. HO-1 was present in the neuroepithelial cells (NECs; putative branchial O2 chemoreceptors) of fish acclimated to 7°C only. Hypoxia exposure increased gill HO-1 activity in 7°C fish (14.0±1.4 to 42.5±3.2pmolbilirubinmin−1mgprotein−1). Inhibition of HO-1 activity with zinc protophorphyrin IX (ZnPPIX) increased the ventilation frequency response to acute hypoxia (30mmHg); frequency increased from 48.3±5.1 to 137.4±16.0 breaths per min (BPM) in hypoxic 7°C fish treated with ZnPPIX compared to 46.2±4.2 to 77.9±5.3 BPM in control fish. Unlike in the control (untreated) 7°C fish exposed to hyperoxia, fish injected with ZnPPIX did not significantly decrease breathing frequency. Inhibiting HO-1 activity was without effect on the hypoxic or hyperoxic ventilatory responses of fish acclimated to 25°C. Based on these observations, we suggest that HO-1 plays an inhibitory role in regulating breathing frequency but only in goldfish acclimated to 7°C.

A potential early physiological marker for CNS oxygen toxicity: hyperoxic hyperpnea precedes seizure in unanesthetized rats breathing hyperbaric oxygen

Hyperbaric oxygen (HBO(2)) stimulates presumptive central CO2-chemoreceptor neurons, increases minute ventilation (V(min)), decreases heart rate (HR) and, if breathed sufficiently long, produces central nervous system oxygen toxicity (CNS-OT; i.e., seizures). The risk of seizures when breathing HBO(2) is variable between individuals and its onset is difficult to predict. We have tested the hypothesis that a predictable pattern of cardiorespiration precedes an impending seizure when breathing HBO2. To test this hypothesis, 27 adult male Sprague-Dawley rats were implanted with radiotelemetry transmitters to assess diaphragmatic/abdominal electromyogram, electrocardiogram, and electroencephalogram. Seven days after surgery, each rat was placed in a sealed, continuously ventilated animal chamber inside a hyperbaric chamber. Both chambers were pressurized in parallel using poikilocapnic 100% O(2) (animal chamber) and air (hyperbaric chamber) to 4, 5, or 6 atmospheres absolute (ATA). Breathing 1 ATA O(2) initially decreased V(min) and HR (Phase 1 of the compound hyperoxic ventilatory response). With continued exposure to normobaric hyperoxia, however, V(min) began increasing toward the end of exposure in one-third of the animals tested. Breathing HBO2 induced an early transient increase in V(min) (Phase 2) and HR during the chamber pressurization, followed by a second significant increase of V(min) ≤8 min prior to seizure (Phase 3). HR, which subsequently decreased during sustained hyperoxia, showed no additional changes prior to seizure. We conclude that hyperoxic hyperpnea (Phase 3 of the compound hyperoxic ventilatory response) is a predictor of an impending seizure while breathing poikilocapnic HBO(2) at rest in unanesthetized rats.

Chronic hyperoxia alters the hyperoxic ventilatory response and diaphragm muscle fiber composition in neonatal rats

Chronic hyperoxia alters the hyperoxic ventilatory response and diaphragm muscle fiber composition in neonatal rats

Ventilatory response to hyperoxia in newborn mice heterozygous for the transcription factorPhox2b

Heterozygous mutations of the transcription factor PHOX2B have been found in most patients with central congenital hypoventilation syndrome, a rare disease characterized by sleep-related hypoventilation and impaired chemosensitivity to sustained hypercapnia and sustained hypoxia. PHOX2B is a master regulator of autonomic reflex pathways, including peripheral chemosensitive pathways. In the present study, we used hyperoxic tests to assess the strength of the peripheral chemoreceptor tonic drive in Phox2b+/-newborn mice. We exposed 69 wild-type and 67 mutant mice to two hyperoxic tests (12-min air followed by 3-min 100% O2) 2 days after birth. Breathing variables were measured noninvasively using whole body flow plethysmography. The initial minute ventilation decrease was larger in mutant pups than in wild-type pups: -37% (SD 13) and -25% (SD 18), respectively, P<0.0001. Furthermore, minute ventilation remained depressed throughout O2 exposure in mutants, possibly because of their previously reported impaired CO2 chemosensitivity, whereas it returned rapidly to the normoxic level in wild-type pups. Hyperoxia considerably increased total apnea duration in mutant compared with wild-type pups (P=0.0001). A complementary experiment established that body temperature was not influenced by hyperoxia in either genotype group and, therefore, did not account for genotype-related differences in the hyperoxic ventilatory response. Thus partial loss of Phox2b function by heterozygosity did not diminish the tonic drive from peripheral chemoreceptors.

Extrabranchial chemoreceptors involved in respiratory reflexes in the neotropical fish Colossoma macropomum (the tambaqui).

In a previous study, complete denervation of the gills in the tambaqui Colossoma macropomum did not eliminate the increase in breathing amplitude seen during exposure of this species to hypoxia. The present study was designed to examine other sites of putative O(2)-sensitive receptors that could be involved in this reflex action. Superfusion of the exposed brain of decerebrate, spinalectomized fish did not reveal the presence of central chemoreceptors responsive to hyperoxic, hypoxic, hypercarbic, acidic or alkaline solutions. Subsequent central transection of cranial nerve IX and X, removing not only all innervation of the gills but also sensory input from the lateral-line, cardiac and visceral branches of the vagus nerve, did not eliminate the increase in breathing amplitude that remained following peripheral gill denervation alone. Administration of exogenous catecholamines (10 and 100 nmol kg(-1) adrenaline) to fish with intact brains and minimal surgical preparation reduced both respiratory frequency and amplitude, suggesting that humoral release of adrenaline also could not be responsible for the increase in breathing amplitude that remained following gill denervation. Denervation of the mandibular branches of cranial nerve V and the opercular and palatine branches of cranial nerve VII in gill-denervated fish (either peripheral gill denervation or central section of cranial nerves IX and X), however, did eliminate the response. Thus, our data suggest that hypoxic and hyperoxic ventilatory responses as well as ventilatory responses to internal and external injections of NaCN in the tambaqui arise from O(2)-sensitive receptors in the orobranchial cavity innervated by cranial nerves V and VII and O(2)-sensitive receptors on the gills innervated by cranial nerves IX and X. Our results also revealed the presence of receptors in the gills that account for all of the increase in ventilation amplitude and part of the increase in ventilation frequency during hyperoxic hypercarbia, a group or groups of receptors, which may be external to the orobranchial cavity (but not in the central nervous system), that contribute to the increase in ventilation frequency seen in response to hyperoxic hypercarbia and the possible presence of CO(2)-sensitive receptors that inhibit ventilation frequency, possibly in the olfactory epithelium.

Ventilatory responses to hypercapnia and hypoxia following chronic hypercapnia in the rat

This study investigated the effects of an 18 week exposure to 10% CO 2 in air on minute ventilation ( V ̇ E ), breathing pattern and the chemoresponiveness of rats to hypoxic and hyperoxic stimuli. We found that V ̇ E remained elevated over the 18 weeks. Nonetheless, the breathing pattern changed significantly. Tidal volume increased and the durations of inspiration and the total cycle decreased. After the sustained hypercapnia the mean Pa CO 2 was 72.0±5.1 (S.D.) mmHg. Every 6 weeks the chemoresponiveness of the CO 2-exposed rats was tested by an acute exposure sequentially to room air, then a 6% O 2, 10% CO 2 and 84% N 2 gas mixture, and finally a 90% O 2 in 10% CO 2 mixture. On either room air or the hyperoxic–hypercapnic mixture V ̇ E fell to its pre-hypercapnic level. On the hypoxic–hypercapnic mixture V ̇ E increased significantly. These results demonstrate that the initial stimulating effect of 10% CO 2 on V ̇ E persisted for the entire 18 weeks without altering hypoxic or hyperoxic ventilatory responses.

Effect of 8 hours of isocapnic/poikilocapnic hypoxia on the ventilatory response to CO2.

The ventilatory sensitivity to CO2 is thought to increase following a sustained exposure to hypoxia (1–5). This study was conducted to determine whether 8 h of poikilo-capnic hypoxia could elicit a change in the hyperoxic ventilatory response to CO2, and whether there were any differences between poikilocapnic and isocapnic exposures to hypoxia.

Hyperoxic ventilatory responses of high altitude acclimatized cats

We have examined the effect of steady-state hyperoxia on the ventilation of sea level (SL) cats and cats acclimatized to simulated high altitude (HA) at 5500 m for three weeks. Three groups of cats were studied. In group I, the ventilatory responses to 10%, 21% and 100% O 2 were studied at SL, and after acclimatization to HA, the ventilatory responses to 10% and 100% O 2 were measured. In group II the ventilatory responses and femoral artery and superior sagittal sinus blood gases were measured in two sets of cats, one at SL and one at HA, during exposure to the gases outlined in group I. In group III, we examined the effect of chronic vagotomy on the ventilatory responses to the gas mixtures outlined in group I. Breathing 100% O 2 at SL had no significant effect on ventilation, tidal volume, respiratory frequency, or cerebral blood flow (inferred from the cerebral veno-arterial CO 2 difference). Ventilation was constant in the HA acclimatized cats while breathing 10% and 100% O 2, but the ventilatory pattern changed dramatically during hyperoxia: respiratory frequency increased and tidal volume fell. Breathing 100% O 2 was associated with changes in CBF, and venous P CO 2 that might be expected to stimulate ventilation, but the change in ventilatory pattern suggests to us that hyperoxic disinhibition of central respiratory processes (which were modified by HA acclimization) is the mechanism whereby ventilation is sustained during hyperoxia at HA. After vagotomy at HA, ventilation constant remained while breathing 100% O 2, but the chages in respiratory pattern were no longer apparent. Therefore, vagal afferents seem to have a role in determining the pattern, but not necessarily the absolute level, of ventilation during hyperoxia. Cats vagotomized at SL prior to HA exposure did not show any evidence of HA ventilatory acclimatization; thus, the vagi may also play a heretofore unrecognized role in the process of acclimatization.

The effect of physostigmine on diazepam-induced ventilatory depression: a double-blind study.

The authors conducted a double-blind crossover study to determine the effects of physostigmine salicylate on hyperoxic ventilatory response to carbon dioxide (VE RCO2) and on awareness in healthy subjects previously sedated with diazepam. Diazepam 0.4 mg/kg iv decreased the slope of VE RCO2 from 2.41 +/- 0.19 to 1.30 +/- 0.15 1 . min-1 . mmHg-1 (mean +/- SEM, P less than 0.001). Subsequent injection of physostigmine 2.0 mg iv was associated with a 0.20 +/- 0.28 1 . min-1 . mmHg-1 decrease in slope; this was significantly different from the 0.56 +/- 0.22 1 . min-1 . mmHg-1 increase in slope associated with saline placebo (P less than 0.05). Level of consciousness, on the other hand, increased more after physostigmine than after saline (P less than 0.01). The authors conclude that despite an apparent increase in awareness resulting from physostigmine administration, the accompanying decrease in ventilatory drive may contraindicate its use in patients who previously have received diazepam.