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Changes in skeletal muscle oxygenation during exercise measured by near-infrared spectroscopy on ascent to altitude

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Abstract

Introduction

We sought to quantify changes in skeletal muscle oxygenation during exercise using near-infrared spectroscopy (NIRS) in healthy volunteers ascending to high altitude.

Methods

Using NIRS, skeletal muscle tissue oxygen saturation (StO2) was measured in the vastus lateralis of 24 subjects. Measurements were performed at sea level (SL; 75 m), at 3,500 m, on arrival at 5,300 m (5,300 m-a; days 15 to 17) and at 5,300 m again (5,300 m-b; days 69 to 71). Amongst the subjects, nine remained at 5,300 m whilst 14 climbed to a maximum of 8,848 m. Exercise was 3 minutes of unloaded cycling followed by an incremental ramp protocol to exhaustion. The absolute StO2 at different stages of exercise along with the difference between StO2 at stages and the rate of change in StO2 were compared between altitudes. Resting peripheral oxygen saturation was recorded.

Results

NIRS data achieving predefined quality criteria were available for 18 subjects at 75 m, 16 subjects at 3,500 m, 16 subjects on arrival at 5,300 m and 16 subjects on departure from 5,300 m. At SL, mean StO2 declined from 74.4% at rest to 36.4% at maximal oxygen consumption (P < 0.0001) and then rose to 82.3% (P < 0.0001) 60 seconds after exercise had ceased. At 3,500 m-a and 5,300 m-b, the pattern was similar to SL but absolute values were approximately 15% lower at all stages. At 5,300 m-a, the resting StO2 was similar to SL and the change in StO2 at each exercise stage less marked. At 5,300 m-b, the rate of decline in StO2 during exercise was more rapid than SL (P = 0.008); here the climbers had a smaller decline in StO2 during exercise (41.0%) and a slower rate of desaturation (0.086%/second) than those who had remained at 5,300 m (62.9% and 0.127%/second) (P = 0.031 and P = 0.047, respectively).

Conclusions

In most individuals, NIRS can be used to measure exercising skeletal muscle oxygenation in the field. During exercise the patterns of absolute oxygenation are broadly similar at altitude and SL. Following prolonged adaptation to altitude, the rate of muscle desaturation is more rapid than observed at SL but less so in those exposed to extreme hypoxia above 5,300 m.

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Abbreviations

ΔStO2:

difference in tissue oxygen saturation between stage means

NIRS:

near-infrared spectroscopy

SL:

sea level

SpO2:

peripheral oxygen saturation

StO2:

tissue oxygen saturation

StO2 rate:

rate of change in tissue oxygen saturation

VO2 max:

maximal oxygen consumption.

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Acknowledgements

The Caudwell Xtreme Everest Research Group wishes to express their heartfelt thanks to the trekkers and Sherpas who made this study possible. Supported by Mr John Caudwell, BOC Medical (now part of Linde Gas Therapeutics), Eli Lilly, the London Clinic, Smiths Medical, Deltex Medical, and the Rolex Foundation (unrestricted grants), the Association of Anaesthetists of Great Britain and Ireland, the United Kingdom Intensive Care Foundation, and the Sir Halley Stewart Trust. DM is a Critical Care Scholar of the London Clinic, and DZHL is a Fellow of the Association of Anaesthetists of Great Britain and Ireland. Some of this work was undertaken at University College London Hospital-University College London Comprehensive Biomedical Research Centre, which received a proportion of funding from the UK Department of Health's National Institute for Health Research Biomedical Research Centre's funding scheme. The Caudwell Xtreme Everest volunteers who trekked to Everest Base Camp also kindly donated to support the research. Caudwell Xtreme Everest is a research project coordinated by the Centre for Altitude, Space, and Extreme Environment Medicine, University College London. Membership, roles, and responsibilities of the Caudwell Xtreme Everest Research Group can be found at http://www.caudwell-xtreme-everest.co.uk/team.

This article is part of Critical Care Volume 13 Supplement 5: Tissue oxygenation (StO2) in healthy volunteers and critically-ill patients. The full contents of the supplement are available online at http://ccforum.com/supplements/13/S5. Publication of the supplement has been supported with funding from Hutchinson Technology Inc.

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  1. University College London Portex Unit, Centre for Altitude, Space and Extreme Environment Medicine (CASE Medicine), Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK

    Daniel S Martin, Denny ZH Levett, Michael Mythen & Mike PW Grocott

  2. Maple House, UCLH/UCL Comprehensive Biomedical Research Centre, 1st Floor, 149 Tottenham Court Road, London, W1T 7NF, UK

    Michael Mythen

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  1. Daniel S Martin
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Correspondence to Daniel S Martin.

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MM and MPWG have received unrestricted research support from Hutchinson Technology.

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Martin, D.S., Levett, D.Z., Mythen, M. et al. Changes in skeletal muscle oxygenation during exercise measured by near-infrared spectroscopy on ascent to altitude. Crit Care 13 (Suppl 5), S7 (2009). https://doi.org/10.1186/cc8005

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