Blood oxygen saturation measured in the presence of a mixture of cyclopropane, sulfur hexafluoride, and ethane.

Some anesthetic gases interfere with the determination of blood O2 values. We evaluated, for its potential for such interference, a gas mixture containing (v/v) approximately 70% ethane, 20% sulfur hexafluoride, and 10% cyclopropane, as is currently used in trace amounts to determine ventilation-perfusion (v/Q) ratios. Normal human blood samples were first tonometered with control gas mixtures containing (v/v): (1) 20.9% O2, 0.04% CO2; (2) 16.0% O2, 4.0% CO2; and (3) 9.9% O2, 7.8% CO2. A large quantity (20.9%) of the v/Q mixture was blended experimentally into the control mixture and the tonometry repeated. The entire experiment was then repeated substituting pure N2 for the v/Q mixture as a dilution control. O2 values were determined by three methods: (1) a polarographic electrode, ABL-300 (ABL); (2) a spectrophotometric method, Co-Oximeter (COOX); and (3) a galvanic cell, Lex-O2-Con (LEX). The v/Q gas mixture lowered significantly all measured LEX values by 2.5-3.6 saturation percent (sat%), but showed no effect, dilution or otherwise, on the O2 values determined by the COOX and ABL methods. The N2 dilution lowered the LEX values by an average of only 0.9 sat%; the ABL and the COOX were approximately 0.6 sat% lower. We therefore suggest that, if any of these O2 measurement methods are used in the presence of the v/Q mixture, baseline O2 values should be determined both before and after injection of the mixture into the bloodstream, prior to performing other experimental manipulations. The difference between the two values, if any, can then be used to interpret subsequent results.

Operation Everest II: neuromuscular performance under conditions of extreme simulated altitude.

The force output of the ankle dorsiflexors was studied during a 40-day simulated ascent of Mt. Everest in a hypobaric chamber; both electrically activated and maximal voluntary contractions (MVCs) were employed. The purpose of this study was to establish whether, under conditions of progressive chronic hypoxia, there was a decrease in muscle force output and/or increased fatigability. We also attempted to identify the main site of any failure, i.e., central nervous system, neuromuscular junction, or muscle fiber. Muscle twitch torque (Pt), tetanic torque (Po), MVC torque, and evoked muscle compound action potential (M wave) were monitored during 205-s exercise periods in five subjects at three simulated altitudes (760, 335, and 282 Torr). All three types of torque measurement were well preserved at the three altitudes. In some subjects, the responses to stimuli interpolated during repeated MVCs provided evidence of "central" fatigue at altitude. In addition, the rate of fatigue during 20-Hz electrical stimulation was greater (P less than 0.01) at altitude and there was increased fatigability of the twitch (P less than 0.025); however, the M wave amplitude was maintained. We conclude that central motor drive becomes more precarious at altitude and is associated with increased muscle fatigue at low excitation frequencies; the latter is the result, in part, of chronic hypoxia and occurs in the muscle fiber interior because no impairment in neuromuscular transmission could be demonstrated.

Symptomatology during hypoxic exposure to flame-retardant chamber atmospheres.

Hypoxia was studied in 12 men during 63-h exposures to 17 and 13% O2, with the subjects serving as their own controls by repeating the measurements in 21% O2. All test atmospheres were contaminated with 0.9% CO2 to simulate the condition of living aboard submarines. The mean SaO2's were 97-98% in all conditions of 21% O2, 96% in 17% O2 (n.s.), and 92% in 13% O2 (P less than 0.05). The blood concentrations of 2,3-diphosphoglycerate were elevated in 13 and 17% O2 (P less than 0.05). Seventeen percent O2 did not cause significant symptoms of environmental stress; however, 13% O2 caused symptoms of acute mountain sickness in 5 of 12 men. In the last 7 h of exposure to 17% O2, reduction of the barometric pressure to 576 Torr reduced the ambient PO2 to 98 Torr (similar to the PO2 of 13% O2 at normobaric pressure). This induced symptoms of acute mountain sickness in 3 of 11 men. All symptomatology and physiologic changes were reversed during recovery in 21% O2. Monitoring devices indicated the presence of volatile organic contaminants at a mean concentration of 6.1 ppm in the chamber atmosphere. Combustion tests in the occupied chamber showed that flame propagation was retarded by lowering the O2 concentration from 21 to 13-17%. We conclude that men can live comfortably in a normobaric, flame-retardant atmosphere consisting of 17% O2-0.9% CO2-6.1 ppm volatile organic compounds-balance N2.

Operation Everest II: comparison of four instruments for measuring blood O2 saturation.

The bias and precision of four different methods for determining O2 saturation (SO2) were evaluated during a study of hypobaric hypoxia conducted with seven male subjects exposed progressively over a 40-day period to simulated altitudes from sea level (760 Torr) to 8,840 m (240 Torr). SO2 of arterial and mixed venous blood samples were measured with the Instrumentation Laboratory 282 CO-oximeter (CO-OX), the Radiometer ABL-300 (ABL), and the Lex-O2-Con-K (LEX). Noninvasive measurements of arterial SO2 were made with a Hewlett-Packard 47201A ear oximeter (EAR-OX). The CO-OX method was used as a secondary standard for comparison with the other methods because it has been validated against the classical Van Slyke method over a wide physiological range (Maas et al., Clin. Chim. Acta 29: 303-309, 1970). The LEX results most closely approximated but consistently underestimated those of the CO-OX: LEX = 0.93 CO-OX -0.86, standard error of the estimate (SEE) = 5.17, r = 0.98, n = 670. The ABL method appeared to combine two linear trends: for SO2 greater than 75%, ABL = 0.84 CO-OX +14.4, SEE = 1.77, r = 0.97, n = 369; less than 75%, ABL = 0.98 CO-OX +5.9, SEE = 4.44, r = 0.97, n = 486. The EAR-OX results were found to approximate those of the CO-OX at SO2 values only greater than 65%: EAR-OX = 1.07 CO-OX -6.12, SEE = 7.71, r = 0.98, n = 326.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute mountain sickness at 4500 m is not altered by repeated eight-hour exposures to 3200-3550 m normobaric hypoxic equivalent.

A lightweight device, designed to supply inspired air at 12.8% O2 concentration (PO2 equivalent to 3960 m altitude) by recirculating a portion of each expired breath after CO2 removal, was tested at sea-level for its ability to induce altitude acclimation. Twelve young men (experimental group) breathed from the device for 7.5-8 h each day for 10 successive days. On the morning of day 1, inspired O2 concentrations averaged 12.8%, as intended, but increased by noontime and remained elevated thereafter. This raised the average hypoxic stimulus to 13.8 +/- 0.9% (PO2 equivalent to 3370 +/- 517 m altitude) for the entire 10-d period. Ten other young men (control group) breathed normoxic air from a placebo device of identical appearance on the same schedule. On day 10, both groups were exposed for the next 2 d to 4500 m altitude in a hypobaric chamber to assess the effect of the treatment on acute mountain sickness (AMS). After the sea level treatment, the experimental group showed no significant differences from control in resting ventilatory rate, respiratory frequency or end tidal PO2, but end-tidal PCO2 was lower; there was no indication of hemoconcentration. At altitude, both groups showed the expected decreases in end-tidal PO2 and PCO2, and increases in hemoglobin concentration and hematocrit indicative of hemoconcentration, with no differences between them. Neither incidence nor severity of AMS differed significantly between groups, but the experimental group had a lower incidence rate than historical controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of dexamethasone on symptoms of acute mountain sickness at Pikes Peak, Colorado (4,300 m).

In a previous controlled study, dexamethasone (DEX) was shown to prevent acute mountain sickness (AMS) during exposure to simulated high altitude. To determine the effect of DEX during actual altitude exposure, 16 young men were treated with either DEX (4 mg every 6 h) or placebo for 48 h prior to and 48 h after being rapidly transported from sea level to the summit of Pikes Peak, CO (4,300 m). Symptoms of AMS were evaluated twice daily at Pikes Peak using the Environmental Symptoms Questionnaire and a clinical assessment. During treatment the mean symptom scores were higher for subjects taking placebo in 18 out of 20 comparisons. On an individual basis, 60% of the subjects receiving placebo met the criteria for being "sick" compared to 31% of subjects receiving DEX. Beginning 24 h after cessation of treatment, DEX subjects experienced a progressive increase in symptom scores which lasted through the end of the altitude sojourn (day 6). The results indicate that DEX is an effective prophylactic treatment for AMS in an actual mountain environment, but that AMS symptoms can occur if the drug is stopped abruptly.

Respiratory response and muscle function during isometric handgrip exercise at high altitude.

The purpose of this investigation was to determine if the hyperventilatory response to fatiguing isometric exercise at sea level could predict resting ventilation and acute mountain sickness (AMS) at 4300 m altitude. Exercise consisted of four successive endurance handgrips held to complete fatigue at 40% of maximum isometric handgrip strength (MHS). There was no relationship between the magnitude or pattern of exercise-induced hyperventilation at sea level and the severity of AMS later at altitude. Sea level hyperventilatory response was not predictive of resting ventilation at altitude. Altitude exposure progressively increased both the incidence and magnitude of the hyperventilatory response to exercise and prolonged it for 60-90 s into the recovery period, providing support for the "central command" theory of ventilatory control during isometric exercise. MHS was significantly increased at altitude--by 11% on day 2 and 16% on day 6. Endurance times to fatigue were reduced, but not always significantly so. A follow-up study involving more practice at sea level demonstrated MHS to be significantly increased throughout an entire 18-d stay at 4300 m and for 3, but not 5, days after descent. Significant changes in endurance could not be demonstrated. Neither AMS nor changes in body weight or circulating norepinephrine levels can account for the temporal pattern of increased grip strength, but the respiratory alkalosis occurring at altitude appears to be a likely mechanism.

The influence of cardiorespiratory fitness on the decrement in maximal aerobic power at high altitude.

There are conflicting reports in the literature which imply that the decrement in maximal aerobic power experienced by a sea-level (SL) resident sojourning at high altitude (HA) is either smaller or larger for the more aerobically "fit" person. In the present study, data collected during several investigations conducted at an altitude of 4300 m were analyzed to determine if the level of aerobic fitness influenced the decrement in maximal oxygen uptake (VO2max) at HA. The VO2max of 51 male SL residents was measured at an altitude of 50 m and again at 4300 m. The subjects' ages, heights, and weights (mean +/- SE) were 22 +/- 1 yr, 177 +/- 7 cm and 78 +/- 2 kg, respectively. The subjects' VO2max ranged from 36 to 60 ml X kg -1 X min -1 (mean +/- SE = 48 +/- 1) and the individual values were normally distributed within this range. Likewise, the decrement in VO2max at HA was normally distributed from 3 ml X kg-1 X min-1 (9% VO2max at SL) to 29 ml X kg-1 X min-1 (54% VO2max at SL), and averaged 13 +/- 1 ml X kg-1 X min-1 (27 +/- 1% VO2max at SL). The linear correlation coefficient between aerobic fitness and the magnitude of the decrement in VO2max at HA expressed in absolute terms was r = 0.56, or expressed as % VO2max at SL was r = 0.30; both were statistically significant (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Procedures for the measurement of acute mountain sickness.

Although acute mountain sickness (AMS) has been studied for well over a century, a standard measure or index of the degree of illness for use in experimental research does not exist. This paper outlines a definition and procedures for an operational measurement of AMS using the Environmental Symptoms Questionnaire (ESQ). After 58 men completed over 650 ESQs during a stay of 1-3 weeks atop Pike's Peak (4300 m), factor analysis produced nine distinct symptom groups, with two factors representing AMS. The first factor contains symptoms indicative of cerebral hypoxia and is labeled AMS-C. The second reflects respiratory distress and is called AMS-R. Signal detection theory was used to establish a criterion score value for each factor. Standard deviation values were used to derive indices of sickness severity. Discussion is given to the possible relationships between the two types of AMS and the more serious conditions of cerebral and pulmonary edema.

Height, weight, percent body fat, and indices of adiposity for young men and women entering the U.S. Army.

The purpose of this investigation was to describe the height (H), weight (W), and percent body fat (%BF) of young men and women (ages 17-35 years) entering the U.S. Army and to determine an index of adiposity that fit criteria described in the literature. H and W were measured with a digital scale and anthropometer, respectively. %BF was calculated from four skinfolds thickness. Men and women were both separated into four age categories. Very little difference in H was found with increasing age. W and %BF increased progressively with age in the males but no increase in either parameter was seen within the three youngest age groups of women. For males, W/H2 was found to be the most appropriate index of adiposity of those studied, having a correlation with %BF of 0.75 and a standard error of estimate of +/- 3.4 %BF. W/H1.5 was the most appropriate index for females, having a correlation with %BF of 0.69 and a standard error of estimate of +/- 3.2 %BF. It was suggested that these indices could be used to replace or supplement the current H-W charts used in the Army. A table for predicting %BF from these indices has been provided.

Phenytoin: ineffective against acute mountain sickness.

Phenytoin sodium was evaluated for its effect on the development and intensity of acute mountain sickness (AMS) because of its ability to reduce intracellular Na+ concentrations in brain and thereby minimize any tendency to increase cellular volume, a hypothetical cause of AMS. Six men aged 19-35 were exposed to approximately 4600 m altitude in a hypobaric chamber for 52 h on two occasions separated by 10 d at sea level. Subjects received wither phenytoin or placebo for 18 h before (700 mg, divided dose) and throughout (100 mg t.i.d.) each altitude exposure in a double-blind, repeated-measures (crossover) design. Phenytoin serum concentrations ranged from 4.4-13.9 micrograms/ml during altitude exposure. Twice daily questionnaires and clinical evaluations showed no marked benefit from phenytoin on the occurrence, severity, or duration of AMS symptoms: headache, nausea, insomnia, and general malaise. Overall, 1 subject felt better, 2 felt worse, 1 felt the same; 2 were not suitably comparable. There was no observed relationship between serum levels and symptoms of AMS. Moderate degrees of weakness and dizziness were each reported by 3 subjects with phenytoin but not with placebo, however. Resting pulmonary ventilation, end-tidal PO2 and PCO2, map reading abilities and respiratory mask donning times were not affected by phenytoin. Under the conditions of this trial, phenytoin did not appear to be useful in managing AMS.

Isometric fatigue induced by different levels of rhythmic exercise.

Three subjects were trained in leg extensor isometric contractions and in cycling. They then cycled for three consecutive bouts, each of 2.75 min at a constant level of VO2, from 20 to 80% VO2 max. Fifteen seconds after each bout of cycling the subjects exerted an isometric contraction of the right leg at 40% of the maximum voluntary contraction. In each experiment, the duration of the three successive isometric contractions decreased as in hand-grip contractions. There was also a linear reduction in isometric endurance as the severity of the preceding rhythmic exercise increased. In other experiments, after three bouts of rhythmic exercise at 20% VO2 max (each followed by a fatiguing contraction at 40% MVC), further bouts of cycling at increasing levels of severity up to 60% VO2 max resulted in a linear fall in isometric endurance which could be reversed by interposing a lighter level of cycling. The heart rates during these experiments showed a steady increase during the isometric exercise, to about 150 beats X min-1, as the bouts of preceding rhythmic exercise became progressively more severe. The isometric contractions had little influence on the heart rate during cycling. But the rhythmic cycling exercise markedly increased the heart rate achieved at the end of the isometric contractions while decreasing the increment in heart rate during the contraction.

Influence of posture on isometric fatigue.

The isometric strength of four trained subjects was unaltered by changes in posture. But the endurance of an isometric contraction held to fatigue at 25 and 40% of the maximum voluntary contraction (MVC) was 20% greater in the sitting than in the recumbent posture. This difference was abolished when the exercise was performed with the arm's circulation arrested. At rest, the blood flow through the forearm was greater when the subjects were in the recumbent than in the sitting position but the reverse was true during isometric contractions. In these two postures, there was no difference in the right atrial pressure during the contraction, suggesting that the low-pressure baroreceptors are not responsible for the differences in blood flow during exercise. To date no mechanism is available to explain these observations.

Comparison of physiological responses of women and men to isometric exercise.

The volunteers for this study were 83 women, aged 19-65 yr, drawn from several different occupations. Three minutes after exerting maximal handgrip strength (MVC) each subject held a tension of 40 percent MVC to fatigue. Blood pressures and heart rates were measured before, during, and after the endurance of contraction. Age was associated with a reduction of strength of the women, whereas their endurance at 40 percent at 40 per cent MVC increased. There was evidence that menopause enhanced those age effects for strength and endurance. At rest, age was associated with a decreased heart rate. As expected, the heart rates of all the women increased during the endurance contraction. But that increase was greater for the younger than for the older women, thereby exaggerating the difference due to age already seen at rest. Systolic blood pressure at rest was higher with age and, in a similar manner, that relationship was also exaggerated throughout the isometric contraction. Diastolic blood pressure, however, was not changed with age at rest, and although the diastolic pressure increased during the isometric exercise, the rate of increase was unaffected by age. The results obtained are compared with those from a similarly large number of men examined in identical circumstances.

Differentiated ratings of perceived exertion during physical conditioning of older individuals using leg-weight loading.

Use of leg weights for physical conditioning was evaluated in 8 middle-aged male Ss; four Ss of similar age served as a control group. Pre- and post-training evaluation consisted of heart rate and oxygen uptake responses to five submaximal work loads which involved either level walking or cycling. Differentiated ratings of perceived exertion elicited for each work load were: a local muscular rating; a central or cardio-pulmonary rating; and an over-all or general rating. Submaximal heart rate decreased 6 to 9 beats/min. from pretraining values for all work load after training. The differentiated ratings for training generally reflected a reduced strain on the cardiovascular system and also improved functioning of the working muscles with training. However, when one set of sensations dominated the exertional perception the others appear to have been perceptually de-emphasized. Local muscular factors seemed to dominate the exertional perception for cycling, but central factors appeared to play a more important role for treadmill walking, at least within the range of velocities investigated.

The assessment of the static component in rhythmic exercise.

A new approach has been devised to assess the "static component" of dynamic exercise. This technique involves the measurement of the isometric endurance of muscles which have just taken part in rhythmic exercise and depends on the repeatability of trained subjects in isometric effort. The premise is that isometric endurance will be inversely related to the static component of the preceeding dynamic exercise. The subjects worked on a bicycle ergometer at known fractions of their maximal aerobic capacity (max Vo2). The rate of pedalling was varied from 30 to 90 rpm, so that for a given % max Vo2, the belt tension varied inversely with the speed of cycling. At any one speed of cycling, isometric endurance decreased as the belt tension increased. Following exercise at 30 rpm, the isometric endurance was 25 to 50% lower than that found at the most advantageous speed of cycling for our subuects; at these faster rates of cycling two subjects showed least static component following exercise at 90 rpm while the remaining subject performed best after cycling at 50 rpm.