Extension of pulmonary O2 tolerance in man at 2 ATA by intermittent O2 exposure

Investigating Disturbances of Oxygen Homeostasis: From Cellular Mechanisms to the Clinical Practice

Soon after its discovery in the 18th century, oxygen was applied as a therapeutic agent to treat severely ill patients. Lack of oxygen, commonly termed as hypoxia, is frequently encountered in different disease states and is detrimental to human life. However, at the end of the 19th century, Paul Bert and James Lorrain Smith identified what is known as oxygen toxicity. The molecular basis of this phenomenon is oxygen's readiness to accept electrons and to form different variants of aggressive radicals that interfere with normal cell functions. The human body has evolved to maintain oxygen homeostasis by different molecular systems that are either activated in the case of oxygen under-supply, or to scavenge and to transform oxygen radicals when excess amounts are encountered. Research has provided insights into cellular mechanisms of oxygen homeostasis and is still called upon in order to better understand related diseases. Oxygen therapy is one of the prime clinical interventions, as it is life saving, readily available, easy to apply and economically affordable. However, the current state of research also implicates a reconsidering of the liberal application of oxygen causing hyperoxia. Increasing evidence from preclinical and clinical studies suggest detrimental outcomes as a consequence of liberal oxygen therapy. In this review, we summarize concepts of cellular mechanisms regarding different forms of disturbed cellular oxygen homeostasis that may help to better define safe clinical application of oxygen therapy.

Audit of practice in Australasian hyperbaric units on the incidence of central nervous system oxygen toxicity

INTRODUCTION

Central nervous system oxygen toxicity (CNS-OT) is an uncommon complication of hyperbaric oxygen treatment (HBOT). Different facilities have developed local protocols in an attempt to reduce the risk of CNS-OT. This audit was performed to elucidate which protocols might be of benefit in mitigating CNS-OT and to open discussion on adopting a common protocol for Treatment Table 14 (TT14) to enable future multicentre clinical trials.

METHODS

Audit of CNS-OT events between units using different compression profiles for TT14, performed at 243 kPa with variable durations of oxygen breathing and 'air breaks', to assess whether there is a statistical diference between protocols. Data were collected retrospectively from public and private hyperbaric facilities in Australia and New Zealand between 01 January 2010 and 31 December 2014.

RESULTS

Eight of 15 units approached participated. During the five-year period 5,193 patients received 96,670 treatments. There were a total of 38 seizures in 33 patients when all treatment pressures were examined. In the group of patients treated at 243 kPa there were a total of 26 seizures in 23 patients. The incidence of seizure per treatment was 0.024% (2.4 per 10,000 treatments) at 243 kPa and the risk per patient was 0.45% (4.5 in 1,000 patients). There were no statistically significant differences between the incidences of CNS-OT using different TT14 protocols in this analysis.

CONCLUSION

HBOT is safe and CNS-OT is uncommon. The risk of CNS-OT per patient at 243 kPa was 1 in 222 (0.45%; range 0-1%) and the overall risk irrespective of treatment table was 0.6% (range 0.31-1.8%). These figures are higher than previously reported as they represent individual patient risk as opposed to risk per treatment. The wide disparity of facility protocols for a 243 kPa table without discernible influence on the incidence of CNS-OT rates should facilitate a national approach to consensus.

Oxygen Toxicity and Special Operations Forces Diving: Hidden and Dangerous

In Special Operations Forces (SOF) closed-circuit rebreathers with 100% oxygen are commonly utilized for covert diving operations. Exposure to high partial pressures of oxygen (PO₂) could cause damage to the central nervous system (CNS) and pulmonary system. Longer exposure time and higher PO₂ leads to faster development of more serious pathology. Exposure to a PO₂ above 1.4 ATA can cause CNS toxicity, leading to a wide range of neurologic complaints including convulsions. Pulmonary oxygen toxicity develops over time when exposed to a PO₂ above 0.5 ATA and can lead to inflammation and fibrosis of lung tissue. Oxygen can also be toxic for the ocular system and may have systemic effects on the inflammatory system. Moreover, some of the effects of oxygen toxicity are irreversible. This paper describes the pathophysiology, epidemiology, signs and symptoms, risk factors and prediction models of oxygen toxicity, and their limitations on SOF diving.

Central Nervous System Oxygen Toxicity and Hyperbaric Oxygen Seizures

INTRODUCTION

The use of hyperbaric oxygen (O2) as a therapeutic agent carries with it the risk of central nervous system (CNS) O2 toxicity.

METHODS

To further the understanding of this risk and the nature of its molecular mechanism, a review was conducted on the literature from various fields.

RESULTS

Numerous physiological changes are produced by increased partial pressures of oxygen (Po2), which may ultimately result in CNS O2 toxicity. The human body has several equilibrated safeguards that minimize effects of reactive species on neural networks, believed to play a primary role in CNS O2 toxicity. Increased partial pressure of oxygen (Po2) appears to saturate protective enzymes and unfavorably shift protective reactions in the direction of neural network overstimulation. Certain regions of the CNS appear more susceptible than others to these effects. Failure to decrease the elevated Po2 can result in a tonic-clonic seizure and death. Randomized, controlled studies in human populations would require a multicenter trial over a long period of time with numerous endpoints used to identify O2 toxicity.

CONCLUSIONS

The mounting scientific evidence and apparent increase in the number of hyperbaric O2 treatments demonstrate a need for further study in the near future.

Hyperoxia in intensive care, emergency, and peri-operative medicine: Dr. Jekyll or Mr. Hyde? A 2015 update

This review summarizes the (patho)-physiological effects of ventilation with high FiO₂ (0.8–1.0), with a special focus on the most recent clinical evidence on its use for the management of circulatory shock and during medical emergencies. Hyperoxia is a cornerstone of the acute management of circulatory shock, a concept which is based on compelling experimental evidence that compensating the imbalance between O₂ supply and requirements (i.e., the oxygen dept) is crucial for survival, at least after trauma. On the other hand, “oxygen toxicity” due to the increased formation of reactive oxygen species limits its use, because it may cause serious deleterious side effects, especially in conditions of ischemia/reperfusion. While these effects are particularly pronounced during long-term administration, i.e., beyond 12–24 h, several retrospective studies suggest that even hyperoxemia of shorter duration is also associated with increased mortality and morbidity. In fact, albeit the clinical evidence from prospective studies is surprisingly scarce, a recent meta-analysis suggests that hyperoxia is associated with increased mortality at least in patients after cardiac arrest, stroke, and traumatic brain injury. Most of these data, however, originate from heterogenous, observational studies with inconsistent results, and therefore, there is a need for the results from the large scale, randomized, controlled clinical trials on the use of hyperoxia, which can be anticipated within the next 2–3 years. Consequently, until then, “conservative” O₂ therapy, i.e., targeting an arterial hemoglobin O₂ saturation of 88–95 % as suggested by the guidelines of the ARDS Network and the Surviving Sepsis Campaign, represents the treatment of choice to avoid exposure to both hypoxemia and excess hyperoxemia.

Hyperbaric oxygen: its mechanisms and efficacy

BACKGROUND

This article outlines therapeutic mechanisms of hyperbaric oxygen therapy and reviews data on its efficacy for clinical problems seen by plastic and reconstructive surgeons.

METHODS

The information in this review was obtained from the peer-reviewed medical literature.

RESULTS

Principal mechanisms of hyperbaric oxygen are based on intracellular generation of reactive species of oxygen and nitrogen. Reactive species are recognized to play a central role in cell signal transduction cascades, and the discussion will focus on these pathways. Systematic reviews and randomized clinical trials support clinical use of hyperbaric oxygen for refractory diabetic wound-healing and radiation injuries; treatment of compromised flaps and grafts and ischemia-reperfusion disorders is supported by animal studies and a small number of clinical trials, but further studies are warranted.

CONCLUSIONS

Clinical and mechanistic data support use of hyperbaric oxygen for a variety of disorders. Further work is needed to clarify clinical utility for some disorders and to hone patient selection criteria to improve cost efficacy.

Oxidative stress is fundamental to hyperbaric oxygen therapy

The goal of this review is to outline advances addressing the role that reactive species of oxygen and nitrogen play in therapeutic mechanisms of hyperbaric oxygen. The review will be organized around major categories of problems or processes where controlled clinical trials have demonstrated clinical efficacy for hyperbaric oxygen therapy. Reactive species are now recognized to play a major role in cell signal transduction cascades, and the discussion will focus on how hyperbaric oxygen acts through these pathways to mediate wound healing and ameliorate postischemic and inflammatory injuries.

Hyperbaric oxygen improves rate of return of spontaneous circulation after prolonged normothermic porcine cardiopulmonary arrest

AIM

This controlled, prospective, randomized porcine study tests the hypothesis that high-dose hyperbaric oxygen (HDHBO2) compared with normobaric oxygen (NBO2) or standard-dose hyperbaric oxygen (SDHBO2), improves return of sustained spontaneous circulation (ROSC) after a normothermic, normobaric, 25-min, non-intervened-upon cardiopulmonary arrest. The study incorporated a direct mechanical ventricular assist device (DMVAD) for open chest continuous cardiac compressions (OCCC) to assist advanced cardiac life support (ACLS). The experiment demonstrates a dose response to oxygen concentration in the breathing mix used in resuscitative ventilation.

MATERIALS AND METHODS

Male pigs (average 30kg weight) underwent a 25-min, normothermic, non-intervened-upon cardiopulmonary arrest. Following arrest all animals were ventilated with 100% oxygen and were subjected to OCCC, incorporating DMVAD-aided ACLS. The animals so treated were randomized to be in one of three groups, with six animals in each group. The NBO2 group remained at 1.0 atmosphere absolute (ATA), while the SDHBO2 and HDHBO2 groups were initially placed at 1.9 and 4.0ATA, respectively. Uniform, but not American Heart Association (AHA) protocol, ACLS was maintained as needed over the ensuing 2h for all animals in all groups. At the end of 2h, the animals were euthanized.

RESULTS

Continuously sustained ROSC (mean arterial pressure > or =50mmHg at all times), without the need of the pump assist over the 2-h resuscitation attempt that followed the 25-min arrest, occurred in four out of six animals in the HDHBO2 group, and in none of the animals in the NBO2 or SBHBO2 groups (p< or =0.001).

CONCLUSIONS

Our results show significantly sustained ROSC using HDHBO2 to resuscitate swine after a 25-min, non-intervened-upon, normothermic cardiopulmonary arrest. These results could not be achieved using NBO2 or SDHBO2.

Prolonged and intermittent normobaric hyperoxia induce different degrees of ischemic tolerance in rat brain tissue

Prior prolonged oxygen exposure is associated with some protection against ischemia-reperfusion (IR) injury to rat brain tissue, but also with toxic effects. We sought to compare the magnitude of protection offered by prolonged and intermittent oxygen pretreatments against IR injury to the rat brain. Rats were divided into four experimental groups, each of 21 animals. The first two were exposed to 95% inspired (normobaric hyperoxia, NBHO) for 4 h/day for 6 consecutive days (intermittent NBHO) or for 24 continuous hours (prolonged NBHO). The second two groups acted as controls were exposed to 21% oxygen. After 24 h, they were subjected to 60 min of right middle cerebral artery occlusion (MCAO) followed by 24 h of reperfusion. The animals were sacrificed for assessment of infarct volume, brain edema, and blood-brain barrier (BBB) permeability, respectively. Prolonged and intermittent NBHO pretreatment reduced infarct volume by 63.3% and 73.7%, respectively, when compared to the respective NBNO groups. Intermittent NBHO (when compared to intermittent NBNO) also reduced the post-ischemic increment of brain water content significantly (81.53+/-0.8%, vs. 80.12+/-0.79%) and Evans Blue extravasation (7.49+/-2.89+/-g/g tissue vs. 3.9+/-0.79 microg/g tissue, P<0.001), while prolonged NBHO had no significant effect on brain water content (81.69+/-1.16% vs. 80.74+/-0.94%) and EB extravasations (6.48+/-2.42 microg/g tissue vs. 4.31+/-1.07 microg/g tissue). Intermittent hyperoxia had relatively more significant effects on brain edema and BBB protection. Although preconditioning with both prolonged and intermittent oxygen exposure protects rat brain tissue against IR injury, the intermittent hyperoxia could have relatively more protective effects in this regard.

No changes in lung function after a saturation dive to 2.5 MPa with intermittent reduction in $$ P_{{{{\rm O}}_{{{\rm 2}}} }} $$ during decompression

Decompression stress and exposure to hyperoxia may cause a reduction in transfer factor of the lung for carbon monoxide and in maximal aerobic capacity after deep saturation dives. In this study lung function and exercise capacity were assessed before and after a helium-oxygen saturation dive to a pressure of 2.5 MPa where the decompression rate was reduced compared with previous deep dives, and the hyperoxic exposure was reduced by administering oxygen intermittently at pressures of 50 and 30 kPa during decompression. Eight experienced divers of median age 41 years (range 29-48) participated in the dive. The incidence of venous gas microemboli was low compared with previous deep dives. Except for one subject having treatment for decompression sickness, no changes in lung function or angiotensin converting enzyme, a marker of pulmonary endothelial cell damage, were demonstrated. The modified diving procedures with respect to decompression rate and hyperoxic exposure may have contributed to the lack of changes in lung function in this dive compared with previous deep saturation dives.

Optimization of oxygen tolerance extension in rats by intermittent exposure

Optimization of oxygen tolerance extension by intermittent exposure was studied in groups of 20 rats exposed to systematically varied patterns of alternating oxygen and normoxic breathing periods at 4.0, 2.0, and 1.5 ATA. Oxygen periods of 20, 60, and 120 min were alternated with normoxic intervals that provided oxygen-to-normoxia ratios of 4:1, 2:1, 1:1, and 1:3. In general, median survival times had nearly linear relationships to increasing normoxic intervals with oxygen period held constant. Exceptions occurred at 4.0 and 2.0 ATA where a 5-min normoxic interval was too short for adequate recovery even with a 20-min oxygen period, and an oxygen period of 120 min was too long even with a normoxic interval of 30 min. These exceptions did not occur at 1.5 ATA. Survival time for many intermittent exposure patterns was equivalent to that for continuous exposure to an oxygen pressure definable as a time-weighted average of the alternating oxygen and normoxia periods. However, this predictive method underestimated the degree of protection achieved by several of the intermittent exposure patterns, especially those performed at 4.0 ATA. Results provided guidance for selection of intermittent exposure patterns for direct evaluation in humans breathing oxygen at 2.0 ATA. Definition of intermittent exposure patterns and conditions that produced prominent gains in oxygen tolerance can also facilitate the performance of future experiments designed to study potential mechanisms for oxygen tolerance extension by intermittent exposure. Heat shock and oxidation-specific stress proteins that are induced by exposure to oxidant injury are suggested for emphasis in such investigations.

Hyperbaric hyperoxia induces a neuromuscular hyperexcitability: assessment of a reduced response in elite oxygen divers

We compared the changes in compound muscle mass action potential (M-wave) recorded in vastus lateralis in response to hyperbaric hyperoxia (HBO) in nine combat divers who dived daily while breathing 100% O2 or O2-enriched mixture (O2 divers) to those measured in eight recreational divers who dived occasionally using compressed air/21% O2 (air divers). The O2 divers completed a 6-h HBO exposure in which the inspired oxygen pressure (PiO2) varied from 1.15 to 2.7 absolute atmospheres (ATA), PiO2 being maintained at 1.15 ATA throughout the first 2-h period, whereas the air divers only completed a 2-h HBO exposure with PiO2 constant at 1.15 ATA. Before HBO exposure, there were no intergroup differences between baseline M-wave characteristics (amplitude and duration), but the conduction time was significantly shorter in O2 divers compared with air divers. After 90 min of HBO (1.15 ATA) the air divers demonstrated neuromuscular hyperexcitability, as evidenced by an increased M-wave amplitude (13%, P<0.01 versus baseline), shortened M-wave duration (5%, P<0.05 versus baseline), and reduced conduction time (5%, P<0.01 versus baseline). In O2 divers, similar HBO-induced M-wave changes were only observed when PiO2 was greater than 1.50 ATA. We conclude that HBO elicites neuromuscular hyperexcitability, attenuated in elite O2 divers.

Arterial haemoglobin oxygen saturation is affected by F(I)O2 at submaximal running velocities in elite athletes

This study was conducted to determine whether arterial desaturation would occur at submaximal workloads in highly trained endurance athletes and whether saturation is affected by the fraction of oxygen in inspired air (F(I)O2). Six highly trained endurance athletes (5 women and 1 man, aged 25+/-4 yr, VO2max 71.3+/-5.0 ml x kg(-1) x min(-1)) ran 4x4 min on a treadmill in normoxia (F(I)O2 0.209), hypoxia (F(I)O2 0.155) and hyperoxia (F(I)O2 0.293) in a randomized order. The running velocities corresponded to 50, 60, 70 and 80% of their normoxic maximal oxygen uptake (VO2max). In hypoxia, the arterial haemoglobin oxygen saturation percentage (SpO2%) was significantly lower than in hyperoxia and normoxia throughout the test, and the difference became more evident with increasing running intensity. In hyperoxia, the SpO2% was significantly higher than in normoxia at 70% running intensity as well as during recovery. The lowest values of SpO2% were 94.0+/-3.8% (P<0.05, compared with rest) in hyperoxia, 91.0+/-3.6% (P<0.001) in normoxia and 72.8+/-10.2% (P<0.001) in hypoxia. Although the SpO2% varied with the F(I)O2, the VO2 was very similar between the trials, but the blood lactate concentration was elevated in hypoxia and decreased in hyperoxia at the 70% and 80% workloads. In conclusion, elite endurance athletes may show an F(I)O2-dependent limitation for arterial O2 saturation even at submaximal running intensities. In hyperoxia and normoxia, the desaturation is partly transient, but in hypoxia the desaturation worsens parallel with the increase in exercise intensity.

Hypoxic ventilatory sensitivity in men is not reduced by prolonged hyperoxia (Predictive Studies V and VI)

Potential adverse effects on the O2-sensing function of the carotid body when its cells are exposed to toxic O2 pressures were assessed during investigations of human organ tolerance to prolonged continuous and intermittent hyperoxia (Predictive Studies V and VI). Isocapnic hypoxic ventilatory responses (HVR) were determined at 1.0 ATA before and after severe hyperoxic exposures: 1) continuous O2 breathing at 1.5, 2.0, and 2.5 ATA for 17.7, 9.0, and 5.7 h and 2) intermittent O2 breathing at 2.0 ATA (30 min O2-30 min normoxia) for 14.3 O2 h within 30-h total time. Postexposure curvature of HVR hyperbolas was not reduced compared with preexposure controls. The hyperbolas were temporarily elevated to higher ventilations than controls due to increments in respiratory frequency that were proportional to O2 exposure time, not O2 pressure. In humans, prolonged hyperoxia does not attenuate the hypoxia-sensing function of the peripheral chemoreceptors, even after exposures that approach limits of human pulmonary and central nervous system O2 tolerance. Current applications of hyperoxia in hyperbaric O2 therapy and in subsea- and aerospace-related operations are guided by and are well within these exposure limits.

Arterial oxygen tension of patients with abnormal lungs treated with hyperbaric oxygen is greater than predicted

The arterial oxygen (O2) tension (PaO2) of patients with normal gas exchange treated with hyperbaric oxygen (HBO2) can be predicted from their pre-HBO2 arterial to alveolar O2 tension ratio (a/A) which remains constant up to a PaO2 of 2,000 mm Hg. We observed that the a/A could not be used to predict the PaO2 of patients with impaired gas exchange (reduced pre-HBO2 a/As) treated with HBO2. Our study provides information about the PaO2 of patients with abnormal lungs treated with HBO2. For clinical reasons, we measured the PaO2 of 24 patients treated with HBO2. We obtained arterial blood gas values from patients with lung dysfunction (a/A < 0.75) prior to, during, and after HBO2. The pre-HBO2 a/A = 0.45 +/- 0.17 (mean +/- 1 SD). During HBO2 the a/A ranged from 0.7 to 0.8 depending on chamber pressure and returned to the pre-HBO2 baseline after HBO2. We conclude the following: (1) The hyperbaric PaO2s of patients with a/A < 0.75 is greater than expected. (2) However, the PaO2 is lower than in patients with normal lung function (a/A > 0.75). Possible explanations include improvement in ventilation/perfusion matching, reduction of venous admixture, and/or extra-alveolar uptake of O2. (3) Exposures to HBO2 treatment pressures greater than recommended by existing protocols may be required in patients with impaired transfer of O2 across the lung to achieve PaO2s similar to patients with normal lung function treated with HBO2.

Oxygen toxicity

OBJECTIVE

The objective of this article is to provide an overview of the biochemistry of oxygen metabolism, including the formation of free radicals and the role of endogenous antioxidants. Pathophysiologic correlates underlying the clinical manifestations of oxygen toxicity are reviewed and management strategies are outlined.

DATA SOURCES

References from basic science and clinical journals were selected from the authors' files and from a search of a computerized database of the biomedical literature.

STUDY SELECTION

Articles selected for review included both historical and current literature concerning the biochemistry and pathophysiology of oxygen toxicity in animals and humans.

DATA SYNTHESIS

The benefits of oxygen therapy have been known for many years; however, its potential toxicity has not been recognized until the last two decades. The lungs, the eyes, and, under certain conditions, the central nervous system are the organs most affected by prolonged exposure to hyperoxic environments. Free radical formation during cellular metabolism under hyperoxic conditions is recognized as the biochemical basis of oxygen injury to cells and organs. Endogenous antioxidants are a primary means of detoxifying reactive oxygen species and preventing hyperoxia-induced cellular damage. When this defense fails or is overwhelmed by the excessive production of hyperoxia-induced free-radical species, distinctive morphologic changes occur at the cellular level. The amount of hyperoxia required to cause cellular damage and the time course of these changes vary from species to species and from individual to individual within the same species. Age, nutritional status, presence of underlying diseases, and certain drugs may influence the development of oxygen toxicity.

CONCLUSIONS

There is currently no reliably effective drug for preventing or delaying the development of oxygen toxicity in humans. Use of the lowest effective oxygen concentration, the avoidance of certain drugs, and attention to nutritional and metabolic factors remain the best means currently available to avoid or minimize oxygen toxicity. Research is continuing into more effective ways to prevent, diagnose, and treat this disorder.

The modulation of oxygen toxicity by intermittent exposure

Intermittent delivery of hyperbaric O2 protects animals from pulmonary and central nervous system toxicity: more total O2 time can be tolerated if interrupted by short periods of low O2. Little is known about the mechanisms or optimization of systematically varied intermittency. Survival time was recorded in groups of 16 awake guinea pigs (239 +/- 23(SD) g) exposed to continuous O2 at 2.8 ATA or to one of six different schedules of O2 delivered with periodic air (PO2 = 0.588 ATA) interruptions. The survival curves had a lag time (11-14 hr of O2 time depending on the intermittency schedule) with a rapid loss of animals thereafter. Data were analyzed with risk models linking the probability of death to the accumulation of a putative toxic substance, X1. A model in which X1 accumulated in proportion to the PO2 and disappeared by first-order decay during periods of low O2 exposure was modified to include an effective rate constant for changes in X1: dX1/dt = a.PO2 + K1.(PO2 - Os).X1. First-order kinetics operated when PO2 was below the oxygen set point (Os), but the rate constant reversed sign to become a self-amplifying system when PO2 was above Os. This model achieved an excellent fit as judged by goodness-of-fit statistics while a simpler one did not. Our analysis suggests that the accumulation of toxicity does not correspond to a stable linear toxic process, but requires one in which a toxic process grows autocatalytically.

Extension of oxygen tolerance in man: philosophy and significance

The respiration of oxygen over a range of partial pressures higher than in the natural environment has expanding usefulness in health and disease. It provides for denitrogenation of the astronaut to prevent aerospace decompression sickness, it facilitates diving of many forms and improves safety in decompression after diving, and it is the key to therapy of diving and iatrogenic gas embolic diseases. In the continuum of general and hyperbaric medicine, it is essential for sustaining viability of damaged or diseased tissues not adequately oxygenated at natural oxygen pressures. Over the entire range of its clinical and operational usefulness, the pressure and duration of tolerable exposure to oxygen is limited by adverse effects on multiple chemical targets, cells, tissues, and organ functions. The rates of development and the qualitative expressions of these effects are different at different respired oxygen pressures. Successful extension of oxygen tolerance, as by slowing the rate of development of adverse effects, will further expand the medical and operational usefulness and safety of oxygen in normal, hypobaric, and hyperbaric environments. A prerequisite baseline for overall extension of oxygen tolerance is the quantitative investigation of early stages of toxic oxygen effects upon specific chemical and composite functions of multiple organ systems, including rates of development and rates of recovery. The practicality of limited oxygen tolerance extension by systematic interruption of oxygen exposure has been demonstrated and the procedure widely used. Broad present goals are both to establish oxygen tolerance for specific tissues and to optimize tolerance extension over the full range of useful oxygen pressures.

Local cerebral glucose utilization rate following intermittent exposures to 2 atmosphere absolute oxygen

Previous studies have shown significant increases in regional cerebral metabolic rate for glucose (rCMRgl) in 14 of 28 investigated brain structures in rats exposed to 1-h oxygen at 2 atmosphere absolute (ATA O2). Continuous 4-h exposure to 2 ATA O2 resulted in significant increases only in superior olivary nucleus and inferior colliculus. In the present study, the rCMRgl was autoradiographically measured by the [14C]2-deoxyglucose technique during the last 30 min of 4 intermittent 1-h exposures to either 2 ATA O2 or air at atmospheric pressure, with 3 h of breathing air outside the pressure chamber between each oxygen or air exposure. Statistically significant reductions in rCMRgl of the oxygen-exposed rats were observed in superior olivary nucleus and inferior colliculus, while no changes were observed in 26 other investigated structures. The previously observed increases in rCMRgl in a single 1- or 4-h exposure at 2 ATA O2 were reduced or reversed during the intermittent hyperbaric oxygen exposure. The relation of the observed changes in rCMRgl during single and intermittent hyperbaric oxygen exposures to the extension of tolerance to hyperbaric oxygenation is discussed.