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Xie J, Xie S, Zhong Z, Dong H, Huang P, Zhou S, Tian H, Zhang J, Wu Y, Li P. Hypoxic preacclimatization combining intermittent hypoxia exposure with physical exercise significantly promotes the tolerance to acute hypoxia. Front Physiol 2024; 15:1367642. [PMID: 38633296 PMCID: PMC11021865 DOI: 10.3389/fphys.2024.1367642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Background: Both hypoxia exposure and physical exercise before ascending have been proved to promote high altitude acclimatization, whether the combination of these two methods can bring about a better effect remains uncertain. Therefore, we designed this study to evaluate the effect of hypoxic preacclimatization combining intermittent hypoxia exposure (IHE) and physical exercise on the tolerance to acute hypoxia and screen the optimal preacclimatization scheme among the lowlanders. Methods: A total of 120 Han Chinese young men were enrolled and randomly assigned into four groups, including the control group and three experimental groups with hypoxic preacclimatization of 5-day rest, 5-day exercise, and 3-day exercise in a hypobaric chamber, respectively. Main physical parameters for hypoxia acclimatization, AMS incidence, physical and mental capacity were measured for each participant in the hypobaric chamber simulated to the altitude of 4500 m in the effect evaluation stage. The effect was compared between different schemes. Results: During the effect evaluation stage, SpO2 of the 5-day rest group and 5-day exercise group was significantly higher than that of the control group (p = 0.001 and p = 0.006, respectively). The participants with 5-day rest had significantly lower HR than the controls (p = 0.018). No significant differences of AMS incidence were found among the four groups, while the proportion of AMS headache symptom (moderate and severe vs. mild) was significantly lower in the 3-day exercise group than that in the control group (p = 0.002). The 5-day exercise group had significantly higher VO2max, than the other three groups (p = 0.033, p < 0.001, and p = 0.023, respectively). The 5-day exercise group also had significantly higher digital symbol and pursuit aiming test scores, while shorter color selection reaction time than the control group (p = 0.005, p = 0.005, and p = 0.004, respectively). Conclusion: Hypoxic preacclimatization combining IHE with physical exercise appears to be efficient in promoting the tolerance to acute hypoxia. Hypoxia duration and physical exercise of moderate intensity are helpful for improvement of SpO2 and HR, relief of AMS headache symptoms, and enhancement of mental and physical operation capacity.
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Affiliation(s)
- Jiaxin Xie
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shenwei Xie
- Department of Health Management, The 953rd Hospital of PLA, Shigatse, China
| | - Zhifeng Zhong
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Huaping Dong
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Pei Huang
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Simin Zhou
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Huaijun Tian
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jijian Zhang
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Yu Wu
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
| | - Peng Li
- Department of High Altitude Operational Medicine, College of High Altitude Military Medicine, Army Medical University (Third Military Medical University), Chongqing, China
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Andersen HB, Andersen M, Andelius TCK, Pedersen MV, Løfgren B, Pedersen M, Ringgaard S, Kyng KJ, Henriksen TB. Epinephrine vs placebo in neonatal resuscitation: ROSC and brain MRS/MRI in term piglets. Pediatr Res 2023; 93:511-519. [PMID: 35681089 DOI: 10.1038/s41390-022-02126-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 05/01/2022] [Accepted: 05/17/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND We aimed to investigate the effect of epinephrine vs placebo on return of spontaneous circulation (ROSC) and brain magnetic resonance spectroscopy and imaging (MRS/MRI) in newborn piglets with hypoxic cardiac arrest (CA). METHODS Twenty-five piglets underwent hypoxia induced by endotracheal tube clamping until CA. The animals were randomized to CPR + intravenous epinephrine or CPR + placebo (normal saline). The primary outcome was ROSC, and secondary outcomes included time-to-ROSC, brain MRS/MRI, and composite endpoint of death or severe brain MRS/MRI abnormality. RESULTS ROSC was more frequent in animals treated with epinephrine than placebo; 10/13 vs 4/12, RR = 2.31 (95% CI: 1.09-5.77). We found no difference in time-to-ROSC (120 (113-211) vs 153 (116-503) seconds, p = 0.7) or 6-h survival (7/13 vs 3/12, p = 0.2). Among survivors, there was no difference between groups in brain MRS/MRI. We found no difference in the composite endpoint of death or severe brain MRS/MRI abnormality; RR = 0.7 (95% CI: 0.37-1.19). CONCLUSIONS Resuscitation with epinephrine compared to placebo improved ROSC frequency after hypoxic CA in newborn piglets. We found no difference in time-to-ROSC or the composite endpoint of death or severe brain MRS/MRI abnormality. IMPACT In a newborn piglet model of hypoxic cardiac arrest, resuscitation with epinephrine compared to placebo improved the rate of return of spontaneous circulation and more than doubled the 6-h survival. Brain MRS/MRI biomarkers were used to evaluate the effect of epinephrine vs placebo. We found no difference between groups in the composite endpoint of death or severe brain MRS/MRI abnormality. This study adds to the limited evidence regarding the effect and safety of epinephrine; the lack of high-quality evidence from randomized clinical trials was highlighted in the latest ILCOR 2020 guidelines, and newborn animal studies were specifically requested.
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Affiliation(s)
- Hannah B Andersen
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - Mads Andersen
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Ted C K Andelius
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mette V Pedersen
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Bo Løfgren
- Research Center for Emergency, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael Pedersen
- Comparative Medicine Lab, Aarhus University Hospital, Aarhus, Denmark
| | | | - Kasper J Kyng
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tine B Henriksen
- Department of Pediatric and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Xu J, Li C, Tang H, Tan D, Fu Y, Zong L, Jing D, Ding B, Cao Y, Lu Z, Tian Y, Chai Y, Meng Y, Wang Z, Zheng YA, Zhao X, Zhang X, Liang L, Zeng Z, Li Y, Walline JH, Song PP, Zheng L, Sun F, Shao S, Sun M, Huang M, Zeng R, Zhang S, Yang X, Yao D, Yu M, Liao H, Xiong Y, Zheng K, Qin Y, An Y, Liu Y, Chen K, Zhu H, Yu X, Du B. Pulse oximetry waveform: A non-invasive physiological predictor for the return of spontaneous circulation in cardiac arrest patients ---- A multicenter, prospective observational study. Resuscitation 2021; 169:189-197. [PMID: 34624410 DOI: 10.1016/j.resuscitation.2021.09.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This study aimed to investigate the predictive value of pulse oximetry plethysmography (POP) for the return of spontaneous circulation (ROSC) in cardiac arrest (CA) patients. METHODS This was a multicenter, observational, prospective cohort study of patients hospitalized with cardiac arrest at 14 teaching hospitals cross China from December 2013 through November 2014. The study endpoint was ROSC, defined as the restoration of a palpable pulse and an autonomous cardiac rhythm lasting for at least 20 minutes after the completion or cessation of CPR. RESULTS 150 out-of-hospital cardiac arrest (OHCA) patients and 291 in-hospital cardiac arrest (IHCA) patients were enrolled prospectively. ROSC was achieved in 20 (13.3%) and 64 (22.0%) patients in these cohorts, respectively. In patients with complete end-tidal carbon dioxide (ETCO2) and POP data, patients with ROSC had significantly higher levels of POP area under the curve (AUCp), wave amplitude (Amp) and ETCO2 level during CPR than those without ROSC (all p < 0.05). Pairwise comparison of receiver operating characteristic (ROC) curve analysis indicated no significant difference was observed between ETCO2 and Amp (p = 0.204) or AUCp (p = 0.588) during the first two minutes of resuscitation. CONCLUSION POP may be a novel and effective method for predicting ROSC during resuscitation, with a prognostic value similar to ETCO2 at early stage.
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Affiliation(s)
- Jun Xu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chen Li
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China; Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hanqi Tang
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Dingyu Tan
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China; Department of Emergency Medicine, Northern Jiangsu People's Hospital, Yangzhou 225001, China
| | - Yangyang Fu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Liang Zong
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Daoyuan Jing
- Department of Emergency Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Banghan Ding
- Department of Emergency Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou 510120, China
| | - Yu Cao
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhongqiu Lu
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yingping Tian
- Department of Emergency Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Yanfen Chai
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Yanli Meng
- Department of Emergency Medicine, HuaBei Petroleum General Hospital, Renqiu 062552, China
| | - Zhen Wang
- Department of Emergency Medicine, Beijing Shijitan Hospital Capital Medical University, Beijing 100038, China
| | - Ya-An Zheng
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Xiaodong Zhao
- Department of Emergency Medicine, First Affiliated Hospital of PLA Hospital, Beijing 100048, China
| | - Xinyan Zhang
- Department of Emergency Medicine, Beijing Haidian Hospital, Beijing 100080, China
| | - Lu Liang
- Department of Emergency Medicine, Affiliated Hospital of Hebei University, Baoding 071000, China
| | - Zhongyi Zeng
- Department of Emergency Medicine, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, China
| | - Yan Li
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Joseph H Walline
- Centre for the Humanities and Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Priscilla P Song
- Centre for the Humanities and Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Liangliang Zheng
- Beijing Hospital, National Center of Gerontology, China, Beijing 100730, China
| | - Feng Sun
- Department of Emergency Medicine, Jiangsu Province Hospital, Yangzhou 210029, China
| | - Shihuan Shao
- Department of Emergency Medicine, Peking University People's Hospital, Beijing 100044, China; Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Ming Sun
- Department of Emergency Medicine, Affiliated Suqian Hospital of Xuzhou Medical University, Xuzhou 221004, China
| | - Mingwei Huang
- Department of Emergency Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Ruifeng Zeng
- Department of Emergency Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Key Laboratory of Research on Emergency in TCM, Guangzhou 510120, China
| | - Shu Zhang
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiaoya Yang
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Dongqi Yao
- Department of Emergency Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Muming Yu
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin 300052, China
| | - Hua Liao
- Department of Emergency Medicine, HuaBei Petroleum General Hospital, Renqiu 062552, China
| | - Yingxia Xiong
- Department of Emergency Medicine, Beijing Shijitan Hospital Capital Medical University, Beijing 100038, China
| | - Kang Zheng
- Department of Emergency Medicine, Peking University Third Hospital, Beijing 100191, China
| | - Yuhong Qin
- Department of Emergency Medicine, First Affiliated Hospital of PLA Hospital, Beijing 100048, China
| | - Yingbo An
- Department of Emergency Medicine, Beijing Haidian Hospital, Beijing 100080, China
| | - Yuxiang Liu
- Department of Emergency Medicine, Affiliated Hospital of Hebei University, Baoding 071000, China
| | - Kun Chen
- Department of Emergency Medicine, Jinhua Municipal Central Hospital, Jinhua 321000, China
| | - Huadong Zhu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xuezhong Yu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
| | - Bin Du
- Department of Medical Intensive Care, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China.
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