title: Influence of expiratory flow-limitation during exercise on systemic oxygen delivery in humans.
abstract: To determine the effects of exercise with expiratory flow-limitation (EFL) on systemic O(2) delivery, seven normal subjects performed incremental exercise with and without EFL at approximately 0.8 l s(-1) (imposed by a Starling resistor in the expiratory line) to determine maximal power output under control (W'(max,c)) and EFL (W'(max,e)) conditions. W'(max,e) was 62.5% of W'(max,c), and EFL exercise caused a significant fall in the ventilatory threshold. In a third test, after exercising at W'(max,e) without EFL for 4 min, EFL was imposed; exercise continued for 4 more minutes or until exhaustion. O(2) consumption (V'(O)(2)) was measured breath-by-breath for the last 90 s of control, and for the first 90 s of EFL exercise. Assuming that the arterio-mixed venous O(2) content remained constant immediately after EFL imposition, we used V'(O)(2) as a measure of cardiac output (Q'(c)). Q'(c) was also calculated by the pulse contour method with blood pressure measured continuously by a photo-plethysmographic device. Both sets of data showed a decrease of Q'(c) due to a decrease in stroke volume by 10% (p < 0.001 for V'(O)(2)) with EFL and remained decreased for the full 90 s. Concurrently, arterial O(2) saturation decreased by 5%, abdominal, pleural and alveolar pressures increased, and duty cycle decreased by 43%. We conclude that this combination of events led to a decrease in venous return secondary to high expiratory pressures, and a decreased duty cycle which decreased O(2) delivery to working muscles by approximately 15%.
authors.affiliation: Dipartimento di Bioingegneria, Politecnico di Milano, Italy. andrea.aliverti@polimi.it
authors.forename: A
authors.initials: A
authors.lastname: Aliverti
authors.forename: R L
authors.initials: RL
authors.lastname: Dellacà
authors.forename: P
authors.initials: P
authors.lastname: Lotti
authors.forename: S
authors.initials: S
authors.lastname: Bertini
authors.forename: R
authors.initials: R
authors.lastname: Duranti
authors.forename: G
authors.initials: G
authors.lastname: Scano
authors.forename: J
authors.initials: J
authors.lastname: Heyman
authors.forename: A
authors.initials: A
authors.lastname: Lo Mauro
authors.forename: A
authors.initials: A
authors.lastname: Pedotti
authors.forename: P T
authors.initials: PT
authors.lastname: Macklem
mesh_terms: D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D015444:Exercise / Q000502:physiology*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008168:Lung / Q000502:physiology; D008176:Lung Volume Measurements; D008297:Male; D010101:Oxygen Consumption / Q000502:physiology*; D011659:Pulmonary Gas Exchange / Q000502:physiology; D012123:Pulmonary Ventilation / Q000502:physiology*