Near-Infrared Spectroscopy Usefulness in Validation of Hyperventilation Test

oleh: Stefan Sandru, Dan Buzescu, Carmen Denise Mihaela Zahiu, Ana Spataru, Anca Maria Panaitescu, Sebastian Isac, Cosmin Ion Balan, Ana-Maria Zagrean, Bogdan Pavel

Format: Article
Diterbitkan: MDPI AG 2022-10-01

Deskripsi

<i>Background</i>: The hyperventilation test is used in clinical practice for diagnosis and therapeutic purposes; however, in the absence of a standardized protocol, the procedure varies significantly, predisposing tested subjects to risks such as cerebral hypoxia and ischemia. Near-infrared spectroscopy (NIRS), a noninvasive technique performed for cerebral oximetry monitoring, was used in the present study to identify the minimum decrease in the end-tidal CO<sub>2</sub> (ETCO<sub>2</sub>) during hyperventilation necessary to induce changes on NIRS. <i>Materials and Methods</i>: We recruited 46 volunteers with no preexisting medical conditions. Each subject was asked to breathe at a baseline rate (8–14 breaths/min) for 2 min and then to hyperventilate at a double respiratory rate for the next 4 min. The parameters recorded during the procedure were the regional cerebral oxyhemoglobin and deoxyhemoglobin concentrations via NIRS, ETCO<sub>2</sub>, and the respiratory rate. <i>Results</i>: During hyperventilation, ETCO<sub>2</sub> values dropped (31.4 ± 12.2%) vs. baseline in all subjects. Changes in cerebral oximetry were observed only in those subjects (<i>n</i> = 30) who registered a decrease (%) in ETCO<sub>2</sub> of 37.58 ± 10.34%, but not in the subjects (<i>n</i> = 16) for which the decrease in ETCO<sub>2</sub> was 20.31 ± 5.6%. According to AUC-ROC analysis, a cutoff value of ETCO<sub>2</sub> decrease >26% was found to predict changes in oximetry (AUC-ROC = 0.93, <i>p</i> < 0.0001). Seven subjects reported symptoms, such as dizziness, vertigo, and numbness, throughout the procedure. <i>Conclusions</i>: The rise in the respiratory rate alone cannot effectively predict the occurrence of a cerebral vasoconstrictor response induced by hyperventilation, and synchronous ETCO<sub>2</sub> and cerebral oximetry monitoring could be used to validate this clinical test. NIRS seems to be a useful tool in predicting vasoconstriction following hyperventilation.