Blood pooling in extrathoracic veins after glossopharyngeal insufflation

Tanja Mijacika; Daria Frestad; Kasper Kyhl; Otto Barak; Ivan Drvis; Niels H. Secher; Ante Buca; Ante Obad; Zeljko Dujic; Per Lav Madsen

doi:10.1007/s00421-017-3545-9

Blood pooling in extrathoracic veins after glossopharyngeal insufflation

Tanja Mijacika, Daria Frestad, Kasper Kyhl, Otto Barak, Ivan Drvis, Niels H. Secher, Ante Buca, Ante Obad, Zeljko Dujic^*, Per Lav Madsen

^*Corresponding author for this work

Department of Clinical Medicine

2 Citations (Scopus)

Abstract

Purpose: Trained breath-hold divers hyperinflate their lungs by glossopharyngeal insufflation (GPI) to prolong submersion time and withstand lung collapse at depths. Pulmonary hyperinflation leads to profound hemodynamic changes. Methods: Thirteen divers performed preparatory breath-holds followed by apnea with GPI. Filling of extrathoracic veins was determined by ultrasound and magnetic resonance imaging and peripheral extravasation of fluid was assessed by electrical impedance. Femoral vein diameter was measured by ultrasound throughout the easy-going and struggle phase of apnea with GPI in eight divers in a sub-study. Results: After GPI, pulmonary volume increased by 0.8 ± 0.6 L above total lung capacity. The diameter of the superior caval (by 36 ± 17%) and intrathoracic part of the inferior caval vein decreased (by 21 ± 16%), while the diameters of the internal jugular (by 53 ± 34%), hepatic (by 28 ± 40%), abdominal part of the inferior caval (by 28 ± 28%), and femoral veins (by 65 ± 50%) all increased (P < 0.05). Blood volume of the internal jugular, the hepatic, the abdominal part of the inferior caval vein, and the combined common iliac and femoral veins increased by 145 ± 115, 80 ± 88, 61 ± 60, and 183 ± 197%, respectively. In the sub-study, femoral vein diameter increased by 44 ± 33% in the easy-going phase of apnea with GPI, subsequently decreasing by 20 ± 16% during the struggle phase. Electrical impedance remained unchanged over the thigh and forearm, thus excluding peripheral fluid extravasation. Conclusions: GPI leads to heart and pulmonary vessel compression, resulting in redistribution of blood to extrathoracic capacitance veins proximal to venous valves. This is partially reversed by the onset of involuntary breathing movements.

Original language	English
Journal	European Journal of Applied Physiology
Volume	117
Issue number	4
Pages (from-to)	641-649
Number of pages	9
ISSN	1439-6319
DOIs	https://doi.org/10.1007/s00421-017-3545-9
Publication status	Published - Apr 2017

Keywords

Blood shift
Breath-hold diving
Magnetic resonance imaging
Pulmonary hyperinflation
Ultrasound

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10.1007/s00421-017-3545-9

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@article{324a3b2325af48b4842694b57fbc6965,

title = "Blood pooling in extrathoracic veins after glossopharyngeal insufflation",

abstract = "Purpose: Trained breath-hold divers hyperinflate their lungs by glossopharyngeal insufflation (GPI) to prolong submersion time and withstand lung collapse at depths. Pulmonary hyperinflation leads to profound hemodynamic changes. Methods: Thirteen divers performed preparatory breath-holds followed by apnea with GPI. Filling of extrathoracic veins was determined by ultrasound and magnetic resonance imaging and peripheral extravasation of fluid was assessed by electrical impedance. Femoral vein diameter was measured by ultrasound throughout the easy-going and struggle phase of apnea with GPI in eight divers in a sub-study. Results: After GPI, pulmonary volume increased by 0.8 ± 0.6 L above total lung capacity. The diameter of the superior caval (by 36 ± 17%) and intrathoracic part of the inferior caval vein decreased (by 21 ± 16%), while the diameters of the internal jugular (by 53 ± 34%), hepatic (by 28 ± 40%), abdominal part of the inferior caval (by 28 ± 28%), and femoral veins (by 65 ± 50%) all increased (P < 0.05). Blood volume of the internal jugular, the hepatic, the abdominal part of the inferior caval vein, and the combined common iliac and femoral veins increased by 145 ± 115, 80 ± 88, 61 ± 60, and 183 ± 197%, respectively. In the sub-study, femoral vein diameter increased by 44 ± 33% in the easy-going phase of apnea with GPI, subsequently decreasing by 20 ± 16% during the struggle phase. Electrical impedance remained unchanged over the thigh and forearm, thus excluding peripheral fluid extravasation. Conclusions: GPI leads to heart and pulmonary vessel compression, resulting in redistribution of blood to extrathoracic capacitance veins proximal to venous valves. This is partially reversed by the onset of involuntary breathing movements.",

keywords = "Blood shift, Breath-hold diving, Magnetic resonance imaging, Pulmonary hyperinflation, Ultrasound",

author = "Tanja Mijacika and Daria Frestad and Kasper Kyhl and Otto Barak and Ivan Drvis and Secher, {Niels H.} and Ante Buca and Ante Obad and Zeljko Dujic and Madsen, {Per Lav}",

year = "2017",

month = apr,

doi = "10.1007/s00421-017-3545-9",

language = "English",

volume = "117",

pages = "641--649",

journal = "European Journal of Applied Physiology",

issn = "1439-6319",

publisher = "Springer",

number = "4",

}

TY - JOUR

T1 - Blood pooling in extrathoracic veins after glossopharyngeal insufflation

AU - Mijacika, Tanja

AU - Frestad, Daria

AU - Kyhl, Kasper

AU - Barak, Otto

AU - Drvis, Ivan

AU - Secher, Niels H.

AU - Buca, Ante

AU - Obad, Ante

AU - Dujic, Zeljko

AU - Madsen, Per Lav

PY - 2017/4

Y1 - 2017/4

N2 - Purpose: Trained breath-hold divers hyperinflate their lungs by glossopharyngeal insufflation (GPI) to prolong submersion time and withstand lung collapse at depths. Pulmonary hyperinflation leads to profound hemodynamic changes. Methods: Thirteen divers performed preparatory breath-holds followed by apnea with GPI. Filling of extrathoracic veins was determined by ultrasound and magnetic resonance imaging and peripheral extravasation of fluid was assessed by electrical impedance. Femoral vein diameter was measured by ultrasound throughout the easy-going and struggle phase of apnea with GPI in eight divers in a sub-study. Results: After GPI, pulmonary volume increased by 0.8 ± 0.6 L above total lung capacity. The diameter of the superior caval (by 36 ± 17%) and intrathoracic part of the inferior caval vein decreased (by 21 ± 16%), while the diameters of the internal jugular (by 53 ± 34%), hepatic (by 28 ± 40%), abdominal part of the inferior caval (by 28 ± 28%), and femoral veins (by 65 ± 50%) all increased (P < 0.05). Blood volume of the internal jugular, the hepatic, the abdominal part of the inferior caval vein, and the combined common iliac and femoral veins increased by 145 ± 115, 80 ± 88, 61 ± 60, and 183 ± 197%, respectively. In the sub-study, femoral vein diameter increased by 44 ± 33% in the easy-going phase of apnea with GPI, subsequently decreasing by 20 ± 16% during the struggle phase. Electrical impedance remained unchanged over the thigh and forearm, thus excluding peripheral fluid extravasation. Conclusions: GPI leads to heart and pulmonary vessel compression, resulting in redistribution of blood to extrathoracic capacitance veins proximal to venous valves. This is partially reversed by the onset of involuntary breathing movements.

AB - Purpose: Trained breath-hold divers hyperinflate their lungs by glossopharyngeal insufflation (GPI) to prolong submersion time and withstand lung collapse at depths. Pulmonary hyperinflation leads to profound hemodynamic changes. Methods: Thirteen divers performed preparatory breath-holds followed by apnea with GPI. Filling of extrathoracic veins was determined by ultrasound and magnetic resonance imaging and peripheral extravasation of fluid was assessed by electrical impedance. Femoral vein diameter was measured by ultrasound throughout the easy-going and struggle phase of apnea with GPI in eight divers in a sub-study. Results: After GPI, pulmonary volume increased by 0.8 ± 0.6 L above total lung capacity. The diameter of the superior caval (by 36 ± 17%) and intrathoracic part of the inferior caval vein decreased (by 21 ± 16%), while the diameters of the internal jugular (by 53 ± 34%), hepatic (by 28 ± 40%), abdominal part of the inferior caval (by 28 ± 28%), and femoral veins (by 65 ± 50%) all increased (P < 0.05). Blood volume of the internal jugular, the hepatic, the abdominal part of the inferior caval vein, and the combined common iliac and femoral veins increased by 145 ± 115, 80 ± 88, 61 ± 60, and 183 ± 197%, respectively. In the sub-study, femoral vein diameter increased by 44 ± 33% in the easy-going phase of apnea with GPI, subsequently decreasing by 20 ± 16% during the struggle phase. Electrical impedance remained unchanged over the thigh and forearm, thus excluding peripheral fluid extravasation. Conclusions: GPI leads to heart and pulmonary vessel compression, resulting in redistribution of blood to extrathoracic capacitance veins proximal to venous valves. This is partially reversed by the onset of involuntary breathing movements.

KW - Blood shift

KW - Breath-hold diving

KW - Magnetic resonance imaging

KW - Pulmonary hyperinflation

KW - Ultrasound

U2 - 10.1007/s00421-017-3545-9

DO - 10.1007/s00421-017-3545-9

M3 - Journal article

C2 - 28243777

AN - SCOPUS:85014044653

SN - 1439-6319

VL - 117

SP - 641

EP - 649

JO - European Journal of Applied Physiology

JF - European Journal of Applied Physiology

IS - 4

ER -

Blood pooling in extrathoracic veins after glossopharyngeal insufflation

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