A carbon monoxide ‘single breath’ method to measure total haemoglobin mass: a feasibility study

NEW FINDINGS: What is the central question of this study? Is it possible to modify the CO-rebreathing method to acquire reliable measurements of haemoglobin mass in ventilated patients? What is the main finding and its importance? A 'single breath' of carbon monoxide with a subsequent 30 sec breath hold provides almost as exact a measure of haemoglobin mass as the established optimized CO-rebreathing method when applied to healthy subjects. The modified method has now to be checked in ventilated patients before it can be used to quantify the contributions of blood loss and of dilution to the severity of anaemia. ABSTRACT: Anaemia is defined by the concentration of haemoglobin ([Hb]). However, this value is dependent upon both the total circulating haemoglobin mass (tHb-mass) and the plasma volume (PV) - neither of which are routinely measured. Carbon monoxide- (CO) rebreathing methods have been successfully used to determine both PV and tHb-mass in various populations. However, these methods are not yet suitable for ventilated patients. This study aimed to modify the CO-rebreathing procedure such that a single inhalation of a CO bolus would enable its use in ventilated patients. Eleven healthy volunteers performed four CO-rebreathing tests in a randomized order, inhaling an identical CO-volume. In two tests, CO was rebreathed for 2min (oCOR), and in the other two tests, a single inhalation of a CO bolus was conducted with a subsequent breath hold of 15sec (Procnew 15sec) or 30sec (Procnew 30sec). Subsequently, the CO volume in the exhaled air was continuously determined for 20 min. The amount of CO exhaled after 7min (after 20min) for oCOR was 3.1 ±0.3ml (5.9 ±1.1ml); for Procnew 15sec, 8.7 ±3.6ml (12.0 ±4.4ml); and for Procnew 30sec, 5.1 ±2.0ml (8.4 ±2.6ml)). tHb-mass determined by oCOR was 843 ±293g, from Procnew 15sec 821 ±288g (difference: p <0.05), and from Procnew 30sec 849 ±311g. Bland-Altman plots demonstrated slightly lower tHb-mass values for Procnew 15sec compared with oCOR (-21.8 ±15.3g) and similar values for Procnew 30sec. In healthy volunteers, a single inhalation of a CO bolus, preferably followed by a 30 sec breath hold, can be used to determine tHb-mass. These results must now be validated for ventilated patients. This article is protected by copyright. All rights reserved

Sustainable Urban Systems: Co-design and Framing for Transformation

Rapid urbanisation generates risks and opportunities for sustainable development. Urban policy and decision makers are challenged by the complexity of cities as social–ecological–technical systems. Consequently there is an increasing need for collaborative knowledge development that supports a whole-of-system view, and transformational change at multiple scales. Such holistic urban approaches are rare in practice. A co-design process involving researchers, practitioners and other stakeholders, has progressed such an approach in the Australian context, aiming to also contribute to international knowledge development and sharing. This process has generated three outputs: (1) a shared framework to support more systematic knowledge development and use, (2) identification of barriers that create a gap between stated urban goals and actual practice, and (3) identification of strategic focal areas to address this gap. Developing integrated strategies at broader urban scales is seen as the most pressing need. The knowledge framework adopts a systems perspective that incorporates the many urban trade-offs and synergies revealed by a systems view. Broader implications are drawn for policy and decision makers, for researchers and for a shared forward agenda

Altitude training and haemoglobin mass from the optimised carbon monoxide rebreathing method determined by a meta-analysis

OBJECTIVE: To characterise the time course of changes in haemoglobin mass (Hbmass) in response to altitude exposure. METHODS: This meta-analysis uses raw data from 17 studies that used carbon monoxide rebreathing to determine Hbmass prealtitude, during altitude and postaltitude. Seven studies were classic altitude training, eight were live high train low (LHTL) and two mixed classic and LHTL. Separate linear-mixed models were fitted to the data from the 17 studies and the resultant estimates of the effects of altitude used in a random effects meta-analysis to obtain an overall estimate of the effect of altitude, with separate analyses during altitude and postaltitude. In addition, within-subject differences from the prealtitude phase for altitude participant and all the data on control participants were used to estimate the analytical SD. The 'true' between-subject response to altitude was estimated from the within-subject differences on altitude participants, between the prealtitude and during-altitude phases, together with the estimated analytical SD. RESULTS: During-altitude Hbmass was estimated to increase by ∼1.1%/100 h for LHTL and classic altitude. Postaltitude Hbmass was estimated to be 3.3% higher than prealtitude values for up to 20 days. The within-subject SD was constant at ∼2% for up to 7 days between observations, indicative of analytical error. A 95% prediction interval for the 'true' response of an athlete exposed to 300 h of altitude was estimated to be 1.1-6%. CONCLUSIONS: Camps as short as 2 weeks of classic and LHTL altitude will quite likely increase Hbmass and most athletes can expect benefit