Controlled hyperventilation using a new ventilation navigator software: a feasibility study to provoke hypocapnia and...

To develop a ventilation navigator to provide controlled hyperventilation and to assess the feasibility to monitor hypocapnia and respiratory alkalosis in healthy subjects.

We developed the Ventilation Navigator software using C++ and utilizing high-precision timers as an advanced platform for respiratory guidance and control, incorporating adjustable breathing rate, and tidal volume, a session timer for automatic cessation. Its graphical user interface is designed to deliver clear visual cues to the patient, facilitating controlled breathing. We assessed the utility of controlled hyperventilation in five healthy probands using end-tidal CO₂ (ETCO₂) against capillary CO₂ and pH. We have successfully achieved respiratory alkalosis (pH >7.50) between 70% and 90% of the subjects' baseline ETCO₂. The linear mixed-effects modelling demonstrated a significant association between ETCO₂ and capillary pH (β = -0.063, SE = 0.008, P < 0.001). There was a moderate, clinically relevant agreement between capillary and ETCO₂ with an offset of 0.48 (1.50 - (-0.54)); however, ETCO₂ was significantly associated with capillary CO₂ (β = 0737, SE = 0.115, P < 0.001) after accounting for repeated measures within individuals. A strong within-individual associations for ETCO₂ vs. capillary CO₂ as demonstrated (Rrm = 0.857, 95% confidence interval: 0.628-0.949, P < 0.001).

We developed a ventilation navigator application to deliver a controlled hyperventilation and assess its feasibility to monitor hypocapnia and respiratory alkalosis in healthy subjects. We are proposing this controlled physiological test to be implemented in the routine diagnostic workup to investigate coronary vasoreactivity in patients having angina with non-occlusive coronary artery disease after it has been validated in patients.