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Transcranial Doppler estimation of cerebral blood flow and cerebrovascular conductance during modified rebreathing
Open accessAbstract
Clinical transcranial Doppler assessment of cerebral vasomotor reactivity (CVMR) uses linear regression of cerebral blood flow velocity (CBFV) vs. end-tidal CO 2 (Pet CO 2) under steady-state conditions. However, the cerebral blood flow (CBF)-Pet CO 2 relationship is nonlinear, even for moderate changes in CO 2. Moreover, CBF is increased by increases in arterial blood pressure (ABP) during hypercapnia. We used a modified rebreathing protocol to estimate CVMR during transient breath-by-breath changes in CBFV and Pet CO 2. Ten healthy subjects (6 men) performed 15 s of hyperventilation followed by 5 min of rebreathing, with supplemental O 2 to maintain arterial oxygen saturation constant. To minimize effects of changes in ABP on CVMR estimation, cerebrovascular conductance index (CVCi) was calculated. CBFV-Pet CO 2 and CVCi-Pet CO 2 relationships were quantified by both linear and nonlinear logistic regression. In three subjects, muscle sympathetic nerve activity was recorded. From hyperventilation to rebreathing, robust changes occurred in Pet CO 2 (20–61 Torr), CBFV (−44 to +104% of baseline), CVCi (−39 to +64%), and ABP (−19 to +23%) (all P < 0.01). Muscle sympathetic nerve activity increased by 446% during hypercapnia. The linear regression slope of CVCi vs. Pet CO 2 was less steep than that of CBFV (3 vs. 5%/Torr; P = 0.01). Logistic regression of CBF-Pet CO 2 ( r 2 = 0.97) and CVCi-Pet CO 2 ( r 2 = 0.93) was superior to linear regression ( r 2 = 0.91, r 2 = 0.85; P = 0.01). CVMR was maximal (6–8%/Torr) for Pet CO 2 of 40–50 Torr. In conclusion, CBFV and CVCi responses to transient changes in Pet CO 2 can be described by a nonlinear logistic function, indicating that CVMR estimation varies within the range from hypocapnia to hypercapnia. Furthermore, quantification of the CVCi-Pet CO 2 relationship may minimize the effects of changes in ABP on the estimation of CVMR. The method developed provides insight into CVMR under transient breath-by-breath changes in CO 2.
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In healthy individuals, voluntary hyperventilation from a PCO2 of 40 down to 20 mmHg leads to reductions in cerebral blood flow of approximately 50%, which is markedly more than can be achieved through orthostatic stress by lower body negative pressure alone.
“In healthy individuals, voluntary hyperventilation from a PCO2 of 40 down to 20 mmHg leads to reductions in CBF of approximately 50% (Claassen et al., 2007), which is markedly more than can be achieved through orthostatic stress by lower body negative pressure alone (Levine et al., 1994).”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Claassen et al., 2007
Because hypocapnia leads to both cerebral vasoconstriction and peripheral vasodilation, it is likely to contribute to pooling of blood in the periphery and reductions in cerebral blood flow, and could thus become a critical factor in inducing fainting.
“Because hypocapnia leads to both cerebral vasoconstriction (Claassen et al., 2007) and peripheral vasodilation (Norcliff-Kaufmann et al., 2008), it is likely to contribute to pooling of blood in the periphery and reductions in cerebral blood flow (CBF), and could thus become a critical factor in inducing fainting.”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Claassen et al., 2007
Following voluntary hyperventilation, rebreathing to increase PCO2 from 20 to 60 mmHg leads to an almost three-fold increase in cerebral blood flow, and more than 100% from a baseline of 40 mmHg.
“Following voluntary hyperventilation, rebreathing to increase PCO2 from 20 to 60mmHg leads to an almost three-fold increase in CBF, and more than 100% from a baseline of 40mmHg (Claassen et al., 2007).”
From The psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm (2010) · cites this paper as Claassen et al., 2007
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van Beek, A. H., Claassen, J. A., Rikkert, M. G. O., & Jansen, R. W. (2008) · Journal of Cerebral Blood Flow & Metabolism · doi:10.1038/jcbfm.2008.13 · Cited by 485
Self-citationThe psychophysiology of blood-injection-injury phobia: Looking beyond the diphasic response paradigm
Ritz, T., Meuret, A. E., & Ayala, E. S. (2010) · International Journal of Psychophysiology · doi:10.1016/j.ijpsycho.2010.05.007 · Cited by 74
“Following voluntary hyperventilation, rebreathing to increase PCO2 from 20 to 60mmHg leads to an almost three-fold increase in CBF, and more than 100% from a baseline of 40mmHg (Claassen et al., 2007).”
BackgroundMethodInfluential
Metadata
- Authors
- Claassen, J. A. H. R., Zhang, R., Fu, Q., Witkowski, S., & Levine, B. D.
- Affiliations
- Radboud University Nijmegen (NL)
- Texas Health Dallas (US)
- Venue
- Journal of Applied Physiology
- Publisher
- American Physiological Society
- Published
- 2007-03
- Volume
- 102
- Issue
- 3
- Pages
- 870-877
- ISSN
- 0161-7567 (ISSN-L)
- 8750-7587
- 1522-1601
- OpenAlex
- W2153425956
- Cited by
- 172
- References
- 3
- Citations by year
- 2026: 6 · 2025: 9 · 2024: 9 · 2023: 9 · 2022: 9 · 2021: 11 · 2020: 15 · 2019: 4 · 2018: 9 · 2017: 7 · 2016: 8 · 2015: 12 · 2014: 15 · 2013: 11 · 2012: 6
- FWCI
- 3.10
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- Journal of Applied Physiology (publishedVersion)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Smith ScholarWorks (Smith College) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Funders
- American Heart Association
- Radboud Universiteit
- Radboud Universitair Medisch Centrum
- Topics
- Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Health Sciences › Medicine › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- cerebrovascular reactivity, cerebrovascular conductance, cerebral blood flow velocity, end-tidal carbon dioxide, rebreathing, hypercapnia, hyperventilation, arterial blood pressure, muscle sympathetic nerve activity, transcranial Doppler, sympathetic nervous system
- MeSH terms
- Adult, Blood Flow Velocity, Blood Pressure, Carbon Dioxide, Cerebrovascular Circulation, Female, Heart Rate, Humans, Hypercapnia, Hyperventilation, Male, Middle Aged, Vasomotor System, Ultrasonography, Doppler, Transcranial
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