Abstract:
OBJECTIVE:To define the changes in middle cerebral artery flow velocity (Vmca) and the electroencephalogram (EEG) during rapid reduction in arterial carbon dioxide (PCO2) from acute hypercapnia. DESIGN. Human volunteer study. SETTING:University-affiliated hospital experimental laboratory. PARTICIPANTS:Nine healthy volunteers aged 25-35 years. INTERVENTIONS:Subjects rebreathed exhaled gas from a bag pre-filled with 5% carbon dioxide (CO2) in oxygen, up to an end-tidal CO2 of 10% or to the limit of discomfort, when they were disconnected. MEASUREMENTS AND RESULTS:Middle cerebral artery blood flow velocity was continuously measured by transcranial Doppler ultrasound, quantitative EEG was recorded and hemodynamics were monitored non-invasively. Vmca closely correlated with end-tidal CO2 changes (r=0.65, p<0.001). When rebreathing ceased, there was a rapid decline in end-tidal CO2 and in Vmca to baseline within 42+/-14 s, followed by a rapid further decline in both variables to below baseline. End-tidal CO2 reached a nadir of 4.4+/-1.1% at 146+/-79 s, with Vmca decreasing to 37+/-10 cm/s at 104+/-65 s (a 40% reduction and 31% below basal values). Electroencephalogram alpha activity significantly decreased and delta activity increased during hypercapnia. During subsequent hypocapnia, delta activity decreased back to baseline, while alpha activity increased, but remained below baseline. CONCLUSIONS:These findings demonstrate the rapid changes occurring in cerebral blood flow during rapid declines in arterial CO2 and the consequent potential for producing brain ischemia and hemodynamic alterations if inadvertent hyperventilation occurs following institution of mechanical ventilation for acute hypercapnia.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Halpern P,Neufeld MY,Sade K,Silbiger A,Szold O,Bornstein NM,Sorkine Pdoi
10.1007/s00134-003-1917-6keywords:
subject
Has Abstractpub_date
2003-10-01 00:00:00pages
1650-5issue
10eissn
0342-4642issn
1432-1238journal_volume
29pub_type
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journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
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pub_type: 杂志文章
doi:10.1007/BF01707665
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更新日期:1989-01-01 00:00:00
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pub_type: 杂志文章,多中心研究
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pub_type: 杂志文章
doi:10.1007/s00134-009-1587-0
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pub_type: 杂志文章,评审
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更新日期:2014-06-01 00:00:00
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更新日期:1997-05-01 00:00:00
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更新日期:1986-01-01 00:00:00
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更新日期:1983-01-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01704704
更新日期:1994-01-01 00:00:00
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更新日期:2007-06-01 00:00:00
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pub_type: 杂志文章,meta分析
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更新日期:2003-03-01 00:00:00
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pub_type: 杂志文章
doi:10.1007/BF00256767
更新日期:1988-01-01 00:00:00
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更新日期:2008-04-01 00:00:00
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pub_type: 杂志文章
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更新日期:2009-07-01 00:00:00
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pub_type: 临床试验,杂志文章,随机对照试验
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更新日期:2002-01-01 00:00:00
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更新日期:2001-03-01 00:00:00
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journal_title:Intensive care medicine
pub_type: 杂志文章
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更新日期:1987-01-01 00:00:00
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更新日期:2013-05-01 00:00:00