Influence of upper body position on middle cerebral artery blood velocity during continuous positive airway pressure breathing
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Continuous positive airway pressure (CPAP) is a treatment modality for pulmonary oxygenation difficulties. CPAP impairs venous return to the heart and, in turn, affects cerebral blood flow (CBF) and augments cerebral blood volume (CBV). We considered that during CPAP, elevation of the upper body would prevent a rise in CBV, while orthostasis would challenge CBF. To determine the body position least affecting indices of CBF and CBV, the middle cerebral artery mean blood velocity (MCA Vmean) and the near-infrared spectroscopy determined frontal cerebral hemoglobin content (cHbT) were evaluated in 11 healthy subjects during CPAP at different body positions (15° head-down tilt, supine, 15°, 30° and 45° upper body elevation). In the supine position, 10 cmH2O of CPAP reduced MCA Vmean by 9 ± 3% and increased cHbT by 4 ± 2 μmol/L (mean ± SEM); (P < 0.05). In the head-down position, CPAP increased cHbT to 13 ± 2 μmol/L but left MCA Vmean unchanged. Upper body elevation by 15° attenuated the CPAP associated reduction in MCA Vmean (−7 ± 2%), while cHbT returned to baseline (1 ± 2 μmol/L). With larger elevation of the upper body MCA Vmean decreased progressively to −17 ± 3%, while cHbT remained unchanged from baseline. These results suggest that upper body elevation by ∼15° during 10 cmH2O CPAP prevents an increase in cerebral blood volume with minimal effect on cerebral blood flow.
KeywordsTranscranial Doppler Near-infrared spectroscopy Posture Head-down tilt
We are grateful to the staff at the Department of Clinical Physiology, Bispebjerg Hospital for lending us equipment for this study.
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