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Ventilatory changes following head-up tilt and standing in healthy subjects

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Abstract

Passive tilting increases ventilation in healthy subjects; however, controversy surrounds the proposed mechanism. This study is aimed to evaluate the possible mechanism for changes to ventilation following passive head-up tilt (HUT) and active standing by comparison of a range of ventilatory, metabolic and mechanical parameters. Ventilatory parameters (V T, V E, V E/VO2, V E/VCO2, f and PetCO2), functional residual capacity (FRC), respiratory mechanics with impulse oscillometry; oxygen consumption (VO2) and carbon dioxide production (VCO2) were measured in 20 healthy male subjects whilst supine, following HUT to 70° and unsupported standing. Data were analysed using a linear mixed model. HUT to 70° from supine increased minute ventilation (V E) (P<0.001), tidal volume (V T) (P=0.001), ventilatory equivalent for O2 (V E/VO2) (P=0.020) and the ventilatory equivalent for CO2 (V E/VCO2) (P<0.001) with no change in f (P=0.488). HUT also increased FRC (P<0.001) and respiratory system reactance (X5Hz) (P<0.001) with reduced respiratory system resistance (R5Hz) (P=0.004) and end-tidal carbon dioxide (PetCO2) (P<0.001) compared to supine. Standing increased V E (P<0.001), V T (P<0.001) and V E/VCO2 (P=0.020) with no change in respiratory rate (f) (P=0.065), V E/VO2 (P=0.543). Similar changes in FRC (P<0.001), R5Hz (P=0.013), X5Hz (P<0.001) and PetCO2 (P<0.001) compared to HUT were found. In contrast to HUT, standing increased VO2 (P=0.002) and VCO2 (P=0.048). The greater increase in V E in standing compared to HUT appears to be related to increased VO2 and VCO2 associated with increased muscle activity in the unsupported standing position. This has implications for exercise prescription and rehabilitation of critically ill patients who have reduced cardiovascular and respiratory reserve.

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Acknowledgements

Authors would like to thank Mrs. Anita Brake and Ms. Caroline Perrow for their assistance with data collection. Financial assistance was provided by the Dorothy Hopkins Award for Clinical Study (Australian Physiotherapy Association) and Royal Brisbane Hospital Research Foundation. PH was supported by the NHMRC of Australia and AC was supported by the Sir Robert Menzies Scholarship for the Allied Health Sciences.

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Authors and Affiliations

  1. Division of Physiotherapy, The University of Queensland, Brisbane, Australia, 4072

    Angela T. Chang & Paul W. Hodges

  2. Department of Intensive Care Medicine, Burns, Trauma and Critical Care Research Unit, Royal Brisbane and women's Hospital, Brisbane, Australia, 4006

    Angela T. Chang & Robert J. Boots

  3. Department of Thoracic Medicine, Royal Brisbane and women's Hospital, Brisbane, Australia, 4006

    Michael G. Brown

  4. Alfred Hospital/La Trobe University Cardiopulmonary Research Centre, Melbourne, Australia, 3001

    Jennifer D. Paratz

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  1. Angela T. Chang
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Correspondence to Angela T. Chang.

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Chang, A.T., Boots, R.J., Brown, M.G. et al. Ventilatory changes following head-up tilt and standing in healthy subjects. Eur J Appl Physiol 95, 409–417 (2005). https://doi.org/10.1007/s00421-005-0019-2

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