Cerebral blood flow during orthostasis:: role of arterial CO2

Cerebral blood flow during orthostasis: role of arterial CO(2). Am J Physiol Regul Integr Comp Physiol 290: R1087 - R1093, 2006. First published November 23, 2005; doi:10.1152/ajpregu. 00446.2005. Reductions in end-tidal Pco(2) (PETco(2)) during upright posture have been suggested to be the result of hyperventilation and the cause of decreases in cerebral blood flow (CBF). The goal of this study was to determine whether decreases in PETco(2) reflected decreases in arterial Pco(2) (Paco(2)) and their relation to increases in alveolar ventilation (VA) and decreases in CBF. Fifteen healthy subjects (10 women and 5 men) were subjected to a 10-min head-up tilt (HUT) protocol. PaCO(2), VA, and cerebral flow velocity (CFV) in the middle and anterior cerebral arteries were examined. In 12 subjects who completed the protocol, reductions in PETCO(2) and PaCO2 (-1.7 +/- 0.5 and -1.1 +/- 0.4 mmHg, P < 0.05) during minute 1 of HUT were associated with a significant increase in V. A (+0.7 +/- 0.3 l/min, P < 0.05). However, further decreases in PaCO2 ( - 0.5 +/- 0.5 mmHg, P < 0.05), from minute 1 to the last minute of HUT, occurred even though VA did not change significantly (-0.2 +/- 0.3 l/min, P < not significant). Similarly, CFV in the middle and anterior cerebral arteries decreased (-7 +/- 2 and -8 +/- 2%, P < 0.05) from minute 1 to the last minute of HUT, despite minimal changes in PaCO2. These data suggest that decreases in PETCO2 and PaCO2 during upright posture are not solely due to increased V. A but could be due to ventilation-perfusion mismatch or a redistribution of CO2 stores. Furthermore, the reduction in PaCO2 did not fully explain the decrease in CFV throughout HUT. These data suggest that factors in addition to a reduction in PaCO2 play a role in the CBF response to orthostatic stress.