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Am J Physiol Regul Integr Comp Physiol (May 16, 2007). doi:10.1152/ajpregu.00087.2007
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Submitted on February 7, 2007
Accepted on May 13, 2007

Inspiratory resistance delays the reporting of symptoms with central hypovolemia: association with cerebral blood flow

Caroline Alice Rickards1*, Kathy L Ryan2, William H Cooke3, Keith G Lurie4, and Victor A. Convertino1

1 Remote Triage, US Army Institute of Surgical Research, Fort Sam Houston, Texas, United States
2 Remote Triage, US Army Institute of Surgical Research, San Antonio, Texas, United States
3 Health and Kinesiology, The University of Texas at San Antonio, San Antonio, Texas, United States
4 Advanced Circulatory Systems, Eden Prairie, Minnesota, United States

* To whom correspondence should be addressed. E-mail: carolinerickards{at}hotmail.com.

We tested the hypothesis that breathing through an inspiratory threshold device (ITD) during progressive central hypovolemia would protect cerebral perfusion and attenuate the reporting of presyncopal symptoms. Methods: Eight human subjects were exposed to lower body negative pressure (LBNP) until the presence of symptoms while breathing through either an active ITD (-7 cmH2O impedance) or a sham ITD (0 cmH2O). Cerebral blood flow velocity (CBFV) was measured continuously via transcranial Doppler and analyzed in both time and frequency domains. Subjects were asked to report any subjective presyncopal symptoms (e.g., dizziness, nausea) at the conclusion of each LBNP exposure. Symptoms were coincident with physiological evidence of cardiovascular collapse (e.g., hypotension, bradycardia). Results: Breathing on the active ITD increased LBNP tolerance time (mean±SEM) from 2014±106 s to 2259±138 s (p=0.006). We compared CBFV responses at the time of symptoms during the sham ITD trial with those at the same absolute time during the active ITD trial (when there were no symptoms). While there was no difference in mean CBFV at these time points (sham, 44±4 cm/s vs. active, 47±4 cm/s; p=0.587), total oscillations (sum of high and low frequency spectral power) of CBFV were higher (p=0.004) with the active ITD (45.6±10.2 cm/s2) than the sham ITD (22.1±5.4 cm/s2). Conclusion: Greater oscillations around the same absolute level of mean CBFV are induced by inspiratory resistance and may contribute to the delay in symptoms and cardiovascular collapse that accompany progressive central hypovolemia.




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K. L. Ryan, W. H. Cooke, C. A. Rickards, K. G. Lurie, and V. A. Convertino
Breathing through an inspiratory threshold device improves stroke volume during central hypovolemia in humans
J Appl Physiol, May 1, 2008; 104(5): 1402 - 1409.
[Abstract] [Full Text] [PDF]




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