title: Middle cerebral artery flow velocity decreases and electroencephalogram (EEG) changes occur as acute hypercapnia reverses.
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.
  
  
  METHODS
  University-affiliated hospital experimental laboratory.
  
  
  METHODS
  Nine healthy volunteers aged 25-35 years.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Department of Emergency Medicine, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizman Street, 64239 Tel Aviv, Israel. dr_halperin@tasmc.health.gov.il
authors.forename: Pinchas
authors.initials: P
authors.lastname: Halpern
authors.forename: Miri Y
authors.initials: MY
authors.lastname: Neufeld
authors.forename: Kobi
authors.initials: K
authors.lastname: Sade
authors.forename: Aviel
authors.initials: A
authors.lastname: Silbiger
authors.forename: Oded
authors.initials: O
authors.lastname: Szold
authors.forename: Natan M
authors.initials: NM
authors.lastname: Bornstein
authors.forename: Patrick
authors.initials: P
authors.lastname: Sorkine
mesh_terms: D000208:Acute Disease; D000328:Adult; D001783:Blood Flow Velocity; D004569:Electroencephalography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D006935:Hypercapnia / Q000503:physiopathology*; D008297:Male; D020768:Middle Cerebral Artery / Q000502:physiology*