Transcranial Doppler estimation of cerebral blood flow and cerebrovascular conductance during modified rebreathing

Jurgen A H R Claassen, Rong Zhang, Qi Fu, Sarah Witkowski, Benjamin D Levine

Research output: Contribution to journalArticlepeer-review

121 Scopus citations


Clinical transcranial Doppler assessment of cerebral vasomotor reactivity (CVMR) uses linear regression of cerebral blood flow velocity (CBFV) vs. end-tidal CO2 (PETCO2) under steady-state conditions. However, the cerebral blood flow (CBF)-PETCO2 relationship is nonlinear, even for moderate changes in CO2. Moreover, CBF is increased by increases in arterial blood pressure (ABP) during hypercapnia. We used a modified rebreathing protocol to estimate CVMR during transient breath-by-breath changes in CBFV and PETCO2. Ten healthy subjects (6 men) performed 15 s of hyperventilation followed by 5 min of rebreathing, with supplemental O2 to maintain arterial oxygen saturation constant. To minimize effects of changes in ABP on CVMR estimation, cerebrovascular conductance index (CVCi) was calculated. CBFV-PETCO2 and CVCi-PETCO2 relationships were quantified by both linear and nonlinear logistic regression. In three subjects, muscle sympathetic nerve activity was recorded. From hyperventilation to rebreathing, robust changes occurred in PETCO2 (20-61 Torr), CBFV (-44 to +104% of baseline), CVCi (-39 to +64%), and ABP (-19 to +23%) (all P < 0.01). Muscle sympathetic nerve activity increased by 446% during hypercapnia. The linear regression slope of CVCi vs. PETCO2 was less steep than that of CBFV (3 vs. 5%/Torr; P = 0.01). Logistic regression of CBF-PETCO2 (r2 = 0.97) and CVCi-PETCO2 (r2 = 0.93) was superior to linear regression (r2 = 0.91, r2 = 0.85; P = 0.01). CVMR was maximal (6-8%/Torr) for PETCO2 of 40-50 Torr. In conclusion, CBFV and CVCi responses to transient changes in PETCO2 can be described by a nonlinear logistic function, indicating that CVMR estimation varies within the range from hypocapnia to hypercapnia. Furthermore, quantification of the CVCi-PETCO2 relationship may minimize the effects of changes in ABP on the estimation of CVMR. The method developed provides insight into CVMR under transient breath-by-breath changes in CO2.

Original languageEnglish (US)
Pages (from-to)870-877
Number of pages8
JournalJournal of applied physiology
Issue number3
StatePublished - Mar 2007


  • Blood pressure
  • Carbon dioxide

ASJC Scopus subject areas

  • Physiology
  • Physiology (medical)


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