Arterial, Cerebrospinal and Venous Pressures in Man During Cough and Strain

Hamilton, W. F.; Woodbury, Robert A.; Harper, H. T.

doi:10.1097/00005053-194411000-00053

Cited by 21 publications

(24 citation statements)

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“…In contrast, with an intact sympathetic nervous system, the VM reduced palm CVC, whereas, for the forearm, the reduction in blood flow was similar relative to the reduction in perfusion pressure such that forearm CVC was unchanged. Associated with well-described changes in arterial blood pressure, during the VM, the increase in intrathoracic pressure causes similar increases in venous pressure (6). This increase in venous pressure contributes to the reduction in perfusion pressure during the VM.…”

Section: Discussionmentioning

confidence: 61%

“…Cutaneous vascular conductance at baseline (CVC base) was calculated from the ratio of skin blood flow and mean arterial blood pressure. During phase IIb of the VM, because increases in intrathoracic pressure result in similar increases in venous pressure (6), cutaneous perfusion pressure under these conditions was estimated as mean arterial pressure minus intrathoracic pressure (30 mmHg). Thus, at this phase of the VM, cutaneous vascular conductance (CVC VM) was calculated from the ratio of skin blood flow to estimated cutaneous perfusion pressure.…”

Section: Subjectsmentioning

confidence: 99%

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Evidence of a myogenic response in vasomotor control of forearm and palm cutaneous microcirculations

Durand

Zhang²,

Cui

et al. 2004

Journal of Applied Physiology

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Evidence of a myogenic response in vasomotor control of forearm and palm cutaneous microcirculations. J Appl Physiol 97: 535-539, 2004. First published April 16, 2004 10.1152/japplphysiol.01299.2003.-Previous investigations of autoregulatory mechanisms in the control of skin blood flow suffer from the possibility of interfering effects of the autonomic nervous system. To address this question, in 11 subjects cutaneous vascular responses were measured during acute changes in perfusion pressure (using Valsalva maneuver; VM) before and after ganglionic blockade via systemic trimethaphan infusion. Cutaneous vascular conductance at baseline (CVC base) and during the last 5 s of the VM (CVC VM) were measured from forearm (nonglabrous) and palm (glabrous) skin. During the VM without ganglionic blockade, compared with CVCbase, CVCVM decreased significantly at the palm [0.79 Ϯ 0.17 to 0.55 Ϯ 0.17 arbitrary units (AU)/mmHg; P ϭ 0.002] but was unchanged at the forearm (0.13 Ϯ 0.02 to 0.16 Ϯ 0.02 AU/mmHg; P ϭ 0.50). After ganglionic blockade, VM induced pronounced decreases in perfusion pressure, which resulted in significant increases in CVC VM at both forearm (0.19 Ϯ 0.03 to 0.31 Ϯ 0.07 AU/mmHg; P ϭ 0.008) and palm (1.84 Ϯ 0.29 to 2.76 Ϯ 0.63 AU/mmHg; P ϭ 0.003) sites. These results suggest that, devoid of autonomic control, both glabrous and nonglabrous skin are capable of exhibiting vasomotor autoregulation during pronounced reductions in perfusion pressure. autoregulation; skin blood flow; Valsalva maneuver CUTANEOUS TISSUE HAS RELATIVELY low metabolic requirements, and control of skin blood flow is primary influenced by thermal factors (e.g., local and internal temperatures). Skin blood flow can also be modulated by nonneurally mediated events, one of which may be vascular cutaneous autoregulation. Vascular autoregulation serves to maintain blood flow and nutrient supply when perfusion pressure is altered. In addition, autoregulatory responses attenuate large changes in capillary pressure that otherwise would occur during changes in perfusion pressure (15).Cutaneous blood flow during normothermic conditions is in excess of that required to provide for its metabolic demand. Given this, the requirement to autoregulate blood flow through this vascular bed during relatively small changes in perfusion pressure would be less critical relative to other vascular beds. Such a response is likely advantageous given that precise autoregulation of cutaneous vasculature would oppose thermally induced cutaneous vasoconstriction and vasodilation, which are necessary to maintain temperature homeostasis (21).The venoarteriolar response is an example of a vascular autoregulatory mechanism that has been identified and widely investigated in human skin (3,7,9,13,23). However, the stimulus for this response is a change in venous pressure regardless of whether perfusion pressure changes or remains constant. This response also requires an intact local neural network (3,7,10,13,23), which is in contrast to traditional myogenic vascular autor...

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Section: Discussionmentioning

confidence: 61%

Section: Subjectsmentioning

confidence: 99%

Evidence of a myogenic response in vasomotor control of forearm and palm cutaneous microcirculations

Durand

Zhang²,

Cui

et al. 2004

Journal of Applied Physiology

View full text Add to dashboard Cite

show abstract

“…In fact, cerebral blood volume can increase only if cerebrospinal fluid volume decreases (total volume of the cranium cannot change); however, both central venous pressure and central spinal fluid pressure are increased during the maneuver (22,24,33). A number of studies, employing BL-based NIRS, report increased cerebral blood volume and oxygenation during VM (34,36,49).…”

Section: Vmmentioning

confidence: 99%

Inconsistent detection of changes in cerebral blood volume by near infrared spectroscopy in standard clinical tests

Canova

Roatta

Bosone³

et al. 2011

Journal of Applied Physiology

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The attractive possibility of near infrared spectroscopy (NIRS) to noninvasively assess cerebral blood volume and oxygenation is challenged by the possible interference from extracranial tissues. However, to what extent this may affect cerebral NIRS monitoring during standard clinical tests is ignored. To address this issue, 29 healthy subjects underwent a randomized sequence of three maneuvers that differently affect intra- and extracranial circulation: Valsalva maneuver (VM), hyperventilation (HV), and head-up tilt (HUT). Putative intracranial (“i”) and extracranial (“e”) NIRS signals were collected from the forehead and from the cheek, respectively, and acquired together with cutaneous plethysmography at the forehead (PPG), cerebral blood velocity from the middle cerebral artery, and arterial blood pressure. Extracranial contribution to cerebral NIRS monitoring was investigated by comparing Beer-Lambert (BL) and spatially resolved spectroscopy (SRS) blood volume indicators [the total hemoglobin concentration (tHb) and the total hemoglobin index, (THI)] and by correlating their changes with changes in extracranial circulation. While THIe and tHbe generally provided concordant indications, tHbi and THIi exhibited opposite-sign changes in a high percentage of cases (VM: 46%; HV: 31%; HUT: 40%). Moreover, tHbi was correlated with THIi only during HV ( P < 0.05), not during VM and HUT, while it correlated with PPG in all three maneuvers ( P < 0.01). These results evidence that extracranial circulation may markedly affect BL parameters in a high percentage of cases, even during standard clinical tests. Surface plethysmography at the forehead is suggested as complementary monitoring helpful in the interpretation of cerebral NIRS parameters.

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“…Disease states alter these responses. 5 The echocardiogram permits the noninvasive determination of an internal dimension of the left atrium, aorta, and left ventricle. We investigated the echocardiogram during the Valsalva and Mueller maneuvers in normal volunteers and in patients with heart disease to determine the change in cardiac chamber size that such maneuvers might produce and the correlation of this change with abnormalities of cardiovascular function.…”

mentioning

confidence: 99%

The effect of the Valsalva maneuver on echocardiographic dimensions in man.

Robertson¹,

Stevens²,

Friesinger³

et al. 1977

Circulation

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SUMMARY Physiologic changes in the circulatory system caused by performing the Valsalva maneuver are blunted or absent in patients with congestive heart failure. Previously there has been no noninvasive method for examining cardiac chamber size during this maneuver. M-mode echocardiography was used to evaluate possible changes in cardiac chamber dimensions in 12 normal subjects (group I) and 15 patients with cardiovascular disease (group II). In group I, the left ventricular end-diastolic dimension decreased 11.2% (±1.5%) and the end-systolic dimension 9.5% (±1.32%), with a fall in stroke volume of 29%. The left atrial (LA) dimension decreased 30%.THE VALSALVA MANEUVER, raising intrathoracic pressure against a closed glottis ("forced expiration"),1 and the Mueller maneuver, reducing intrathoracic pressure behind a closed glottis ("forced inspiration"),2 have been used in the investigation of cardiovascular hemodynamics and autonomic nervous system function.2 4 Both produce marked hemodynamic changes, resulting in widespread alterations in the central and peripheral circulation. Disease states alter these responses.5 The echocardiogram permits the noninvasive determination of an internal dimension of the left atrium, aorta, and left ventricle. We investigated the echocardiogram during the Valsalva and Mueller maneuvers in normal volunteers and in patients with heart disease to determine the change in cardiac chamber size that such maneuvers might produce and the correlation of this change with abnormalities of cardiovascular function. MethodsTwenty men and seven women were studied. Group I was composed of 12 normal subjects (age range 21 to 58 years, mean = 32) who had no history of cardiovascular or other disease. These subjects were chosen from a group of 24 volunteers because they had satisfactory ventricular and atrial echograms throughout the Valsalva maneuver. Group II consisted of 15 patients (19 to 65 years, mean = 47) admitted to Vanderbilt University Hospital for cardiac evaluation and included patients with ischemic heart disease, aortic stenosis, mitral regurgitation, mitral stenosis and one with severe hypertension. These patients (excepting the hypertensive patient) underwent cardiac catheterization within one week of the study described below. Their The Valsalva and Mueller maneuvers were calibrated using a standard mouthpiece connected in parallel to a graduated manometer and a Statham transducer. The manometer displayed the positive or negative pressure generated by the patient and was placed in view of the patient so that he could maintain the desired pressure. The pressure generated was recorded on the echocardiogram (via a pulse amplifier) or the time during which it was maintained was marked by a separate observer using a marker channel on the strip chart recorder. All subjects were thoroughly instructed and practiced each maneuver several times. Movement and tension of the thoracic and abdominal musculature were observed to ensure valid performance.Left atrial diameter was measured as an...

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Arterial, Cerebrospinal and Venous Pressures in Man During Cough and Strain

Cited by 21 publications

References 0 publications

Evidence of a myogenic response in vasomotor control of forearm and palm cutaneous microcirculations

Evidence of a myogenic response in vasomotor control of forearm and palm cutaneous microcirculations

Inconsistent detection of changes in cerebral blood volume by near infrared spectroscopy in standard clinical tests

The effect of the Valsalva maneuver on echocardiographic dimensions in man.

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