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Effects of Cold Water Immersion on Cerebral Blood Flow Velocity in the Middle Cerebral Artery MRU SRD

Winter 2012
Lemieux CE, Impey KA, MacKay CM, Skow RJ, Day TA
Mount Royal University Department of Chemical and Biological Sciences Faculty of Science and Technology

ABSTRACT
The cold pressor test (CPT) is a common method used to experimentally manipulate cardiorespiratory and cerebrovascular responses to cold-water immersion. Traditionally, CPT is used to transiently augment sympathetic activity, which increases mean arterial blood pressure (MAP) and ventilation. Increases in MAP may translate to a rise in cerebral blood flow velocity (CBFv). Conversely, the resulting increase in ventilation results in a reduction of blood carbon dioxide (CO2) concentrations, which may translate to a reduction of CBFv. We aimed to investigate these opposing mechanisms responsible for the regulation of CBFv during CPT. In our experiment, hypertensive and hypocapnic influences on CBFv were examined by experimentally inducing CPT through immersion of four subjects in 8C, 15C, 23C and 37C water baths for a period of 5 minutes following baseline in room air (23C). We measured MAP using a finometer, respiratory gases using a facemask and gas analyzers, and CBF velocity (CBFv) using transcranial Doppler ultrasound (TCD) of the middle cerebral artery. We found that upon immersion in 8C water, ventilation (P= 0.004) increased and both CO2 (P= 0.003) and CBFv (P= 0.001) decreased. Our results suggest that a hyperventilation induced hypocapnic response of the cerebral vessels leads to a drop in CBFv upon cold-water immersion.

INTRODUCTION
The cold pressor response increases mean arterial pressure and ventilation, either of which have to potential to transiently change cerebral blood flow velocity (CBFv) (Datta & Tipton, 2006; Zvan, Zaletel, Pretnar, Pogacnik, & Kiauta, 1998). The cold pressure response can alter systemic blood pressure through an increase in sympathetic nervous system activity, and increases in systemic blood pressure leads to transient increases in CBF (Battisti-Charbonney et al., 2011; Lucas et al., 2010; Zvan et al., 1998). In contrast, the cold pressor response induces hyperventilation decreasing arterial carbon dioxide concentrations (hypocapnia) resulting in a subsequent decrease in CBF (Ainslie & Duffin, 2009; Battisti-Charbonney et al., 2011; Mantoni, Rasmussen, Belhage, & Pott, 2008).

METHODS
Four healthy female volunteers were recruited for participation in this study by word of mouth. Their physical characteristics and resting measurements are described in Table 1. Each subject was tested during the follicular phase (day 6-14) of the menstrual cycle. Following instrumentation with transcranial Doppler ultrasound and finometer, each subject underwent a 5 minute baseline in room air followed by 8C, 15C, 23C or 37C water immersion to mid-chest for 5 minutes and then allowed to recover for a minimum of 5 minutes prior to next immersion. Each variable was sampled every 10s during both baseline or during water immersion and averaged over the duration. A sample tracing is seen in Figure 1. Statistical analysis included one way repeated measures ANOVA with a Student Newman-Keuls post-hoc test to determine significant differences between physiological variables across immersion temperatures.

Physical Characteristics 23.3 2.52 Age (yrs) 20.93 1.54 BMI (kg/m2) Resting Variables 94.43 14.65 HR (bpm) 86.82 24.56 MAP (mmHg) 6.57 3.41 VE (L/min) 29.63 3.59 PETCO2 (mmHg) 54.03 9.38 MCAv (cm/s) Table 1- Subject demographics and measurements for heart rate (HR), mean arterial pressure (MAP), minute ventilation (VE), end-tidal CO2 (PET CO2), and mean blood flow velocity in the middle cerebral artery (MCAv). Variables shown as mean SD.

HYPOTHESIS
CEREBRAL BLOOD FLOW VELOCITY WILL DECREASE IN 8C AND 15C AND INCREASE TO BASELINE VALUES IN 23C AND 37C.

PROTOCOL
Water immersion 8C 5 min
CBFV (cm/s)
70

Cerebral Blood Flow Velocity in the MCA

Baseline 5 min.

Water immersion 15C 5 min Water immersion 23C 5 min Water immersion 37C 5 min

Recovery 2 min.

60 50 40 30 20 10 0 * P=0.001

RESULTS

Baseline
120

8C

15C

23C

37C

CBFv
MAP (mmHg)

Mean Arterial Pressure


NSD P=0.269

100 80 60 40 20 0

MAP

Baseline

8C

15C

23C

37C
40 35 30 25 20 15 10 5 0

Resp Flow
CO2 (mmHg)

CO2

35 30 25 20 15 10 5 0

Ventilation and CO2


** P= 0.004

P= 0.003

Baseline CO2 Figure 1- Sample raw data tracing from subject 3 8C water immersion from Lab Chart. Cerebral blood flow in the middle cerebral artery was measured using transcranial Doppler ultrasound, mean arterial pressure was measured using a finometer, carbon dioxide percentages were measured by gas analyzers and respiratory flow measured using a pneumotachometer.

8C

15C VE

23C

37C

Figure 2- Hyperventilation during cold pressor test decreases arterial carbon dioxide levels (P= 0.003) and blood flow velocity in the middle cerebral artery (P= 0.001). No changes in mean arterial pressure were observed between water immersion temperatures (p=0.269). * P= 0.082 compared to 37C. ** P=0.0 compared to 37C. P= 0.003 compared to 37C.

DISCUSSION
The initial response to cold water immersion is cold shock which includes an increase in ventilation, heart rate and blood pressure and sympathetic activity (Datta & Tipton, 2006; Victor, Leimbach, Seal, Wallin, & Mark, 1987). It has been shown that the maximal response occurs below 10C during the first 30 seconds of the immersion. (Datta & Tipton, 2006; Mantoni et al., 2008). Changes in mean arterial pressure (MAP) during cold water immersion are thought to be the result of both increases in sympathetic nervous system activity and increases in thoracic pressure from the water immersion (Datta and Tipton, 2006). Increases in MAP due to the increase in sympathetic nervous system activity may therefore increase CBFv (Lucas et al., 2010). Similarly, the cold water immersion induces hyperventilation by sympathetic nervous system activation (Datta & Tipton, 2006; Victor et al., 1987). As reviewed by Ainslie and Duffin (2009), the increase in ventilation leads to decreased blood carbon dioxide (CO2) levels, subsequently decreasing CBFv. The extent to which these competing stimuli affect CBFv during cold water immersion is unknown. The results of the current study found no significant change in MAP (p= 0.269), likely due to the small number of subjects tested or difficulty with finometry during cold exposure. Therefore, in our study MAP is not the driving force for any change in CBFv observed. However, in response to cold water immersion, ventilation increased leading to a hyperventilation induced arterial hypocapnia and a resulting decrease in CBFv in the middle cerebral artery. Thus, arterial CO2 dominates over changes in MAP in driving the dynamic changes in CBFv in response to cold water immersion.

CONCLUSION
There was a decrease in cerebral blood flow velocity observed during cold water immersion as a result of hyperventilation induced hypocapnia. Arterial CO2 dominates over changes in MAP in driving the dynamic changes in CBFv in response to cold water immersion.

ACKNOWLEDGEMENTS AND ETHICS


Special thanks to Khatija Westbrook from Health and Wellness Services This study received approval from MRU Research Ethics Board protocol 2011-91S

REFERENCES
Ainslie, P. N., & Duffin, J. (2009). Integration of cerebrovascular CO2 reactivity and chemoreflex control of breathing: Mechanisms of regulation, measurement, and interpretation. American Journal of Physiology - Regulatory Integrative and Comparative Physiology, 296(5), R1473-R1495. Battisti-Charbonney, A., Fisher, J., & Duffin, J. (2011). The cerebrovascular response to carbon dioxide in humans. Journal of Physiology, 589(12), 30393048. Datta, A., & Tipton, M. (2006). Respiratory responses to cold water immersion: Neural pathways, interactions, and clinical consequences awake and asleep. Journal of Applied Physiology, 100(6), 2057-2064. Lucas, S. J. E., Tzeng, Y. C., Galvin, S. D., Thomas, K. N., Ogoh, S., & Ainslie, P. N. (2010). Influence of changes in blood pressure on cerebral perfusion and oxygenation. Hypertension, 55(3), 698-705. Mantoni, T., Rasmussen, J. H., Belhage, B., & Pott, F. C. (2008). Voluntary respiratory control and cerebral blood flow velocity upon ice-water immersion. Aviation Space and Environmental Medicine, 79(8), 765-768. Victor, R. G., Leimbach Jr., W. N., & Seals, D. R. (1987). Effects of the cold pressor test on muscle sympathetic nerve activity in humans. Hypertension, 9(5), 429-436. Zvan, B., Zaletel, M., Pretnar, J., Pogacnik, T., & Kiauta, T. (1998). Influence of the cold pressor test on the middle cerebral artery circulation. Journal of the Autonomic Nervous System, 74(2-3), 175-178.

VE (L/min)