Indomethacin‐induced impairment of regional cerebrovascular reactivity: implications for respiratory control

Key points Anterior and posterior cerebral circulations have differential reactivity to changes in arterial blood gases, but the implications for the chemoreflex control of breathing are unclear. Indomethacin‐induced blunting of cerebrovascular flow responsiveness did not affect central or peripheral respiratory chemoreflex magnitude using steady‐state end‐tidal forcing techniques. Posterior reactivity was related to hypoxic ventilatory decline, suggesting that CO 2 washout from central chemoreceptors modulates hypoxic ventilatory dynamics. Our data indicate that steady‐state end‐tidal forcing techniques reduce the arterial–venous gradients, attenuating the effect of brain blood flow on ventilatory responses. Our study confirms the importance of measuring posterior cerebrovasculature when investigating the link between cerebral blood flow and the chemical control of breathing. Abstract Cerebrovascular reactivity impacts CO 2 –[H + ] washout at the central chemoreceptors and hence has marked influence on the control of ventilation. To date, the integration of cerebral blood flow (CBF) and ventilation has been investigated exclusively with measures of anterior CBF, which has a differential reactivity from the vertebrobasilar system and perfuses the brainstem. We hypothesized that: (1) posterior versus anterior CBF would have a stronger relationship to central chemoreflex magnitude during hypercapnia, and (2) that higher posterior reactivity would lead to a greater hypoxic ventilatory decline (HVD). End‐tidal forcing was used to induce steady‐state hyperoxic (300 mmHg ) hypercapnia (+3, +6 and +9 mmHg ) and isocapnic hypoxia (45 mmHg ) before and following pharmacological blunting (indomethacin; INDO; 1.45 ± 0.17 mg kg −1 ) of resting CBF and reactivity. In 22 young healthy volunteers, ventilation, intra‐cranial arterial blood velocities and extra‐cranial blood flows were measured during these challenges. INDO‐induced blunting of cerebrovascular flow responsiveness (CVR) to CO 2 was unrelated to variability in ventilatory sensitivity during hyperoxic hypercapnia. Further results in a sub‐group of volunteers ( n = 9) revealed that elevations of via end‐tidal forcing reduce arterial–jugular venous gradients, attenuating the effect of CBF on chemoreflex responses. During isocapnic hypoxia, vertebral artery CVR was related to the magnitude of HVD ( R 2 = 0.27; P < 0.04; n = 16), suggesting that CO 2 –[H + ] washout from central chemoreceptors modulates hypoxic ventilatory dynamics. No relationships were apparent with anterior CVR. As higher posterior, but not anterior, CVR was linked to HVD, our study highlights the importance of measuring flow in posterior vessels to investigate CBF and ventilatory integration.