Lower Body Negative Pressure: Historical Perspective, Research Findings, and Clinical Applications

Lower body negative pressure (LBNP) is a technique that redistributes blood from the upper body to the dependent regions of the pelvis and legs, thus reducing central venous pressure and venous return. The subject is placed in a cylindrical air-tight metal tank, which is sealed at the level of the iliac crests, and subatmospheric pressure is produced using a vacuum pump. This article reviews the historical background, physiological effects, research findings, and clinical applications of LBNP. LBNP is found in both the basic science and clinical literature, encompassing its diverse investigational and clinical applications. The first references to LBNP were in 1952 describing its effectiveness in inducing hypotensive anesthesia. Major interest in LBNP began in the mid 1960s when it was used to characterize the cardiovascular responses to hemorrhage and orthostatic stress, especially that associated with the weightlessness of space flight; these studies have continued to the present day. Advantages of LBNP for such experimental studies include the following: (1) The degree of central hypovolemia is easily controlled and has a rapid onset and reversal. (2) The technique is repeatable, reproducible, and noninvasive. (3) No exogenous pharmacologic agent is required to produce venous pooling. (4) The findings are independent of gravity. In recent years, a few institutions have applied LBNP clinically to diagnose abnormalities in cardiovascular autonomic function and, when combined with echocardiography, to uncover changes in cardiac performance through analysis of Starling curves.