Adjustment of reduced arterial blood pressure--a tool for investigations into gradually reduced brain function

Hypoxic-ischemic disorders of the neonatal brain function depend in particular on critical decrease of arterial blood pressure (ABP) below the limited range of cerebral autoregulation. An experimental design including an extracorporal ABP controller is presented which enables the induction of gradual hemorrhagic hypotension at different stages of blood flow reduction up to stages of critically disturbed systemic and regional hemodynamics and oxygen supply. In nine newborn piglets several levels of critically reduced ABP (60, 50, 40, 35 mmHg, normal about 75 mmHg) were stabilized over 30 min, and heart rate, breathing, blood gases, systemic and cerebral hemodynamics, and electrocorticogram were recorded. It was found that the reduced circulating blood volume was redistributed in favour of the vital organs. Therefore, brain cortical blood flow was slightly increased at ABP = 60 and ABP = 50 mmHg. A significant reduction of cortical blood flow occurred only at ABP = 35 mmHg. The experimental design which was based on an extracorporal ABP controller is necessary and sufficient for producing functional states of gradual hemorrhagic hypotension with high stability and accuracy, enabling a systematic study of disturbed regional hemodynamics and disturbed energy metabolism under steady state conditions, even under critically changed states of the systemic cardiovascular regulation.