{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T04:51:01Z","timestamp":1791607861572,"version":"4.3.4"},"reference-count":38,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,11,20]],"date-time":"2018-11-20T00:00:00Z","timestamp":1542672000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100008898","name":"National Space Biomedical Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008898","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Physiology"],"published-print":{"date-parts":[[2019,1]]},"abstract":"<jats:sec>\n                    <jats:title>Key points<\/jats:title>\n                    <jats:p>\n                      <jats:list list-type=\"bullet\">\n                        <jats:list-item>\n                          <jats:p>During long\u2010term missions, some astronauts experience structural and functional changes of the eyes and brain which resemble signs\/symptoms experienced by patients with intracranial hypertension.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Weightlessness prevents the normal cerebral volume and pressure \u2018unloading\u2019 associated with upright postures on Earth, which may be part of the cerebral and ocular pathophysiology.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>By placing the lower body in a negative pressure device (LBNP) that pulls fluid away from cranial compartments, we simulated effects of gravity and significantly lowered pressure within the brain parenchyma and ventricle compartments.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>Application of incremental LBNP demonstrated a non\u2010linear dose\u2013response curve, suggesting 20\u00a0mmHg LBNP as the optimal level for reducing pressure in the brain without impairing cerebral perfusion pressure.<\/jats:p>\n                        <\/jats:list-item>\n                        <jats:list-item>\n                          <jats:p>This non\u2010invasive method of reducing pressure in the brain holds potential as a countermeasure in space as well as having treatment potential for patients on Earth with traumatic brain injury or other pathology leading to intracranial hypertension.<\/jats:p>\n                        <\/jats:list-item>\n                      <\/jats:list>\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Abstract<\/jats:title>\n                    <jats:p>\n                      Patients with elevated intracranial pressure (ICP) exhibit neuro\u2010ocular symptoms including headache, papilloedema and loss of vision. Some of these symptoms are also present in astronauts during and after prolonged space\u2010flight where lack of gravitational stress prevents daily lowering of ICP associated with upright posture. Lower body negative pressure (LBNP) simulates the effects of gravity by displacing fluid caudally and we hypothesized that LBNP would lower ICP without compromising cerebral perfusion. Ten cerebrally intact volunteers were included: six ambulatory neurosurgical patients with parenchymal ICP\u2010sensors and four former cancer patients with Ommaya\u2010reservoirs to the frontal horn of a lateral ventricle. We applied LBNP while recording ICP and blood pressure while supine, and during simulated intracranial hypertension by 15\u00b0 head\u2010down tilt. LBNP from 0 to 50\u00a0mmHg at increments of 10\u00a0mmHg lowered ICP in a non\u2010linear dose\u2010dependent fashion; when supine (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a010), ICP was decreased from 15\u00a0\u00b1\u00a02\u00a0mmHg to 14\u00a0\u00b1\u00a04, 12\u00a0\u00b1\u00a05, 11\u00a0\u00b1\u00a04, 10\u00a0\u00b1\u00a03 and 9\u00a0\u00b1\u00a04\u00a0mmHg, respectively (\n                      <jats:italic>P\u00a0<\/jats:italic>\n                      &lt;\u00a00.0001). Cerebral perfusion pressure (CPP), calculated as mean arterial blood pressure at midbrain level minus ICP, was unchanged (from 70\u00a0\u00b1\u00a012\u00a0mmHg to 67\u00a0\u00b1\u00a09, 69\u00a0\u00b1\u00a010, 70\u00a0\u00b1\u00a012, 72\u00a0\u00b1\u00a013 and 74\u00a0\u00b1\u00a015\u00a0mmHg;\n                      <jats:italic>P\u00a0<\/jats:italic>\n                      =\u00a00.02). A 15\u00b0 head\u2010down tilt (\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a06) increased ICP to 26\u00a0\u00b1\u00a04\u00a0mmHg, while application of LBNP lowered ICP (to 21\u00a0\u00b1\u00a04, 20\u00a0\u00b1\u00a04, 18\u00a0\u00b1\u00a04, 17\u00a0\u00b1\u00a04 and 17\u00a0\u00b1\u00a04\u00a0mmHg;\n                      <jats:italic>P\u00a0<\/jats:italic>\n                      &lt;\u00a00.0001) and increased CPP (\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.01). An LBNP of 20\u00a0mmHg may be the optimal level to lower ICP without impairing CPP to counteract spaceflight\u2010associated neuro\u2010ocular syndrome in astronauts. Furthermore, LBNP holds clinical potential as a safe, non\u2010invasive method for lowering ICP and improving CPP for patients with pathologically elevated ICP on Earth.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1113\/jp276557","type":"journal-article","created":{"date-parts":[[2018,10,5]],"date-time":"2018-10-05T22:36:49Z","timestamp":1538779009000},"page":"237-248","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":93,"title":["Lower body negative pressure to safely reduce intracranial pressure"],"prefix":"10.1113","volume":"597","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5155-9651","authenticated-orcid":false,"given":"Lonnie G.","family":"Petersen","sequence":"first","affiliation":[{"name":"Department of Biomedical Sciences Faculty of Health Sciences University of Copenhagen  Denmark"},{"name":"Department of Orthopedic Surgery University of California  San Diego CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2166-7966","authenticated-orcid":false,"given":"Justin S.","family":"Lawley","sequence":"additional","affiliation":[{"name":"Institute for Exercise and Environmental Medicine Texas Health Presbyterian Dallas  Dallas TX USA"},{"name":"University of Texas Southwestern Medical Center  Dallas TX USA"},{"name":"Institut f\u00fcr Sportwissenschaft Universit\u00e4t Innsbruck  Innsbruck Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2915-249X","authenticated-orcid":false,"given":"Alexander","family":"Lilja\u2010Cyron","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johan C. 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