{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T02:39:26Z","timestamp":1777084766740,"version":"3.51.4"},"reference-count":52,"publisher":"Aerospace Medical Association","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>\n                    <jats:bold>INTRODUCTION:<\/jats:bold>\n                    Exposure to head-to-toe acceleration (G\n                    <jats:sub>z<\/jats:sub>\n                    ) may lead to G-induced loss of consciousness due to reduced head-level blood pressure and flow. Despite various countermeasures, G-induced loss of consciousness remains a safety concern, causing accidents and fatalities. Inhalation of 5% carbon dioxide (CO\n                    <jats:sub>2<\/jats:sub>\n                    ) and higher concentrations can improve G-tolerance but lead to adverse symptoms. This study investigated the impact of 5% and lower concentrations of CO\n                    <jats:sub>2<\/jats:sub>\n                    on the cardiovascular system during orthostatic stress.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>METHODS:<\/jats:bold>\n                    To simulate +G\n                    <jats:sub>z<\/jats:sub>\n                    cardiovascular effects, 20 healthy subjects (11 males, 9 females) were exposed to 5 gas mixtures (room air, 2%, 3%, 4%, and 5% CO\n                    <jats:sub>2<\/jats:sub>\n                    ) while undergoing lower body negative pressure of \u221260 mmHg combined with an 80\u00b0 head-up tilt. Cardiovascular and respiratory parameters were continuously monitored and subjective symptoms were assessed.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>RESULTS:<\/jats:bold>\n                    Compared to room air, breathing 5% CO\n                    <jats:sub>2<\/jats:sub>\n                    significantly increased systolic (+18.4 \u00b1 16.4 mmHg), diastolic (+30.0 \u00b1 9.5 mmHg), and mean arterial (+26.1 \u00b1 11.0 mmHg) blood pressure during orthostatic stress. However, this was also associated with a perceived increase in breathlessness (median 2.5, interquartile range 1.25\u20133) and difficulty breathing (median 2, interquartile range 1\u20133). Lower concentrations of CO\n                    <jats:sub>2<\/jats:sub>\n                    were better tolerated but did not significantly affect physiological response during orthostatic challenge.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>DISCUSSION:<\/jats:bold>\n                    These findings suggest breathing higher concentrations of CO\n                    <jats:sub>2<\/jats:sub>\n                    (5%) can elicit significant cardiovascular changes which potentially could increase G-tolerance, although they are also associated with respiratory discomfort in some individuals. However, as this is an exploratory study, further research that more accurately replicates the complex physiological changes that occur during G\n                    <jats:sub>z<\/jats:sub>\n                    exposure is still required.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>\n                      Twardowska K, Bortnowschi M, Skert R, Lee Y-H, Rafferty G, Pollock R.\n                      <jats:italic>Cardiovascular effects of hypercapnia during lower body negative pressure and head-up tilt<\/jats:italic>\n                      . Aerosp Med Hum Perform. 2026; 97(1):3\u201310.\n                    <\/jats:bold>\n                  <\/jats:p>","DOI":"10.3357\/amhp.6715.2026","type":"journal-article","created":{"date-parts":[[2026,2,10]],"date-time":"2026-02-10T13:42:09Z","timestamp":1770730929000},"page":"3-10","source":"Crossref","is-referenced-by-count":0,"title":["Cardiovascular Effects of Hypercapnia During Lower Body Negative Pressure and Head-Up Tilt"],"prefix":"10.3357","volume":"97","author":[{"given":"Karolina","family":"Twardowska","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mara","family":"Bortnowschi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rocco","family":"Skert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi-Hsin","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerrard","family":"Rafferty","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ross","family":"Pollock","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1911","reference":[{"issue":"6","key":"B1","series-title":"Aviat Space Environ Med.","first-page":"619","article-title":"G-induced loss of consciousness: retrospective survey results from 2259 military aircrew","volume":"77","author":"Green NDC","year":"2006","unstructured":"Green NDC, Ford SA. G-induced loss of consciousness: retrospective survey results from 2259 military aircrew. Aviat Space Environ Med. 2006 Jun; 77(6):619\u201323."},{"issue":"6","key":"B2","series-title":"Aerosp Med Hum Perform.","first-page":"550","article-title":"Incidence of G-induced loss of consciousness and almost loss of consciousness in the Royal Air Force","volume":"88","author":"Slungaard E","year":"2017","unstructured":"Slungaard E, McLeod J, Green NDC, Kiran A, Newham DJ, Harridge SDR. Incidence of G-induced loss of consciousness and almost loss of consciousness in the Royal Air Force. Aerosp Med Hum Perform. 2017 Jun 1; 88(6):550\u20135."},{"key":"B3","series-title":"Ernsting\u2019s aviation and space medicine.","first-page":"131","article-title":"Long duration acceleration","author":"Green NDC.","year":"2016","unstructured":"Green NDC. Long duration acceleration. In: Gradwell DP, Rainford DJ, editors. Ernsting\u2019s aviation and space medicine. Boca Raton (FL): CRC Press; 2016:131\u201356."},{"issue":"2","key":"B4","series-title":"Am J Physiol.","first-page":"355","article-title":"Protection of the cerebral circulation by the cerebrospinal fluid under the influence of radial acceleration","volume":"151","author":"Rushmer RF","year":"1947","unstructured":"Rushmer RF, Beckman EL, Lee D. Protection of the cerebral circulation by the cerebrospinal fluid under the influence of radial acceleration. Am J Physiol. 1947 Dec 1; 151(2):355\u201365."},{"issue":"3\u20134","key":"B5","series-title":"J Physiol.","first-page":"225","article-title":"The regulation of the lung\u2014ventilation","volume":"32","author":"Haldane JS","year":"1905","unstructured":"Haldane JS, Priestley JG. The regulation of the lung\u2014ventilation. 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J Physiol. 2006 Nov 15; 577(Pt 1):369\u201386."},{"issue":"1","key":"B8","series-title":"Am J Physiol.","first-page":"22","article-title":"Protection against acceleratory forces by carbon dioxide inhalation","volume":"152","author":"Van Middlesworth L","year":"1948","unstructured":"Van Middlesworth L, Kline RF. Protection against acceleratory forces by carbon dioxide inhalation. Am J Physiol. 1948 Jan 1; 152(1):22\u20136."},{"key":"B9","series-title":"Gravitational stress in aerospace medicine.","first-page":"115","article-title":"The physiology of positive acceleration","year":"1961","unstructured":"Gauer OH, Zuidema GD, editors. The physiology of positive acceleration. In: Gravitational stress in aerospace medicine. 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J Appl Physiol (1985). 1996 Apr; 80(4):1138\u201343."},{"key":"B14","series-title":"Cotes\u2019 lung function.","first-page":"301","article-title":"Transfer of gases into the blood of alveolar capillaries","author":"Cotes JE.","year":"2020","unstructured":"Cotes JE. Transfer of gases into the blood of alveolar capillaries. In: Maynard RL, Pearce SJ, Nemery B, Wagner PD, Cooper BG, editors. Cotes\u2019 lung function. 2nd ed. Hoboken (NJ): Wiley Blackwell; 2020:301\u201311."},{"key":"B15","series-title":"J Appl Physiol.","first-page":"454","article-title":"Effect of carbon dioxide inhalation on arterial pressure, ECG and plasma catecholamines and 17-OH corticosteroids in normal man","volume":"15","author":"Sechzer PH","year":"1960","unstructured":"Sechzer PH, Egbert LD, Linde HW, Cooper DY, Dripps RD, Price HL. Effect of carbon dioxide inhalation on arterial pressure, ECG and plasma catecholamines and 17-OH corticosteroids in normal man. 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Anesthesiology. 1974 Oct; 41(4):345\u20139."},{"issue":"4","key":"B18","series-title":"J Appl Physiol (1985).","first-page":"1752","article-title":"Association of sex and age with responses to lower-body negative pressure","volume":"65","author":"Frey MA","year":"1988","unstructured":"Frey MA, Hoffler GW. Association of sex and age with responses to lower-body negative pressure. J Appl Physiol (1985). 1988 Oct; 65(4):1752\u20136."},{"issue":"2","key":"B19","series-title":"Aviat Space Environ Med.","first-page":"138","article-title":"Cardiovascular responses of men and women to lower body negative pressure","volume":"48","author":"Montgomery LD","year":"1977","unstructured":"Montgomery LD, Kirk PJ, Payne PA, Gerber RL, Newton SD, Williams BA. Cardiovascular responses of men and women to lower body negative pressure. 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Stroke. 1998 Sep; 29(9):1876\u201381."},{"issue":"6","key":"B24","series-title":"Anesthesiology.","first-page":"604","article-title":"Dynamics of changes in carbon dioxide stores","volume":"21","author":"Farhi LE","year":"1960","unstructured":"Farhi LE, Rahn H. Dynamics of changes in carbon dioxide stores. Anesthesiology. 1960 Nov\u2013Dec; 21(6):604\u201314."},{"issue":"5","key":"B25","series-title":"Aviat Space Environ Med.","first-page":"459","article-title":"LBNP: past protocols and technical considerations for experimental design","volume":"79","author":"Goswami N","year":"2008","unstructured":"Goswami N, Loeppky JA, Hinghofer-Szalkay H. LBNP: past protocols and technical considerations for experimental design. Aviat Space Environ Med. 2008 May; 79(5):459\u201371."},{"issue":"6","key":"B26","series-title":"Chest.","first-page":"2165","article-title":"Hormones and breathing","volume":"122","author":"Saaresranta T","year":"2002","unstructured":"Saaresranta T, Polo O. Hormones and breathing. Chest. 2002 Dec; 122(6):2165\u201382."},{"issue":"6","key":"B1","series-title":"Aviat Space Environ Med.","first-page":"619","article-title":"G-induced loss of consciousness: retrospective survey results from 2259 military aircrew","volume":"77","author":"Green NDC","year":"2006","unstructured":"Green NDC, Ford SA. G-induced loss of consciousness: retrospective survey results from 2259 military aircrew. Aviat Space Environ Med. 2006 Jun; 77(6):619\u201323."},{"issue":"6","key":"B2","series-title":"Aerosp Med Hum Perform.","first-page":"550","article-title":"Incidence of G-induced loss of consciousness and almost loss of consciousness in the Royal Air Force","volume":"88","author":"Slungaard E","year":"2017","unstructured":"Slungaard E, McLeod J, Green NDC, Kiran A, Newham DJ, Harridge SDR. Incidence of G-induced loss of consciousness and almost loss of consciousness in the Royal Air Force. Aerosp Med Hum Perform. 2017 Jun 1; 88(6):550\u20135."},{"key":"B3","series-title":"Ernsting\u2019s aviation and space medicine.","first-page":"131","article-title":"Long duration acceleration","author":"Green NDC.","year":"2016","unstructured":"Green NDC. Long duration acceleration. In: Gradwell DP, Rainford DJ, editors. Ernsting\u2019s aviation and space medicine. Boca Raton (FL): CRC Press; 2016:131\u201356."},{"issue":"2","key":"B4","series-title":"Am J Physiol.","first-page":"355","article-title":"Protection of the cerebral circulation by the cerebrospinal fluid under the influence of radial acceleration","volume":"151","author":"Rushmer RF","year":"1947","unstructured":"Rushmer RF, Beckman EL, Lee D. Protection of the cerebral circulation by the cerebrospinal fluid under the influence of radial acceleration. Am J Physiol. 1947 Dec 1; 151(2):355\u201365."},{"issue":"3\u20134","key":"B5","series-title":"J Physiol.","first-page":"225","article-title":"The regulation of the lung\u2014ventilation","volume":"32","author":"Haldane JS","year":"1905","unstructured":"Haldane JS, Priestley JG. The regulation of the lung\u2014ventilation. J Physiol. 1905 May 9; 32(3\u20134):225\u201366."},{"issue":"3, Pt 2","key":"B6","series-title":"Am J Physiol.","article-title":"Effects of hypercapnia and hypoxia on the cardiovascular system: vascular capacitance and aortic chemoreceptors","volume":"259","author":"Rothe CF","year":"1990","unstructured":"Rothe CF, Maass-Moreno R, Flanagan AD. Effects of hypercapnia and hypoxia on the cardiovascular system: vascular capacitance and aortic chemoreceptors. Am J Physiol. 1990 Sep; 259(3, Pt 2)."},{"issue":"Pt 1","key":"B7","series-title":"J Physiol.","first-page":"369","article-title":"Central chemoreceptors and sympathetic vasomotor outflow","volume":"577","author":"Moreira TS","year":"2006","unstructured":"Moreira TS, Takakura AC, Colombari E, Guyenet PG. Central chemoreceptors and sympathetic vasomotor outflow. J Physiol. 2006 Nov 15; 577(Pt 1):369\u201386."},{"issue":"1","key":"B8","series-title":"Am J Physiol.","first-page":"22","article-title":"Protection against acceleratory forces by carbon dioxide inhalation","volume":"152","author":"Van Middlesworth L","year":"1948","unstructured":"Van Middlesworth L, Kline RF. Protection against acceleratory forces by carbon dioxide inhalation. 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Available from https:\/\/apps.dtic.mil\/sti\/tr\/pdf\/ADA009593.pdf."},{"key":"B11","series-title":"High G physiological protection training.","author":"Bates C Jr","year":"1990","unstructured":"Bates C Jr, Santucci G, Buick F, Burton R, Cl\u00e8re JM,  High G physiological protection training. Neuilly sur Seine (France): North Atlantic Treaty Organization, Advisory Group for Aerospace Research and Development; 1990. Report No.: AGARD-AG-322. [Accessed 2025 Oct. 8]. Available from https:\/\/apps.dtic.mil\/sti\/tr\/pdf\/ADA235181.pdf."},{"issue":"6","key":"B12","series-title":"Aviat Space Environ Med.","first-page":"467","article-title":"Hemodynamic responses to seated and supine lower body negative pressure: comparison with +Gz acceleration","volume":"63","author":"Polese A","year":"1992","unstructured":"Polese A, Sandler H, Montgomery LD. Hemodynamic responses to seated and supine lower body negative pressure: comparison with +Gz acceleration. 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Hoboken (NJ): Wiley Blackwell; 2020:301\u201311."},{"key":"B15","series-title":"J Appl Physiol.","first-page":"454","article-title":"Effect of carbon dioxide inhalation on arterial pressure, ECG and plasma catecholamines and 17-OH corticosteroids in normal man","volume":"15","author":"Sechzer PH","year":"1960","unstructured":"Sechzer PH, Egbert LD, Linde HW, Cooper DY, Dripps RD, Price HL. Effect of carbon dioxide inhalation on arterial pressure, ECG and plasma catecholamines and 17-OH corticosteroids in normal man. J Appl Physiol. 1960 May; 15:454\u20138."},{"issue":"12","key":"B16","series-title":"Aviat Space Environ Med.","first-page":"1012","article-title":"Hyperventilation in response to progressive reduction in central blood volume to near syncope","volume":"80","author":"Convertino VA","year":"2009","unstructured":"Convertino VA, Rickards CA, Lurie KG, Ryan KL. Hyperventilation in response to progressive reduction in central blood volume to near syncope. 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