John E. Davis

Cardiovascular Responses to Standing: Effect of Hydration

Many astronauts experience intolerance to orthostatic stress after space flight, despite the ingestion of salt tablets and water equivalent to 0.9% saline just before their return to Earth. Previous research indicates that the ingestion of 1.07% saline solution increased plasma volume more than did 0.9% saline. Therefore, the authors hypothesized that the 1.07% saline would be more effective in reducing orthostatic stress during standing. In this study, six men (22–47 years) performed a 5‐minute “stand test” (5 minutes supine followed by 5 minutes standing) under four hydration conditions: 1) hypohydrated (HYPO, 20 mg intravenous [IV] Lasix), 2) euhydrated (EU), 3) rehydrated with 1 L 0.9% saline 2 hours after Lasix, or 4) rehydrated with 1 L 1.07% saline. Stand tests were done 4 to 5 hours after rehydration. Plasma volume was reduced 10% after Lasix, and was restored by both rehydration solutions. When subjects stood, their diastolic pressure, mean pressure, heart rate (HR), and peripheral resistance increased (P < .05), and their stroke volume (SV), cardiac output (CO), and thoracic fluid (TF, by impedance cardiography) decreased (P < .05). Systolic arterial pressure (SBP) increased when subjects stood after saline, but decreased if subjects were HYPO or EU (P < .05 for 1.07% versus HYPO and EU). Heart rate (HR), another indicator of orthostatic stress, did not differ among hydration states. During the last minute of the stand test, TF was greater if subjects had fluid countermeasures. Stroke volume, CO, and TF were significantly less during minute 5 of standing than during minute 3. Whether they would continue to fall in a longer stand test is not known. The results for SBP indicate that 1.07% saline may have advantages over 0.9% saline as a countermeasure to postspace‐flight or postbedrest orthostatic intolerance.

Heat stress associated with the use of vapor-barrier garments

Use of personal protective devices in the workplace, while intended to diminish risk of injury, may in some cases increase personal risk from environmental hazards. A case of a juvenile diabetic with complaints of near syncope while working in a plastics laminating process is analyzed. Although his symptoms might be attributed to a variety of causes, they were traced to the effects of heat stress related to wearing vapor-barrier disposable coveralls in a warm environment (85 degrees F). A field study of asbestos workers involved in abatement of asbestos steam pipe insulation illustrates how clothing impermeable to sweat may result in elevation of core body temperature. When workers use vapor-barrier coveralls, work practices or wet bulb globe temperature limits may need to be revised to prevent heat-related injury.

Cerebral autoregulation index at high altitude assessed by thigh‐cuff and transfer function analysis techniques

What is the central question of this study? Whether cerebral autoregulation (CA) is impaired at high altitude and associated with acute mountain sickness remains controversial. We sought to compare two of the most common methods to assess dynamic CA in subjects who ascended to 3424 m and acclimatized. What is the main finding and its importance? We found that CA was reduced at 3424 m when assessed by the classic thigh‐cuff inflation–deflation technique, but not when evaluated by transfer function analysis. These findings suggest that the cerebral vasculature of healthy individuals may become less able to buffer a large, abrupt drop in arterial blood pressure, while still maintaining the ability to regulate slow rhythmical oscillations, during periods of moderate hypoxaemia.

Orthostatic responses at 4860 m in low, moderate, and high altitude residents

This study evaluated the influence of altitude of residence on orthostatic responses when exposed to high altitude. Data collection took place at the Carrel hut (4860 m) on Chimborazo in Ecuador. After being transported to the hut by vehicle, 69 people volunteered for the study. A 3-min stand test (rapid change from supine to standing) provided an orthostatic challenge while resting heart rate (RHR), systolic (SBP) and diastolic (DBP) blood pressures, and arterial oxygen saturation (SpO2) were measured. Participants were separated into four groups based on altitude of residence and ethnicity: LOW (<1500 m; n=15), MOD (1500-3000 m, n=30), and HIGH (>3000 m, n=11) Ecuadorians, and non-Ecuadorian lowlanders (NE-LOW, n=13). Supine and standing RHRs were lower (p<0.05) for HIGH compared to other groups. Furthermore, standing increased RHR in LOW, MOD, and NE-LOW by 11.9 ± 5.3, 9.5 ± 4.1, and 11.6 ± 7.4 bpm, respectively, while HIGH stayed the same (0.6 bpm increase ± 3.3). Additionally, mean arterial pressure decreased slightly but not significantly upon standing in all groups except HIGH. The difference in Spo2 among groups was not significant (p>0.05). Altitude of residence influences the cardiovascular responses to orthostatic stress with HIGH having blunted responses and greater tolerance.