Effect of Acute Heat Exposure on the Pressor Response to a Voluntary Hypoxic Apnea: A Cross-tolerance Study

The pressor response induced by a voluntary hypoxic apnea is exaggerated in individuals with obstructive sleep apnea and is strongly correlated to sympathetic overactivity. Acute heat exposure alters neural control of blood pressure, but its effect on the pressor response to a voluntary hypoxic apnea has never been explored. PURPOSE: To test the hypothesis that acute heat exposure attenuates the pressor response to a voluntary hypoxic apnea, and thereby manifest as a form of physiological cross-tolerance. METHODS: Eight adults (3 females, 26 ± 2 yrs) were exposed to passive heat stress (water perfused suit) sufficient to increase body core temperature by 1.2 °C. Voluntary hypoxic apneas were performed in duplicate before acute heat exposure (pre-heat) and in recovery when body core temperature returned to ≤ 0.3 °C of baseline. Participants breathed gas mixtures of varying FiO2 (21%, 16%, and 12%; randomized) for 1 min followed immediately by a 15 s end-expiratory apnea. Beat-by-beat arterial blood pressure (Finometer) and arterial oxygen saturation (finger pulse oximetry) were measured throughout. The pressor response was calculated as the difference between baseline mean arterial pressure and the peak response following each apnea. RESULTS: The change in arterial oxygen saturation during each apnea did not differ from pre-heat to recovery (FiO2 21%, pre-heat 0 ± 1 % vs. recovery 0 ± 2 %; FiO2 16%, pre-heat -4 ± 1 % vs. recovery -4 ± 2 %; FiO2 12%, pre-heat -8 ± 3 % vs. recovery -10 ± 4 %; P = 0.3 for interaction). The pressor response to a voluntary apnea was attenuated in recovery from acute heat exposure across all concentrations of FiO2 (FiO2 21%, pre-heat 19 ± 8 mmHg vs. recovery 16 ± 8 mmHg; FiO2 16%, pre-heat 27 ± 8 mmHg vs. recovery 20 ± 8 mmHg; FiO2 12%, pre-heat 33 ± 11 mmHg vs. recovery 27 ± 13 mmHg; P = 0.02 for main effect of time). CONCLUSION: These data suggest that acute heat exposure induces a cross-tolerance effect such that the pressor response to a voluntary hypoxic apnea is reduced. Acute heat exposure could improve hypertension in adults with obstructive sleep apnea, secondary to altered chemoreflex function and sympathetic neural control, and provide additional therapeutic options for this population to improve cardiovascular health

Heparin-Induced Thrombocytopenia and Thrombosis Syndrome or H.I.T.T.S.

Heparin induced thrombocytopenia has been reported to occur in 10-30% of patients receiving heparin therapy. Approximately 0.6-10% of these patients wlll develop a rare and poorly recognized paradoxical thrombosis. The suspected mechanism is an IgG mediated immune complex that causes platelet aggregation. Clinical hallmarks include thrombocytopenia, increasing heparin tolerance and recurrent arterial embolism. Laboratory testing as well as treatment modalities are presented. This paper reports on two open-heart surgery cases that developed heparin induced thrombocytopenia and the thrombosis syndrome (H.I.T.T.S.)

Novel split chest tube improves post-surgical thoracic drainage

Objective: Conventional, separate mediastinal and pleural tubes are often inefficient at draining thoracic effusions. Description: We developed a Y-shaped chest tube with split ends that divide within the thoracic cavity, permitting separate intrathoracic placement and requiring a single exit port. In this study, thoracic drainage by the split drain vs. that of separate drains was tested. Methods: After sternotomy, pericardiotomy, and left pleurotomy, pigs were fitted with separate chest drains (n=10) or a split tube prototype (n=9) with internal openings positioned in the mediastinum and in the costodiaphragmatic recess. Separate series of experiments were conducted to test drainage of D5W or 0.58 M sucrose, an aqueous solution with viscosity approximating that of plasma. One litre of fluid was infused into the thorax, and suction was applied at -20 cm H2O for 30 min. Results: When D5W was infused, the split drain left a residual volume of 53±99 ml (mean value ± SD) vs. 148 ± 120 for the separate drain (P = 0.007), representing a drainage efficiency (i.e. drained vol/[drained + residual vol]) of 95 ± 10% vs. 86 ± 12% for the separate drains (P = 0.011). In the second series, the split drain evacuated more 0.58 M sucrose in the first minute (967 ± 129 ml) than the separate drains (680 ± 192 ml, P<0.001). By 30 min, the split drain evacuated a similar volume of sucrose vs. the conventional drain (1089 ± 72 vs. 1056 ± 78 ml; P = 0.5). Residual volume tended to be lower (25 ± 10 vs. 62 ± 72 ml; P = 0.128) and drainage efficiency tended to be higher (98 ± 1 vs. 95 ± 6%; P = 0.111) with the split drain vs. conventional separate drains. Conclusion: The split chest tube drained the thoracic cavity at least as effectively as conventional separate tubes. This new device could potentially alleviate postoperative complications