Physicians and medical residents are particularly affected by sleep deprivation are, especially in East European countries. The aim of our study is to analyze the effect of caffeine intake on cardiovascular functions in sleep deprived residents (clinicians in-training) after continuous 24h on-call duty. 26 medical residents aged between 22-33 years old, 12 men and 14 women, who began their activity at 2 pm were included. Each subject consumed coffee or caffeinated drinks such as Coca cola during this period, after 2 am, expressed in caffeine units. We have evaluated their cardiovascular function using impedance cardiography (ICG-M501) and blood pressure measurement using the manometric method, before (at 7 pm) and after caffeine consumption (at 7 am), during one night of on-call duty. Surprisingly, after caffeine consumption, all subjects have had a decrease of the heart rate after one night of sleep deprivation (from mean: 83 b/min before to 69.73 b/min after, p = 0.000), also the mean arterial blood pressure is lower after the overnight call (from mean: 95.3 mmHg before to 88.9 mmHg after). Moreover, cardiac output, stroke volume and cardiac index decreases along with an increase of peripheral vascular resistance. Caffeine intake exerts a paradoxical effect on sleep deprived subjects; acute sleep loss, due to continuously, intense on-call work, modifies several cardiovascular parameters, such as heart rate, blood pressures, stroke volume and cardiac output.
Preeclampsia is a severe disorder that can complicate pregnancy with serious consequences for mother and newborn. Although a specific hemodynamics profile can be observed during normal pregnancy, preeclampsia ischaracterized by several specific changes like increased cardiac output, sodium and water retention leading to blood volume expansion, reductions in systemic vascular resistance and systemic blood pressure. Impedance cardiography is a noninvasive method which can provide hemodynamic parameters in pregnancy. We present two cases of pregnancy complicated with preeclampsia and the hemodynamic particularities each of them has. The first one includes a patient with early onset of preeclampsia. She was monitored with impedance cardiography. We observed thatheather index decreased in the second trimester of pregnancy. The second case is focused on recurrent preeclampsia. The hemodynamic profile determined by impedance cardiography showed increased systemic vascular resistance beginningin the second trimester of pregnancy until delivery. Impedance cardiography is a noninvasive method, but its' accuracy in monitoring patients with high risk of preeclampsia should be proved with randomized control trials.
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