Beat-by-beat variations in blood pressure and RR-interval are interrelated by the actions of baroreflex and non-baroreflex responses. This study had two purposes: (1) to examine the spontaneous relationships between RR-interval and systolic blood pressure to determine the relative occurrence of baroreflex and non-baroreflex responses in humans, and (2) to compare the beat-sequence method with a cross spectral estimate of the baroreflex response slope. Eight healthy men were studied during 10 h of quiet, seated rest, and six men and three women were studied during rest, rest plus fixed pace breathing, and a cold pressor test. RR-interval and continuous, non-invasive arterial blood pressure were measured with a computerized system. A baroreflex sequence was defined by a series of at least three consecutive heart beats in which systolic pressure and the following RR-interval either both increased or both decreased. A non-baroreflex relationship was defined by sequences of at least three beats by opposite directional changes of RR-interval and systolic pressure of that beat. The results showed that there were approximately 30% as many non-baroreflex compared to baroreflex slopes. Individual subject mean baroreflex and non-baroreflex slopes were highly correlated (r = 0.72, P < 0.001). Absolute slope values were not different, and they were unaffected by time, fixed pace breathing, or cold pressor test. The data showed the relatively simple beat-by-beat sequence method to yield spontaneous baroreflex response slopes that were quantitatively similar to, and highly correlated with (r = 0.85-0.94), baroreflex response slopes calculated by spectral analysis methods.

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We compared two methods of assessment of baroreflex sensitivity in eight supine healthy volunteers during repeated baseline measurements and various conditions of cardiac autonomic blockade. The spontaneous baroreflex method involved computer scanning of recordings of continuous finger arterial pressure and electrocardiogram to locate sequences of three or more beats in which pressure spontaneously increased or decreased, with parallel changes in pulse intervals. The mean regression slope of all these sequences during each study condition was considered to represent the mean spontaneous baroreflex slope. In the drug-induced method, sigmoidal curves were constructed from data obtained by bolus injections of phenylephrine and nitroprusside; the tangents taken at the resting pressure of each of these curves were compared with the mean spontaneous baroreflex slopes. The two methods yielded slopes that were highly correlated (r = .96, P < .001), with significant but similar intraindividual baseline variability. Atropine virtually eliminated the baroreflex slope; subsequent addition of propranolol did not alter it further. Propranolol or clonidine alone increased average baroreflex slope to the extent that they increased resting pulse interval (r = .69 to .83). The spontaneous baroreflex method provides a reliable, noninvasive assessment of human vagal cardiac baroreflex sensitivity within its physiological operating range.

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Patients with hypertension exhibit reduced heart rate control during the recovery period after elective surgery. Clonidine prevents this reduction in heart rate control. This may represent a basis for the improved circulatory stability seen with perioperative administration of clonidine.

In this model, the systolic pressure and pulse pressure variations, and inferior vena cava flow fluctuations were dependent on IAP values which caused changes in pleural pressure swing, and this dependency was more marked during hypovolaemia. The present study suggests that dynamic indices are not exclusively related to volaemia in the presence of increased IAP. However, their fluid responsiveness predictive value could not be ascertained as no fluid challenge was performed.

Objective: To evaluate a monitor of pulmonary gas exchange (Deltatrac, Datex) in a clinical setting. Design: After in vitro evaluation, comparison over 2 min between ~rO 2 and VCO2 values measured by the Deltatrac and the Douglas bag technique. Comparisons were also achieved over 8 h periods between the Deltatrac and a system using a mass-spectrometer. Setting: Polyvalent intensive care unit (ICU 15 beds) in a 1200 bed general hospital. Patients: Comparison with the Douglas bag technique in I0 patients undergoing controlled ventilation. Comparison with the massspectrometer system in 25 other patients undergoing controlled or pressure support ventilation.Measurements and results: Compared to the results obtained by the Douglas bag technique, the bias (+2SD) for VO2 and VCO2 was -3.5 _+ 26.6 and 6.1 + 12.7 ml' min -i, respectively. By comparison with the mass-spectrometer system, the bias for VO2 and RQ was -5.8_+ 16.0 ml.min -1 and 0.018 + 0.048, respectively. No drift between the two systems was observed over time. Conclusions:The Deltatrac appears suitable for go 2 and VCO2 measurements in ventilated patients and equivalent to a mass-spectrometer system for long term measurements.

The effect of intense muscular work (80% of maximal oxygen uptake) on responses of plasma hormones involved in electrolyte and water balance were measured in 14 male subjects. They were divided into three groups according to their maximal oxygen uptake and the duration of exercise performed until exhaustion: well trained subjects (group I), trained subjects (group II), and untrained subjects (group III). Pulmonary gas exchange, heart rate, rectal and skin temperature, and weight loss were measured as well as hematocrit and plasma and urine sodium and potassium concentrations. Rectal temperature increased significantly in all subjects after exhaustion. The variation of hematocrit was smallest and the weight loss greatest in the well-trained subjects. Plasma aldosterone, renin activity (PRA), vasopressin (AVP), and neurophysin (Np) displayed highly significant increases after exercise in all three groups: PRA was increased 4.5 times (p < 0.01), aldosterone 13 times (p < 0.05), Np 2.6 times (p pe 0.05), and AVP 4.8 times (p < 0.05). Nevertheless, there was no correlation between the changes in PRA and those in plasma aldosterone, nor between aldosterone and plasma sodium or potassium. At the urinary level, the only striking observation was that free water clearance tends to become positive after exercise. Our results provide evidence that this kind of exercise produces a highly significant increase in plasma levels of the hormones involved in electrolyte and water balance. They also indicate that it is among the well-trained subjects that sweat loss is highest though the hematocrit increase is the smallest; this suggests that water is shifted more efficiently from the extravascular compartment.