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Systolic blood pressure was determined weekly to assess the development of hypertension in sedentary and active Dahl salt-sensitive (S) rats that were exercised by running at 20 m/min, 60 min/day, 5 days/wk. The marked rise in blood pressure that occurred with feeding 8% NaCl (wt/wt) diet in Dahl S rats could be attenuated by chronically practiced endurance running, but only if exercise at 20 m/min was started at the beginning of salt feeding. Under the same dietary feeding conditions, running at 27 m/min resulted in incomplete attenuation of hypertension. Further, running for 30 min/day was not as beneficial as running 60 min/day at 20 m/min. Delaying the start of exercise for 6 wk after the beginning of salt feeding did not result in reduction of hypertension in the S rat. These experiments indicate that increases in blood pressure can be prevented in Dahl S rats for 12 wk if running is initiated concomitantly with salt feeding. Blood pressure is not reduced if hypertension due to salt feeding has been continued for 6 wk. The results also indicate that there is an optimal exercise intensity, duration, or both, for controlling hypertension in Dahl rats.

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Complex cardiac procedures often require blood transfusion because of surgical bleeding or coagulopathy. Thrombelastography (TEG) was introduced in our institution to direct transfusion management in cardiothoracic surgery. The goal of this study was to quantify the effect of TEG on transfusion rates peri- and postoperatively. All patients who underwent complex cardiac surgery, defined as open multiple valve repair/replacement, coronary artery bypass grafting with open valve repair/replacement, or aortic root/arch repair before and after implementation of TEG were identified and retrospectively analyzed. Minimally invasive cases were excluded. Patient characteristics and blood use were compared with t test and chi-square test. A generalized linear model including patient characteristics, preoperative and postoperative lab values, and autotransfusion volume was used to determine the impact of TEG on perioperative, postoperative, and total blood use. In total, 681 patients were identified, 370 in the pre-TEG period and 311 patients post-TEG. Patient demographics were not significantly different between periods. Mean units of red blood cells, plasma, and cryoprecipitate were significantly reduced after TEG was implemented (all, p < .0001); use of platelets was reduced but did not reach significance. Mean units of all blood products in the perioperative period and over the entire stay were reduced by approximately 40% (both, p < .0001). Total proportion of patients exposed to transfusion was significantly lower after introduction of TEG (p < .01). Controlling for related factors on multivariate analysis, such as preoperative laboratory values and autotransfusion volume, use of TEG was associated with significant reduction in perioperative and overall blood product transfusion. TEG-directed management of blood product administration during complex cardiac surgeries significantly reduced the units of blood products received perioperatively but not blood usage more than 24 hours after surgery. Overall, fewer patients were exposed to allogenic blood. The use of TEG to guide blood product administration significantly impacted transfusion therapy and associated costs.

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