Blood Volume Distribution Research Articles

Plasma volume expansion by albumin in cirrhosis. Relation to blood volume distribution, arterial compliance and severity of disease

Background/Aims: The aim of the study was to investigate the effect of a standard albumin load on blood volume distribution, arterial compliance, and the renin-angiotensin-aldosterone system in patients with different degrees of cirrhosis. Methods: 31 patients with cirrhosis (Child classes A/B/C=8/14/9) received an intravenous infusion of 40 g human serum albumin during a haemodynamic investigation. Results: Whereas plasma- and blood volume increased by 23 and 15%, respectively ( P<0.001), a significant increase in central blood volume was found only in class A patients (+8%, P<0.05), but not in class B or class C patients (+2.7%, not significant (n.s.)). In contrast, arterial compliance only increased significantly in class C patients (+18%, P<0.05), but not in class A or class B patients (+6%, n.s.). Plasma renin activity (PRA) decreased significantly in class C patients (−31%, P<0.05). When all patients were compared, the change in arterial compliance was inversely correlated to the change in PRA ( r=−0.50, P<0.01). Conclusions: Although infusion of albumin does not expand the central blood volume in patients with advanced cirrhosis, the results indicate a significant improvement in the low effective arterial blood volume of such patients, which may be important in the prevention of circulatory dysfunction.

Quinine distribution in mice with Plasmodium berghei malaria.

The disposition of a single 80 mg/kg injection of quinine base was compared in control and Plasmodium berghei-infected mice. Pharmacokinetic parameters were determined on repeated whole blood samples from caudal vein (experiment 1) and quinine distribution was evaluated in tissues and blood fractions from mice sacrificed two hours post dosing (experiment 2). Quinine concentrations were assessed by high performance liquid chromatography with fluorometric detection. Whole blood concentrations and AUC(0 - infinity) of quinine increased in a parasitaemia-dependent manner. Quinine blood clearance and peak blood concentrations of metabolites negatively correlated with the parasitaemia. The apparent distribution volume of quinine only decreased in severely ill mice. Quinine concentrations rise in a parasitaemia-dependent manner in homogenates of spleen, lungs and kidney and in erythrocyte pellets. The negative relationship, observed between the parasitaemia and the tissue-to-whole blood ratio for muscle, heart, liver and brain, contributes to the reduction of the blood distribution volume. Quinine uptake by muscle and heart was dependent on the free fraction of plasma quinine. The liver and brain concentrations of quinine were similar in control and infected mice. The tissue-to-plasma free fraction ratios decrease when the parasitaemia rises suggesting a restrictive uptake of quinine by these tissues. In conclusion. P. berghei malaria decreases both total clearance and apparent volume of distribution with a heterogeneous redistribution of quinine between the tissues.

The effect of terlipressin on blood volume distribution in patients with cirrhosis

The effect of terlipressin on blood volume distribution in patients with cirrhosis

Perception of posture and cerebral blood flow

The perception of posture in man is made possible by the information of the vestibular organs, the visual system, the proprioception and the blood volume distribution. The present study examined the cerebral blood flow velocity (CBFV) and the fluid volume of the thoracic cavity under different pressure conditions and their effects on the perception of posture. Changes in blood flow velocity were measured by transcranial Doppler sonography (TCD), and changes in the blood volume distribution of the upper torso were registered by impedance plethysmography. The results indicated that the cerebral blood flow volume and the thoracic blood volume changed in the same manner. Lower Body Positive Pressure (+30 mmHg) led to an increase in central volume and CBFV. During the Lower Body Negative Pressure Treatment (−30 mmHg), the central blood volume and the cerebral blood flow velocity decreased while venous pooling occurred. Additionally, the changes in both parameters were associated with an altered posture perception. The correlations between the SHP and the two physiological parameters cerebral blood flow velocity and fluid shift in the upper thorax indicate that the fluid shift in the thoracic cavity was more closely related to the SHP than to the changes in cerebral blood volume.

Ultrasonic Imaging of Organ Perfusion with SH U 563A

Ultrasound (US) diagnosis uses B-mode images to provide anatomic information and uses Doppler analysis to measure the velocity of blood flow. It has recently been discovered that the active acoustic response of US contrast agents, acoustic emission, allows detection of some contrast agents in the microvascular compartment and even as stationary contrast with color Doppler imaging (1–3). The underlying phenomenon is the complex interaction between the incident ultrasound wave and microbubbles. The incident ultrasound can drive the microbubbles into oscillation, and depending on the size of the microbubbles and the properties of their shells, that oscillation can become resonant. As the microbubbles undergo nonlinear oscillation, they emit signals containing harmonic components of the fundamental frequency as well as broadband signal components. In principle, the microbubbles act as an active sound source within the US field (4). The signals originating from microbubbles due to stimulated acoustic emission can be used for specific detection of the US contrast agent with different techniques: conventional color Doppler imaging; and more complex pulse sequences, such as wideband harmonic imaging (5,6), in new high-end US equipment. With color Doppler imaging, the induced acoustic emissions are detected as signals with a random value, resulting in a peculiar mosaic pattern varying with time. The underlying mechanism is that color Doppler flow mapping depends on the correlation between successive pulses. This is infringed by the nonlinear response of SH U 563A (Schering, Berlin, Germany) resulting in a loss of correlation of the pulses during the destruction of the microbubble. Because this technique is not using color Doppler imaging in its original fashion, it may also be described as “loss of correlation” (LOC) imaging, to distinguish this technique from vascular color Doppler imaging. Although the same technique, color Doppler imaging, is used, the image content is changed from a flow image based on correlation to a map of the contrast distribution based on LOC and destruction of the microbubbles during the scanning process (1). The contrast agent distribution, the localization map, is generated by the presence of the random color spots, with varying color in the image and between subsequent images. The information on tissue perfusion during the vascular phase and the distribution of active reticuloendothelial system (RES) cells after uptake is provided by this map. It gives a direct image of the microvascular compartment and the RES compartment, independent of flow velocity. SH U 563A is a novel polymeric US contrast agent, optimized for this nonlinear acoustic response. Due to the durability of the polymer shell, no degradation is observed during the capillary passage in the vascular phase, allowing a complete delineation of the microvascular compartment. Therefore, SH U 563A may be considered as an ideal perfusion tracer, demonstrating, in theory, the blood volume distribution. Acad Radiol 2002; 9(suppl 1):S46–S51

Impaired pulmonary artery contractile responses in a rat model of microgravity: role of nitric oxide.

Vascular contractile hyporesponsiveness is an important mechanism underlying orthostatic intolerance after microgravity. Baroreceptor reflexes can modulate both pulmonary resistance and capacitance function and thus cardiac output. We hypothesized, therefore, that pulmonary vasoreactivity is impaired in the hindlimb-unweighted (HLU) rat model of microgravity. Pulmonary artery (PA) contractile responses to phenylephrine (PE) and U-46619 (U4) were significantly decreased in the PAs from HLU vs. control (C) animals. N(G)-nitro-L-arginine methyl ester (10(-5) M) enhanced the contractile responses in the PA rings from both C and HLU animals and completely abolished the differential responses to PE and U4 in HLU vs. C animals. Vasorelaxant responses to ACh were significantly enhanced in PA rings from HLU rats compared with C. Moreover, vasorelaxant responses to sodium nitroprusside were also significantly enhanced. Endothelial nitric oxide synthase (eNOS) and soluble guanlyl cyclase expression were significantly enhanced in PA and lung tissue from HLU rats. In marked contrast, the expression of inducible nitric oxide synthase was unchanged in lung tissue. These data support the hypothesis that vascular contractile responsiveness is attenuated in PAs from HLU rats and that this hyporesponsiveness is due at least in part to increased nitric oxide synthase activity resulting from enhanced eNOS expression. These findings may have important implications for blood volume distribution and attenuated stroke volume responses to orthostatic stress after microgravity exposure.

Definition of shock types

Definitions of shock types. Hypovolaemic shock is a state of insufficient perfusion of vital organs with consecutive imbalance of oxygen supply and demand due to an intravascular volume deficiency with critically impaired cardiac preload. Subtypes are haemorrhagic shock, hypovolaemic shock in the narrow sense, traumatic-haemorrhagic shock and traumatic-hypovolaemic shock. Cardiac shock is caused by a primary critical cardiac pump failure with consecutive inadequate oxygen supply of the organism. Anaphylactic shock is an acute failure of blood volume distribution (distributive shock) and caused by IgE-dependent, type-I-allergic, classical hypersensibility, or a physically, chemically, or osmotically induced IgE-independent anaphylactoid hypersensibility. The septic shock is a sepsis-induced distribution failure of the circulating blood volume in the sense of a distributive shock. The neurogenic shock is a distributive shock induced by generalized and extensive vasodilatation with consecutive hypovolaemia due to an imbalance of sympathetic and parasympathetic regulation of vascular smooth muscles.

Blood volume distribution in patients with cirrhosis: aspects of the dual-head gamma-camera technique

Background/Aims : Patients with cirrhosis have increased total blood volume (TBV). The size of the ‘effective’ blood volume has been closely investigated, whereas the distribution of the blood volume outside the thorax has not been examined. The aim was to estimate the blood volume distribution in patients with cirrhosis and portal hypertension, using a dual-head gamma-camera technique (DHGCT) and to validate this technique. Methods : Twenty-three patients with cirrhosis, 11 non-cirrhotic control patients, and six healthy controls had their blood volume distribution determined by the DHGCT. Results : The close relation between the estimated blood volume in the thorax region and the central and arterial blood volume, obtained by the dynamic indicator dilution technique ( r =0.87, P <0.001), indicates validity of the DHGCT. Whole-body scintigraphy showed altered blood volume distribution in the cirrhotic patients with increased splanchnic blood volume (SpBV: 25.0 vs. 18.2% of TBV in controls, P <0.001), and all but one patient with hepatic venous pressure gradient above 12 mmHg had SpBV above 20% of TBV, but the blood volumes in the liver region were similar. Conclusions : DHGCT is a valid method of estimating the blood volume distribution. Patients with cirrhosis and portal hypertension have grossly increased blood pooling in the splanchnic region, indicating splanchnic congestion.

Haemodynamic and volumetric monitoring during haemorrhagic shock in swine

Various studies have been performed concerning haemodynamics in the shock state. The aim of this study was to examine if a haemodynamic approach based on volumetric indices can offer a new method of evaluation. Volumetric measurements of ventricular filling and cardiac function were compared with classical haemodynamic variables during induced haemorrhagic shock in swine. Twelve hybrid swine were anaesthetized and underwent arteriectomy to induce haemorrhagic shock. Blood was collected in ACD treated bags and reinfused via the same vein after a shock period of 90 min. Haemodynamic and volume measurements were evaluated. Seven swine survived to complete the protocol and reached the final experimental time (90 min after reinfusion), while the remaining five died 1 h after reinfusion. Concerning the haemodynamics, afterload changes characterized the haemorrhagic shock period, while blood volume distribution dictated ventricular filling and ventricular kinetics during the post-reinfusion period. Systemic vascular resistance was different in the two groups. This study suggests that blood volumetric evaluations can offer better comparative data than pulmonary catheterisation for a precise assessment of cardiac output. Preload values have turned out to be of greater relevance than traditional pressure variables.

Redistribution of blood volume in type I diabetes.

Impaired activity of endothelium-derived nitric oxide in Type I (insulin-dependent) diabetes mellitus will cause an increased vascular tone. Considering the lower production of nitric oxide in veins than in arteries, an impaired activity would have less vasoconstrictive effect in veins. The reported minimally changed total plasma volume in diabetes might, therefore, indicate a redistribution of blood volumes from the arterial to the venous side of the circulation. This could be more pronounced in patients with microalbuminuria. In 16 normoalbuminuric and 16 microalbuminuric Type I diabetic patients and 16 individually matched healthy control subjects, venous and arterial blood volumes, venous myogenic response and arterial distensibilities were assessed in the upper arm using an electrical bio-impedance method. In diabetic patients, the venous blood volume and venous myogenic response were increased (p < 0.02 and p < 0.05, respectively), whereas the arterial blood volume did not change. Moreover, in diabetic patients the distensibility of the large arteries was decreased (p < 0.05) but increased in the total arterial bed (p < 0.05). Therefore, the distensibility of the small arteries must have been increased. No differences were found between normoalbuminuric and microalbuminuric diabetic patients. The increase in venous blood volume and myogenic response and the decrease in distensibility of the large arteries in the upper arm are in agreement with the expected shift towards venous blood volume distribution in Type I diabetes with and without microalbuminuria. Furthermore, they support the haemodynamic hypothesis of the pathogenesis of diabetic microangiopathy.

Efficacy of a Single Oral Dose of Isosorbide 5‐Mononitrate in Normal Dogs and in Dogs with Congestive Heart Failure

Isosorbide 5‐mononitrate (5‐ISMN) was evaluated in normal dogs and dogs with congestive heart failure (CHF) in a randomized, blinded, and placebo‐controlled study. Equilibrium blood pool imaging was used to detect changes in regional blood volume distribution. Six normal dogs were administered placebo, 2, 3, and 4 mg/kg 5‐ISMN PO on separate days with a 1‐week washout period between randomized dosings. Six dogs with CHF were administered placebo or 4 mg/kg 5‐ISMN on separate days with a 1‐week washout period between randomized dosings. Data were collected at baseline and at 15, 30, 45, 60, 90, 120, 150, 180, 210, and 240 minutes after dosing. Measured variables included indirect arterial blood pressure (BP), heart rate (HR), packed cell volume (PCV), scintigraphic count rates for normal dogs, and scintigraphic count rates for CHF dogs. Blood for plasma 5‐ISMN concentration determination was collected at 60 minutes. Scintigraphic counts were corrected for decay and expressed as a percentage of the whole. No differences were detected in BP, HR, PCV, thoracic blood volume percentage (TBVP), or abdominal blood volume percentage (ABVP) between placebo and 5‐ISMN in normal dogs at any dose. No differences were detected in TBVP or ABVP between placebo and 5‐ISMN in dogs with CHF. Plasma 5‐ISMN concentration exceeded the minimum therapeutic concentration in all dogs and at all doses 60 minutes after drug administration. Equilibrium blood pool imaging failed to detect a shift in blood volume with oral 5‐ISMN administration at any dose tested in normal dogs and dogs with CHF, despite adequate drug absorption. On the basis of the results of this study, 5‐ISMN may not be beneficial in the treatment of dogs with CHF.

Presynaptic alpha2-adrenoceptor-mediated modulation of adenosine 5' triphosphate and noradrenaline corelease: differences in canine mesenteric artery and vein.

1. The modulatory effects of agonists and antagonists of prejunctional alpha2-adrenoceptors on the electrical field stimulation (EFS, 0.3 ms, 12 V)-induced release of endogenous noradrenaline (NA) and the cotransmitter adenosine 5' triphosphate (ATP) were measured in endothelium-denuded segments of canine inferior mesenteric artery and compared with effects in mesenteric vein. The overflow of NA and ATP was evoked by long-duration (2 min) EFS at low frequency (4 Hz) and high frequency (16 Hz) of stimulation and was analysed using HPLC techniques with electrochemical detection and fluorescence detection, respectively. 2. The EFS-evoked overflow of both NA and ATP was significantly reduced by tetrodotoxin (1 microM) and guanethidine (10 microM) in the artery and vein. Desipramine (10 microM), a blocker of neuronal uptake of NA, increased the EFS (4 and 16 Hz)-evoked overflow of NA in both artery and vein. EFS-evoked overflow of NA in vein exceeded the NA overflow in artery at both 4 and 16 Hz in control preparations as well as in the presence of desipramine. However, the EFS-evoked overflow of ATP was equal in the artery and vein. 3. Stimulation of alpha2-adrenoceptors with clonidine (0.1 microM) and oxymethazoline (0.3 microM) reduced the EFS evoked overflow of NA in both artery and vein at 4 Hz, whereas the NA overflow at 16 Hz remained unchanged in both blood vessels. The overflow of ATP as well as of ADP (and hence ATP:ADP ratio) was unaffected by the alpha2-adrenoceptor agonists in the artery and vein. 4. In artery, blockade of alpha2-adrenoceptors with yohimbine at a concentration of 0.1 microM caused no effect on the NA overflow neither at 4 Hz nor at 16 Hz of EFS. Yohimbine at a concentration of 1 microM increased the overflow of NA at 4 Hz but not 16 Hz of EFS. In vein, however, yohimbine (0.1 and 1 microM) increased NA overflow at both 4 and 16 Hz of stimulation. Idazoxan (1 microM) increased the NA overflow in artery only at 4 Hz, whereas in vein idazoxan increased the NA overflow at both 4 and 16 Hz. No changes of EFS-evoked ATP overflow were observed in the presence of 0.1 microM yohimbine in both artery and vein. Greater concentration of yohimbine (i.e. 1 microM) increased the overflow of ATP in both the artery and vein only at 4 Hz EFS. Idazoxan (1 microM) enhanced the ATP overflow only at 16 Hz in vein. The overflow of ADP was affected by both yohimbine and idazoxan in a similar manner to the ATP overflow so that the ATP:ADP ratios were not changed. 5. In conclusion, sympathetic nerves in both mesenteric arteries and veins appear to release ATP along with NA. Release of NA in veins exceeds release of NA in arteries, whereas both the canine artery and vein release equal amount of ATP. At long-duration nerve stimulation (as might occur during stress) the alpha2-adrenoceptors appear to rather modulate release of NA than release of the cotransmitter ATP. The prejunctional autoinhibition of NA release is more effective at lower frequencies of nerve stimulation. The alpha2-adrenoceptor-mediated neuromodulation plays a greater role in veins than arteries. Quantitative differences in alpha2-adrenoceptor-mediated neuromodulation in the arteries and veins may participate to differing contributions of mesenteric blood vessels to the control of blood flow and volume distribution in splanchnic circulation.

Blood volume changes and oxygenation during labor--a laser spectroscopic analysis

Hemodynamic patterns and the distribution of blood volume are influenced by the onset of labour. This study evaluates patterns of oxygenation and changes of blood volume after the induction of contractions. A prototype NIR-laser spectrometer was applied in 28 cases. We found a rise of blood volume and oxygen saturation (HbO2) during the peak of contractions. Cerebral tissue oxygenation was monitored by registration of relative changes of cytochrome-aa3. No significant change of tissue oxygenation was detected during variable volume load. This implicates compliance of the redox state during labour.

Splanchnic and systemic hemodynamic derangement in decompensated cirrhosis.

Patients with cirrhosis and portal hypertension exhibit characteristic hemodynamic changes with hyperkinetic systemic circulation, abnormal distribution of blood volume and neurohumoral dysregulation. Their plasma and noncentral blood volumes are increased. Splanchnic vasodilation is of pathogenic significance to the low systemic vascular resistance and abnormal volume distribution of blood, which are important elements in the development of the concomitant cardiac dysfunction, recently termed 'cirrhotic cardiomyopathy'. Systolic and diastolic functions are impaired with direct relation to the degree of liver dysfunction. Significant pathophysiological mechanisms are reduced beta-adrenergic receptor signal transduction, defective cardiac excitation-contraction coupling and conductance abnormalities. Vasodilators such as nitric oxide and calcitonin gene-related peptide are among the candidates in vasodilation and increased arterial compliance. Reflex-induced, enhanced sympathetic nervous system activity, activation of the renin-angiotensin aldosterone system, and elevated circulation vasopressin and endothelin-1 are implicated in hemodynamic counter-regulation in cirrhosis. Recent research has focused on the assertion that the hemodynamic and neurohumoral abnormalities in cirrhosis are part of a general cardiovascular dysfunction, influencing the course of the disease with the reduction of organ function, with sodium and water retention as the outcome. These aspects are relevant to therapy.

Efficacy of a single oral dose of isorsorbide 5-mononitrate in normal dogs and in dogs with congestive heart failure.

Isosorbide 5-mononitrate (5-ISMN) was evaluated in normal dogs and dogs with congestive heart failure (CHF) in a randomized, blinded, and placebo-controlled study. Equilibrium blood pool imaging was used to detect changes in regional blood volume distribution. Six normal dogs were administered placebo, 2, 3, and 4 mg/kg 5-ISMN PO on separate days with a 1-week washout period between randomized dosings. Six dogs with CHF were administered placebo or 4 mg/kg 5-ISMN on separate days with a 1-week washout period between randomized dosings. Data were collected at baseline and at 15, 30, 45, 60, 90, 120, 150, 180, 210, and 240 minutes after dosing. Measured variables included indirect arterial blood pressure (BP), heart rate (HR), packed cell volume (PCV), scintigraphic count rates for normal dogs, and scintigraphic count rates for CHF dogs. Blood for plasma 5-ISMN concentration determination was collected at 60 minutes. Scintigraphic counts were corrected for decay and expressed as a percentage of the whole. No differences were detected in BP, HR, PCV, thoracic blood volume percentage (TBVP), or abdominal blood volume percentage (ABVP) between placebo and 5-ISMN in normal dogs at any dose. No differences were detected in TBVP or ABVP between placebo and 5-ISMN in dogs with CHF Plasma 5-ISMN concentration exceeded the minimum therapeutic concentration in all dogs and at all doses 60 minutes after drug administration. Equilibrium blood pool imaging failed to detect a shift in blood volume with oral 5-ISMN administration at any dose tested in normal dogs and dogs with CHF, despite adequate drug absorption. On the basis of the results of this study, 5-ISMN may not be beneficial in the treatment of dogs with CHF.

Effects of the Sitting Position on the Distribution of Blood Volume in Patients Undergoing Neurosurgical Procedures

The use of the sitting position in neurosurgery is often associated with decreased arterial pressure (MAP) and stroke volume index (SVI). A shift in blood from the intra- to the extrathoracic compartment may be responsible for this cardiovascular response. However, little is known of the amount of shift in blood volume after transfer from the supine to the sitting position. Therefore, we measured simultaneously changes in intrathoracic blood volume (ITBV) caused by a change in body position in anaesthetized patients. Measurements of cardiac index (CI), ITBV, pulmonary (PBV) and total circulating (TBVcirc) blood volumes were performed in the supine and sitting position. CI, ITBV, PBV and TBVcirc were measured using a thermodye dilution technique. Fluid input was restricted to 14 ml kg-1 before induction of anaesthesia. Change in body position caused a significant decrease in ITBV and was accompanied by a significant decrease in CI, SVI and MAP. Changes in ITBV correlated (r = 0.78) with changes in SVI. Thus a change in blood volume distribution between the intra- and extrathoracic compartment occurred after a change from the supine to the sitting position. Indicator dilution enables quantification of this shift and may be helpful in guiding fluid therapy in selected patients.

Evidence for a vestibulo-cardiac reflex in man

Changes in posture demand rapid cardiovascular adjustments to maintain blood pressure and volume distribution. We demonstrated a vestibulo-cardiac reflex in supine individuals by measuring electrocardiogram and arterial blood pressure after small backwards drops of the head triggered at varying intervals after the R-spike. In normal volunteers heart rate was accelerated by drops occurring within 500-600 ms of a beat, but no rapid effect was noted in patients with a vestibular defect. The speed at which the vestibular signal of head drop accelerated heart rate implies a direct reflex. Impairment of the vestibulo-cardiac reflex would help to explain the vaso-vagal consequences of labyrinthitis.

Indocyanine green kinetics characterize blood volume and flow distribution and their alteration by propranolol

Although indocyanine green can be used to estimate cardiac output and blood volume independently, a recirculatory multicompartmental indocyanine green model enables description of these and additional intravascular events. Our model was used to describe the effect of propranolol on blood volume and flow distribution in humans. Indocyanine green disposition was determined twice in four healthy adult men, once during a propranolol infusion that decreased cardiac output. After injection of indocyanine green, arterial blood was collected frequently for 2 minutes and less frequently thereafter. Plasma indocyanine green concentrations were measured by HPLC. The recirculatory pharmacokinetic model incorporates data from both the initial transient oscillations and the later post-mixing portions of the blood indocyanine green concentration versus time curves to characterize not only blood volume and cardiac output but also their distribution among a central blood volume and fast and slow peripheral volumes in lumped parallel circuits. Flow through the central circulation (cardiac output) is described by two parallel Erlang distribution functions generated by two linear chains of compartments in parallel. Propranolol reduced cardiac output from 10.6 to 4.1 L/min. Most of the decrease in cardiac output was at the expense of blood flow to the fast peripheral circuit, which represented nonsplanchnic circulation. Propranolol also reduced the blood volume of the fast peripheral circuit by more than half. Our indocyanine green model is able to derive estimates of blood volume and cardiac output, as well as their systemic distribution during different physiologic conditions.

Effects of the sitting position on the distribution of blood volume in patients undergoing neurosurgical procedures

The use of the sitting position in neurosurgery is often associated with decreased arterial pressure (MAP) and stroke volume index (SVI). A shift in blood from the intra- to the extrathoracic compartment may be responsible for this cardiovascular response. However, little is known of the amount of shift in blood volume after transfer from the supine to the sitting position. Therefore, we measured simultaneously changes in intrathoracic blood volume (ITBV) caused by a change in body position in anaesthetized patients. Measurements of cardiac index (CI), ITBV, pulmonary (PBV) and total circulating (TBVcirc) blood volumes were performed in the supine and sitting position. CI, ITBV, PBV and TBVcirc were measured using a thermodye dilution technique. Fluid input was restricted to 14 ml kg-1 before induction of anaesthesia. Change in body position caused a significant decrease in ITBV and was accompanied by a significant decrease in CI, SVI and MAP. Changes in ITBV correlated (r = 0.78) with changes in SVI. Thus a change in blood volume distribution between the intra- and extrathoracic compartment occurred after a change from the supine to the sitting position. Indicator dilution enables quantification of this shift and may be helpful in guiding fluid therapy in selected patients.

Effect of prone sleeping on circulatory control in infants

BACKGROUNDThe mechanism of death in sudden infant death syndrome (SIDS) remains unclear. Progressive bradycardia is the pre-eminent terminal event, suggesting that circulatory failure might be a crucial factor. Vasomotor tone...