PubMed · 4863457
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W G Prout, R V Jones. 1967. Resuscitation--fluid replacement.. https://doi.org/10.1136/pgmj.43.503.592
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BACKGROUND: This survey focuses on distribution of cardiac output to various organs and on some dynamic changes occurring in cardiac output and its distribution. MATERIALS AND METHODS: Data presented are largely related to work carried out in our research group, where Doppler ultrasonography is widely used for measurement of cardiac output and arterial blood flow. Additional data are drawn from relevant literature, in part compiled through search in the PubMed database. DATA AND INTERPRETATIONS: The difference in blood flow to various organs is emphasised, with e.g. brain and endocrine organs receiving large and stable blood supplies, whereas inactive muscles are sparsely perfused. Attention is drawn to distribution patterns in situations where cardiac output is markedly increased. Such situations are muscular exercise, with a dramatic increase in muscle blood flow, the occurrence of bodily heat surplus, with increased skin blood flow, and the postprandial situation, with augmented blood flow to the gastrointestinal tract. Of particular interest are situations where two or more demands for increased blood supply occur simultaneously, such as muscular exercise in the period just after a meal. Physically trained persons are apparently better than others at maintaining gastrointestinal blood supply during exercise.
BACKGROUND: Obstructive (OSA) and central sleep apnea (CSA) can coexist in patients with congestive heart failure (CHF). However, the reason why OSA events occur at one time and CSA events at another has not been determined. We hypothesized that a change in PCO(2) would be associated with an alteration in apnea type: a decrease in PCO(2) should lead to CSA. METHODS AND RESULTS: To test this hypothesis, we evaluated minute ventilation (V(I)), transcutaneous PCO(2) (PtcCO(2)), circulation time, and periodic breathing cycle length during overnight polysomnography in 12 patients with CHF and coexisting OSA and CSA. V(I) was significantly greater (mean+/-SEM, 9.4+/-1.3 versus 8.0+/-0.9 L/min; P:<0.05) and PtcCO(2) was lower (39.4+/-1.0 versus 41.9+/-1.1 mm Hg, P:<0.01) during episodes of CSA than of OSA. These changes were associated with significant lengthening of circulation time (23.6+/-3.7 versus 21.1+/-3.6 seconds, P:<0.01) and periodic breathing cycle length (53.7+/-3.5 versus 49.6+/-2.9 seconds, P:<0.01). In addition, the proportion of obstructive events decreased (from 68.5+/-11.4% to 22.5+/-7.2%, P:<0.001) and of CSA events increased (from 31.5+/-11.4% to 77.5+/-7.2%, P:<0.001) from the first to the last quarter of the night in association with a significant decrease in PtcCO(2) (from 42.6+/-0.9 to 40.8+/-0.9 mm Hg, P:<0.01). CONCLUSIONS: In patients with CHF, the shift from OSA to CSA is associated with a reduction in PCO(2). This appears to be related to an overnight deterioration in cardiac function as suggested by the concurrent lengthening of circulation time. Therefore, in CHF patients, alterations in cardiac function may influence apnea type.
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