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The Circulatory Responses to Hyperthermia Induced by Radiant Heat

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The Circulatory Responses to Hyperthermia Induced by Radiant Heat THE CIRCULATORY RESPONSES TO HYPERTHERMIA INDUCED BY RADIANT HEAT O. Prec, … , S. Rodbard, L. N. Katz J Clin Invest. 1949;28(2):301-306. https://doi.org/10.1172/JCI102072. Research Article Find the latest version: https://jci.me/102072/pdf THE CIRCULATORY RESPONSES TO HYPERTHERMIA INDUCED BY RADIANT HEAT' By 0. PREC,2 R. ROSENMAN, K. BRAUN,8 R. HARRIS, S. RODBARD, AND L. N. KATZ (From the Cardiovascular Department,4 Medical Research Institute, Michael Reese Hospital, Chicago) (Received for publication July 19, 1948) An elevation of the body temperature evokes femoral artery recorded mean arterial blood pressures on many physiological changes, as a direct result of a kymograph. Mean pulmonary arterial and right auric- ular pressures were obtained with saline manometers the increased rate of metabolism and the greater attached to their respective radio-opaque cardiac cathe- demand for oxygen and substrate, and indirectly in ters. Cardiac output was calculated according to the warm blooded animals because of the elicitation of Fick formula, blood from the pulmonary artery being thermolytic mechanisms. An understanding of the used as mixed venous blood, and oxygen consumption being recorded with a basal metabolism apparatus at- interrelationships between these factors is of ob- tached to the cannulated trachea. Hematocrits of the vious importance in an appreciation of the dynam- arterial blood were determined according to the method of ics of hyperthermia and in the establishment of a Wintrobe. Blood O0 and CO2 analyses were performed by rationale for its treatment. Despite many impor- the Van Slyke-Neill technique. A detailed description of tant contributions to this problem, there is a pau- these methods is given elsewhere (1). Measurements similar to the above were also obtained in a series of city of information concerning the effect of hyper- three dogs heated by short wave diathermy,5 but unless thermia on the cardiac output and the right intra- specified, the results given below refer only to those cardiac pressures. We have therefore undertaken experiments in which radiant heat was employed. Simi- an analytical study of the circulation in lar measurements were made on three control anes- hyper- thetized dogs kept thermia in an effort to assay these adjustments at room temperature. more satisfactorily. Our present have experiments DISCUSSION OF RESULTS been limited to a study of the changes which occur following exposure to radiant heat since this Oxygen consumption method of producing hyperthermia seemed to be Many studies have demonstrated a close parallel the simplest, being free from incidental effects pro- between the rise in body temperature and the in- duced by pyrogens and by other methods. A few creased oxygen consumption (2-4) which ac- experiments were done with short wave diathermy. companies the acceleration of cellular metabolism during fever. In our experiments (Figure 1) an METHOD average increase of 57% was observed at a body Hyperthermia was induced in nine dogs. Six dogs, temperature of 420 C, the greatest increase being anesthetized with sodium pentobarbital, were exposed to 100%o in one instance. During the cooling period radiant heat from several bulbs until light the body tem- oxygen consumption peratures (about 380 C) gradually increased to 42° C decreased simultaneously during a two-hour interval. Body temperatures were with the fall in body temperature and returned to reduced during the following one- to two-hour periods control levels as the temperature of the animal by using cold wet cloths applied to the body and by again reached 380 C. In the control series only draft-producing electric fans. Temperatures were ob- slight and insignificant changes in oxygen con- tained from a thermometer placed deeply in the recto- sigmoid area. A mercury manometer attached to a sumption took place. idin part by a grant from the Department of the Respiration and content of Army to the Michael Reese Hospital (Dr. L. N. Katz, blood gases responsible investigator). The production of hyperthermia was accom- 2Rockefeller Fellow from Prague, Czechoslovakia. panied by an increase in respiratory rate and 8Hadassah Fellow from Jerusalem, Israel. 4This department is supported in part by the Michael 5 The Burdick Corporation generously supplied the Reese Research Foundation. short wave equipment. 301 302 0. PREC, R. ROSENMAN, K. BRAUN, R. HARRIS, S. RODBARD, AND L. N. KATZ A-V DIFF. 2r volume (Figure 1) similar to that which has been reported in all types of naturally occurring fever o4. 01 A-V DIFf '91 RESR (2). During recooling the respiratory rate and 70 PtLSE volume decreased proportionately to the tempera- i/ 60 22 ture fall. It is of interest to note, however, that Is 50 - 210 greater than normal rates and volumes of respira- -40 - 200 . v)~ tion persisted even after the conclusion of the cool- ' RES 30- 190 ing period and the return of body temperature to 20- 180 control levels. This effect may have been due to aP. the greater rate of destruction of the anesthetic ' PULE 1-970 agent during the febrile period and a consequent 1301 heightened activity of the respiratory center. In 10 139 120I the control series no significant changes were -1- noted. 9120 9| iB.P. -2 Differences in the respiratory response were 'RAp _ -3 i00 noted, depending on the type of heating used. With radiant heat the respirations were regular 90 and only slightly decreased in depth. When the 80 fever was produced with short wave diathermy, 70 - respirations became shallow and grossly irregu- 60 lar. The hyperpnea was probably due to the in- -I C.O. 50 creased CO2 production in the tissues, the in- 37 38 39 40 41 42 41 40 39 38 creased activity of the respiratory center itself, SODY TEMPERATURE-S'C and the initiation of thermolytic reflexes. It has FIG. 1. A COMPOSITE GRAPH OF THE AVERAGE VALUES been reported that extreme tachypnea and shallow THE HEATING AND COOL- OF VARIOUS FACTORS DURING respiration may seriously interfere with the ex- ING OF SIX DOGS change of alveolar air, and thus decrease the arte- A-V Diff. represents the arteriovenous oxygen dif- rial oxygen content (3, 5). However, the slope ference (vols.%); QO2, the oxygen consumption in cc./ of the oxygen consumption curve in our experi- kg./min.; Resp. and Pulse are, respectively, the respira- ments indicated that the diffusion of oxygen in the tory and pulse rates per minute; B.P., the mean arterial was not when radiant heat was blood pressure in mm. Hg; C.O., the cardiac output in lungs impaired cc./kg./min.; and R.A.P., the mean right auricular pres- employed. With diathermy, the slope of the sure in cm. saline. curve was highly irregular. It was because of this TABLE I Oxygen content of arterial and venous blood (volume per cent) Body Dog no. Hi Dog no. H2 Dog no. H3 Dog no. H4 Dog no. H5 Dog no. H6 tempera- ture Art. Ven. Art. Ven. Art. Ven. Art. Ven. Art. Ven. Art. Ven. 0 C. 36 12.6 6.3 24.1 20.8 37 20.6 13.6 25.1 16.2 - 38 - 11.6 3 12.8 7.5 -- 14.9 12.1 39 19.7 10.4 11.7 2.4 13 5.5 23 8 15.5 11 16 12 41 19 8 12 2 12 2.7 24.5 9.6 19.4 6.3 16.2 11.4 42 19.7 5.7 12 1.9 12.1 25.3 10.1 - 16 10 40 19 8.7 - 13 5 - 20.3 7 16.4 8.7 39 - 24.8 6.3 -- - 38 18.9 8.7 - 12.7 6.0 - 20 4.6 15.4 7.9 37 I - - - 24.6 I3.2 -- - - Art. = arterial. Ven. = venous. CIRCULATORY RESPONSES TO HYPERTHERMIA 303 irregularity that the results obtained with dia- it that the utilization of oxygen increased pro- thermy were not treated in the present study. portionately to the rise in body temperature de- The arterial oxygen content varied only slightly spite the progressively reduced cardiac output during our experiments with an average decrease (Figure 1). The average arteriovenous oxygen of 0.8 vol.%o. The large difference in dog H5 difference was 6.1 vol.% at 36° to 380 C and in- (Table I) was associated with a simultaneous in- creased to 11.3 vol.% at 420 C, remaining high in crease in hematocrit. No significant changes were some instances or even increasing during the re- noted in the control series. Others have reported cooling period. The increase in A-V oxygen dif- decreases in arterial oxygen content during hy- ference was relatively greater than the increase in perpyrexia (3, 6) with a relatively greater de- oxygen consumption. These findings are in gen- crease in venous blood oxygen content (3). eral agreement with those of Uyeno (3). The effect of hyperpnea on the CO2 content of the arterial and venous blood should be empha- Hematocrit sized. Figure 2 shows that as the respiratory rate Approximately 100 cc. of blood were removed increased, the CO2 content of the arterial blood and replaced by isotonic saline solution during decreased. The curve for venous blood is similar each experiment. Hematocrits of arterial blood to that of arterial blood but shifted to the right. samples showed no consistent trends. During The primacy of the thermolytic mechanism which fever it has been reported (7) that there is usu- is effected chiefly by panting in the dog is seen by ally an initial hemodilution with increased blood the marked reduction of blood CO2 and the conse- volume. quent alkalotic tendency. Despite this tendency to alkalosis, the respiratory rate continued at high Cardiac output levels.
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