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Biomedical subjects

R F Grover

Publications and source records attributed to R F Grover.

At least 37 records · Page 2Linked to original sources
PubMed1982

Maternal hyperventilation helps preserve arterial oxygenation during high-altitude pregnancy.

We examined arterial oxygenation during pregnancy and 3 mo postpartum in 35 nonsmoking residents of Leadville, CO (elevation 3,100 m) to determine how well and by what mechanisms maternal arterial oxygenation was maintained during pregnancy at high altitude. Hyperventilation raised arterial O2 saturation above that in the nonpregnant state. Respiratory alkalosis persisted throughout pregnancy, shifting the O2-hemoglobin dissociation curve to the left, further facilitating O2 loading in the lung. However, a decrease in blood hemoglobin concentration and a slight increase in the alveolar-arterial O2 gradient in the late pregnancy caused the arterial O2 content to fall below that in the nonpregnant state. Compared to published sea level values, the Leadville women had higher ventilation and hemoglobin values, yielding arterial O2 contents as high as in pregnant women at sea level. Thus, ventilation and hemoglobin concentration were important variables contributing to O2 ttransport during pregnancy at high altitude.

Adult↗
PubMed1982

Infant birth weight is related to maternal arterial oxygenation at high altitude.

Infant birth weight is reported to decrease at high altitude as a reulst of fetal growth retardation (McCullough, Reeves, and Liljegren. Arch. Environ, Health. 32: 36--39, 1977) but not all babies born at high altitude are small. We hypothesized that maternal characteristics acting to lower arterial O2 content would contribute to smaller infant birth weight. To test this hypothesis, we measured arterial oxygenation serially during pregnancy and again postpartum in 44 residents of Leadville, CO (elevation 3,100 m). We identified three maternal characteristics--ventilation, hemoglobin concentration, and smoking habits--that were related to the birth weight of the offspring. Mothers of smaller babies (less than 2,900 g) compared to mothers of larger babies (greater than 3,500 g) were characterized by hypoventilation, no change or a decrease in ventilation and arterial O2 saturation from early to late gestation, and a falling hemoglobin concentration that combined to lower arterial O2 content in the 3rd trimester. Maternal smoking at 3,100 m was associated with a two to threefold greater reduction in infant birth weight (-546 g) than reported from sea level. Thus, maternal arterial oxygenation during pregnancy may be important for predicting fetal growth retardation and the process of adaptation to high altitude.

Adaptation, Physiological↗
PubMed1982

Fluid retention and relative hypoventilation in acute mountain sickness.

The presence of pulmonary, cerebral, and/or peripheral edema in acute mountain sickness (AMS) implies a derangement in the body's handling of water. Previously, we demonstrated water retention and increased symptoms of AMS when hypocapnia was prevented in subjects exposed to simulated high altitude. This led us to the hypothesis that upon ascent to high altitude, those persons who fail to increase their ventilation adequately and hence do not become hypocapnic will retain water reflected as weight gain and will develop AMS. To test this hypothesis, we studied in Kathmandu, Nepal (1,377 m) 42 healthy western tourists; all were restudied in Pheriche (4,243 m) within 6 days of exposure to high altitude. Symptoms of AMS were highly correlated (p less than 0.001) with weight change, suggesting that persons becoming symptomatic retained fluid. On going from low to high altitude, those persons who lost weight and remained well increased their resting ventilation, whereas those who gained weight did not (p = 0.03). This relative hypoventilation in the latter group was confirmed by higher values of Pco2 (heated hand vein blood) and lower values of arterial saturation (ear oximeter) at Pheriche. Vital capacity measured in Kathmandu was correlated with arterial saturation at Pheriche (p = 0.02); persons with low vital capacity were more hypoxemic with more symptoms of AMS. We conclude that relative hypoventilation and weight gain appear early in the development of AMS suggesting links between altitude hypoxia, hyperventilation, hypocapnia, and the body's handling of water.

Acute Disease↗
PubMed1981

Acute mountain sickness and the edemas of high altitude: a common pathogenesis?

Within days of ascent to high altitude when symptoms of acute mountain sickness (AMS) are common, pulmonary and cerebral edema may also develop. Although peripheral edema of the hands, face or feet may also appear, its association with AMS is unclear. In addition, persons with high altitude pulmonary edema often report an antidiuresis. Hence, altitude sickness appears to result from abnormalities in the handling of body water. To test this hypothesis, we studied 102 men and women who were trekking in the Mount Everest region of Nepal. Most were seen both at low (1377 m) and at high (4243 m) altitude. Severity of AMS was measured by an established Symptom Score derived from a questionnaire and physical examination. Change in body water was inferred from change in body weight in less than 10 days. Peripheral edema was assessed separately by physical examination. AMS Symptom Score correlated directly with weight change; those who remained well lost weight, whereas increasing signs and symptoms of AMS occurred in those with increasing weight gain. The symptomatic subjects also developed peripheral edema and reported decreased urinary output. These findings support the hypothesis that with rapid ascent to high altitude, abnormalities in the handling of body water, with antidiuresis, result in fluid retention (weight gain) manifest as peripheral, pulmonary, and/or cerebral edema.

Adolescent↗
PubMed1980

Control of breathing in Sherpas at low and high altitude.

Sherpas are well known for their physical performance at extreme altitudes, yet they are reported to have blunted ventilatory responses to acute hypoxia and relative hypoventilation in chronic hypoxia. To examine this paradox, we studied ventilatory control in Sherpas in comparison to that in Westerners at both low and high altitude. At low altitude, 25 Sherpas had higher minute ventilation, higher respiratory frequency, and lower end-tidal carbon dioxide tension than 25 Westerners. The hypoxic ventilatory response of Sherpas was found to be similar to that in Westerners, even though long altitude exposure had blunted the responses of some Sherpas. At high altitude, Sherpas again had higher minute ventilation and a tendency toward higher arterial oxygen saturation than Westerners. Oxygen administration increased ventilation further in Sherpas but decreased ventilation in Westerners. We conclude that Sherpas differ from other high-altitude natives; their hypoxic ventilatory response is not blunted, and they exhibit relative hyperventilation.

Adaptation, Physiological↗
PubMed1980

Ventilatory acclimatization to high altitude is prevented by CO2 breathing.

The hypoxia of high altitude stimulates ventilation. If the resultant respiratory alkalosis inhibits the initial increase in ventilation, then with prevention of alkalosis, ventilation should rise immediately to a stable plateau. 4 subjects inspired CO2 (3.77%) from ambient air in a hypobaric chamber (PB = 440-455 Torr) during 100 h at high altitude. Ventilation (for given oxygen uptakes at rest and during exercise) increased promptly and remained stable. 4 control subjects exposed to high altitude without CO2 supplementation showed the expected progressive increases in ventilation with time. The hyperoxic CO2 ventilatory response curve shifted progressively to the left with time in the control subjects, but not in those given supplemental CO2. The latter group also failed to increase the ventilatory response to isocapnic hypoxia. Thus, CO2 supplementation at high altitude prevented the so-called "ventilatory acclimatization' from occurring. Prevention of respiratory alkalosis at high altitude probably permitted maintenance of [H+] at some central nervous system locus, thus allowing an uninhibited hypoxic stimulation of ventilation.

Acclimatization↗
PubMed1979

Postnatal changes in response of canine neonatal pulmonary arteries to histamine.

Postnatal development of histamine receptors in the canine pulmonary circulation was examined utilizing histamine cumulative dose-response curves of pulmonary arteries isolated from neonatal and adult dogs. The maximal contractile response to histamine was relatively low at birth (avg 0.069 g) and increased with postnatal age, reaching a maximum in the adult (avg 1.10 g). H2-receptor blockade with metiamide increased the contractile response to histamine during the first 2 wk of life (avg 0.38 g), suggesting H2-receptor dominance over H1-receptors in the newborn. Maximal developed tension, in response to KCl, gradually increased with postnatal age, suggesting progressive maturation of the smooth muscle response. In contrast to pulmonary arteries, isolated tracheal segments from puppies aged 1-5 days demonstrated large contractile responses (avg 5 g). Histamine (in microgram/g of wet wt of lung tissue) was absent in the lungs from 3rd trimester fetal dogs and rapidly increased over the first 2 wk of life, reaching a maximum in the adult. It is concluded that 1) the response of pulmonary arteries to histamine changes during the first 2 wk of life; 2) this change may reflect a decrease in H2-receptors and an increase in H1-receptors; 3) the contractile ability of pulmonary vascular smooth muscle increases with postnatal age; and 4) histamine is unavailable for physiological responses in the fetal dog pulmonary circulation.

Animals↗
PubMed1979

Pregnancy-induced pulmonary hypertension in cows susceptible to high mountain disease.

Observations in several species suggest that pulmonary vascular reactivity may be reduced during pregnancy. We tested this hypothesis in two groups of unanesthetized cows, one "susceptible" and one "resistant" to high mountain or brisket disease. At the altitude of residence (1,524 m), mean pulmonary arterial pressure was elevated during pregnancy by 18% and total pulmonary vascular resistance by 32% in susceptible but not in resistant cows. During acute exposure to simulated altitudes of 2,120--4,550 m, pulmonary arterial pressure was increased by 16% and total pulmonary resistance by 28% during pregnancy in susceptible cows. The pulmonary pressor response to a 5 microgram/kg bolus of prostaglandin FIalpha was not different during pregnancy in either group. Resistant cows hyperventilated while pregnant, raising arterial partial pressure of oxygen (PaO2) by 6 Torr both at 1,524 m and, on the average, by 7 Torr at altitudes of 2,120--4,550 m. Susceptible cows increased their PaO2 less than did the resistant cows during pregnancy. The results indicated that pregnancy was associated with a greater rise in pulmonary arterial pressure and total pulmonary vascular resistance during acute hypoxia and failed to elicit as great a ventilatory response in susceptible than in resistant cows.

Altitude↗
PubMed1979

Accentuated hypoxemia at high altitude in subjects susceptible to high-altitude pulmonary edema.

To investigate the hypotheses that activated coagulation, catecholamine release, or arginine vasopressin release are involved in the pathogenesis of high-altitude pulmonary edema (HAPE), we measured these variables in seven subjects susceptible to HAPE and in nine control subjects at an altitude of 1,600 m, and after 6 and 12 h at a simulated altitude of 4,150 m. Each subject was studied twice, once after 3 days of placebo medication and once after 3 days of premedication with aspirin and dipyridamole. At high altitude, HAPE-susceptible subjects showed significantly exaggerated hypoxemia and a slightly higher end-tidal carbon dioxide partial pressure that did not account fully for the hypoxemia. Fibrinolytic activity was significantly accelerated in both groups at high altitude, whereas other coagulation measurements, catecholamines and arginine vasopressin levels, and pulmonary function tests were not significantly changed. Similar findings were obtained after both placebo and platelet-inhibitor premedication. The results indicate that none of the three hypothesized mechanisms, i.e., activated coagulation, excessive catecholamine release, or antidiuresis, would account for HAPE susceptibility. Instead, HAPE-susceptible subjects exhibited exaggerated hypoxemia associated with relative hypoventilation and a widened alveolar-arterial gas pressure difference.

Adolescent↗
PubMed1979

Cardiac function in goats exposed to carbon monoxide.

To investigate the possibility that prolonged carbon monoxide (CO) exposure would depress myocardial function, six chronically instrumented, unsedated goats were exposed to 160--200 ppm CO for 2 wk, resulting in a mean carboxyhemoglobin saturation of 20%. Cardiac index and stroke volume remained unchanged during and after exposure. Hematocrit and hemoglobin concentration started increasing on the 10th day of exposure, this increase reached statistical significance (P less than 0.05) on the 6th postexposure day. Contractility (Vmax) of the left ventricular myocardium and heart rate were unchanged during exposure to CO, but both were significantly (P less than 0.05) decreased at some time during the 1st wk after removal from CO. If there was a decrease in intrinsic myocardial function during CO exposure, it may have been masked by increased sympathetic activity. The mechanism(s) that might produce the decrease in heart rate and contractility after removal from CO are not obvious. Possible explanations are discussed.

Animals↗
PubMed1978

Impaired oxygenation during sleep in excessive polycythemia of high altitude: improvement with respiratory stimulation.

Although polycythemia of high altitude is usually due to excessive hypoxemia, in some patients the hematocrit is elevated out of proportion to the degree of hypoxemia measured awake. One possible explanation is that severe hypoxemia occurs during sleep in these subjects. We therefore monitored oxygen saturation (SaO2), breathing pattern, and electroencephalogram (EEG) during sleep in five normal high-altitude residents and in five patients with excessive polycythemia. The polycythemic patients were studied as part of a placebo--drug double-blind crossover trial of the respiratory stimulant drug medroxyprogesterone acetate (MPA). The polycythemic patients while taking placebo were much more hypoxemic during sleep than the normals (all-night mean SaO2: 79.4 +/- 1.7% versus 87.8 +/- 1.7%, p less than 0.01). Abnormalities in breathing patterns were observed in all the subjects, especially during REM stage sleep. In polycythemic subjects, this resulted in precipitous hypoxemia with SaO2 as low as 50%--70%. Severe hypoxemia was not observed in control subjects despite similar abnormalities in breathing. Significant improvement in nocturnal SaO2 occurred when the polycythemic patients were taking MPA, mean SaO2 rising from 79.4 +/- 1.7% to 83.7 +/- 0.7%, p less than 0.05. Of probably greater importance, MPA largely prevented the precipitous drops in SaO2, mean lowest SaO2 rising from 64.6 +/- 4.7% to 76.0 +/- 2.1% p less than 0.05. The severe decreases in SaO2 during sleep may explain elevations in hematocrit that are out of proportion to the awake SaO2 in man at high altitude. The therapeutic effect of MPA in this condition may be due to amelioration of sleep hypoxemia.

Adult↗