Is cardiac filling pressure the limiting factor in adjusting to heat stress?

摘要

The concept that a specific level of central venous pressure (CVP) limits man's adjustment to heat stress has been debated. Evidence was presented that identifies a true limit of adjustment as being more related to factors affecting evaporative cooling, such as level of hydration, release of active vasodilation substance (AVS), and sweat gland fatigue. However, it was conceded that decreases in CVP and subsequent low-pressure baroreceptor activation modify cutaneous blood flow and subsequently reduce conductance of heat from the core to the periphery. It was suggested that CVP merely reflects a downstream pressure, which must be allowed to reach a pressure lower than that observed in the peripheral venous bed during active cutaneous vasodilation, to insure adequate venous return. However, a loss of evaporative cooling has been observed during prolonged progressive dehydration of subjects in the supine position, resulting in 3 to 4 percent loss of total body weight. This loss of evaporative cooling was not apparent when euhydration was maintained. As it was unlikely that CVP was reduced in these experiments in the supine position, it was concluded that CVP was not the limiting factor in man's adjustment to heat stress.