Gradient compression garments protect against orthostatic intolerance during recovery from bed rest

IntroductionAbdomen-high, lower body graded compression garments (GCGs) may represent the next-generation of orthostatic intolerance protection with applications for exploration missions and commercial space flight.PurposeTo evaluate the efficacy of the GCG to prevent orthostatic intolerance after a 14-day 6° head-down tilt bed rest (BR) and to determine whether wearing thigh-high compression garments impairs recovery from BR.MethodsSixteen (12 M, 4 F) subjects participated in a 15-min 80° head-up tilt test 5 day before BR (BR-5), on the last morning of BR (BR+0), and on day 1 (BR+1) and 3 after BR (BR+3). No subjects wore the GCG on BR-5, and all subjects wore the GCG during testing on BR+0. Control subjects (n = 8) wore the GCG only through testing on BR+0. Treatment subjects (n = 8) wore the GCG on BR+0 and thigh-high garments on BR+1 and BR+2.ResultsNo subjects were presyncopal during tilt on BR+0 while wearing the GCG. Despite lower plasma volume index (BR-5: 1.52 ± 0.06, BR+0: 1.32 ± 0.05 l/m2), the tilt-induced increase in heart rate (ΔHR, 17 ± 2 bpm) and decrease in stroke volume (ΔSV, −28 ± 3 ml) on BR+0 were less than on BR-5 (24 ± 2 bpm, −43 ± 4 ml). On BR+1 ΔHR in the control group (33 ± 4 bpm) was higher than in the treatment group (23 ± 2 bpm) but there were no group differences on BR+3.ConclusionsWearing the GCG prevented the orthostatic intolerance that is normally present after BR. Thigh-high garments provided protection after BR, and wearing these garments did not impair recovery.

[1]  A R Kotovskaya,et al.  Human +Gx tolerance with the use of anti-G suits during descent from orbit of the Soyuz space vehicles. , 1998, Journal of gravitational physiology : a journal of the International Society for Gravitational Physiology.

[2]  L. E. Warren,et al.  Long-duration head-down bed rest: project overview, vital signs, and fluid balance. , 2009, Aviation, space, and environmental medicine.

[3]  J. Lanier,et al.  Evaluation and management of orthostatic hypotension. , 2011, American family physician.

[4]  Steven H Platts,et al.  Plasma volume restoration with salt tablets and water after bed rest prevents orthostatic hypotension and changes in supine hemodynamic and endocrine variables. , 2005, American journal of physiology. Heart and circulatory physiology.

[5]  Stuart M. C. Lee,et al.  Compression garments as countermeasures to orthostatic intolerance. , 2009, Aviation Space and Environmental Medicine.

[6]  Michael B Stenger,et al.  Gradient compression garments as a countermeasure to post-spaceflight orthostatic intolerance. , 2010, Aviation, space, and environmental medicine.

[7]  J. Karemaker,et al.  Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction , 2004, Clinical Autonomic Research.

[8]  Lawrence F. Dietlein,et al.  Biomedical Results of Apollo , 2011 .

[9]  C. G. Blomqvist,et al.  Orthostatic intolerance after spaceflight. , 1996, Journal of applied physiology.

[10]  Janice V Meck,et al.  Mechanisms of postspaceflight orthostatic hypotension: low alpha1-adrenergic receptor responses before flight and central autonomic dysregulation postflight. , 2004, American journal of physiology. Heart and circulatory physiology.

[11]  R. Hughson,et al.  Insufficient flow reduction during LBNP in both splanchnic and lower limb areas is associated with orthostatic intolerance after bedrest. , 2008, American journal of physiology. Heart and circulatory physiology.

[12]  Richard S. Johnston,et al.  Biomedical results from Skylab , 1977 .

[13]  F. Lateef,et al.  Military anti-shock garment: Historical relic or a device with unrealized potential? , 2008, Journal of emergencies, trauma, and shock.

[14]  V. Convertino,et al.  Efficacy of compression of different capacitance beds in the amelioration of orthostatic hypotension , 1997, Clinical Autonomic Research.

[15]  P A Bishop,et al.  Carbon dioxide accumulation, walking performance, and metabolic cost in the NASA launch and entry suit. , 1999, Aviation, space, and environmental medicine.

[16]  Janice V Meck,et al.  Postspaceflight orthostatic hypotension occurs mostly in women and is predicted by low vascular resistance. , 2002, Journal of applied physiology.

[17]  R. Baevsky,et al.  Autonomic cardiovascular and respiratory control during prolonged spaceflights aboard the International Space Station. , 2007, Journal of applied physiology.

[18]  B D Levine,et al.  Cardiac atrophy after bed-rest deconditioning: a nonneural mechanism for orthostatic intolerance. , 1997, Circulation.

[19]  Daniel L. Feeback,et al.  Muscle volume, MRI relaxation times (T2), and body composition after spaceflight. , 2000, Journal of applied physiology.

[20]  W. Thornton,et al.  Fluid shifts in weightlessness. , 1987, Aviation, space, and environmental medicine.

[21]  G. W. Hoffler,et al.  Anthropometric changes and fluid shifts , 1977 .

[22]  R. L. Johnson,et al.  Lower body negative pressure: Third manned Skylab mission , 1977 .

[23]  S. Skinner,et al.  Determination of hemoglobin mass and blood volume with CO: evaluation and application of a method. , 1995, Journal of applied physiology.

[24]  John B Charles,et al.  Cardiovascular effects of anti-G suit and cooling garment during space shuttle re-entry and landing. , 2003, Aviation, space, and environmental medicine.

[25]  Kotovskaya Ar,et al.  Human +Gx tolerance with the use of anti-G suits during descent from orbit of the Soyuz space vehicles. , 1998 .

[26]  Michael B Stenger,et al.  Cardiovascular adaptations to long-duration head-down bed rest. , 2009, Aviation, space, and environmental medicine.

[27]  Michael B Stenger,et al.  Metabolic consequences of garments worn to protect against post-spaceflight orthostatic intolerance. , 2011, Aviation, space, and environmental medicine.

[28]  T. E. Brown,et al.  Subnormal norepinephrine release relates to presyncope in astronauts after spaceflight. , 1996, Journal of applied physiology.

[29]  S. Watanuki,et al.  Effects of wearing compression stockings on cardiovascular responses. , 1994, The Annals of physiological anthropology = Seiri Jinruigaku Kenkyukai kaishi.

[30]  Cyndya Shibao,et al.  ASH Position Paper: Evaluation and Treatment of Orthostatic Hypotension , 2013, Journal of clinical hypertension.

[31]  Carlos J. Reyes,et al.  Marked Exacerbation of Orthostatic Intolerance After Long- vs. Short-Duration Spaceflight in Veteran Astronauts , 2001, Psychosomatic medicine.

[32]  R. L. Johnson,et al.  Apollo flight crew cardiovascular evaluations , 1975 .

[33]  A D Moore,et al.  Inflight exercise affects stand test responses after space flight. , 1999, Medicine and science in sports and exercise.

[34]  T. R. Phillips,et al.  Abdomen-high elastic gradient compression garments during post-spaceflight stand tests. , 2013, Aviation, space, and environmental medicine.