Cardiovascular adaptations driven by exposure to weightlessness cause some astronauts to experience orthostatic intolerance upon return to Earth. Maladaptations of spaceflight that lead to hemodynamic instability are temporary, and therefore astronauts provide for researchers a powerful model to study cardiovascular dysfunction in terrestrial patients. Orthostatic intolerance in astronauts is linked to changes in the autonomic control of cardiovascular function, and so patients that suffer neurocardiogenic syncope may benefit from a greater understanding of the effects of spaceflight on the autonomic nervous system. In addition, appropriate autonomic compensation is fundamental to the maintenance of stable arterial pressures and brain blood flow in patients suffering traumatic bleeding injuries. The application of lower body negative pressure (LBNP), an experimental procedure used widely in aerospace physiology, induces autonomic and hemodynamic responses that are similar to actual hemorrhage and therefore may emerge as a useful experimental tool to simulate hemorrhage in humans. Observations that standing astronauts and severely injured patients are challenged to maintain venous return has contributed to the development of an inspiratory impedance threshold device that serves as a controlled "Mueller maneuver" and has the potential to reduce orthostatic intolerance in returning astronauts and slow the progression to hemorrhagic shock in bleeding patients. In this review, we focus on describing new concepts that have arisen from studies of astronauts, patients, and victims of trauma, and highlight the necessity of developing the capability of monitoring medical information continuously and remotely. Remote medical monitoring will be essential for longduration space missions and has the potential to save lives on the battlefield and in the civilian sector.
Keywords: microgravity, autonomic nervous system, orthostatic intolerance, combat casualty care, hemorrhagic shock
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