Haemodynamic Monitoring in Space
Keywords:
cardiovascular system, shock, weightlessness, microgravity, space medicine.Abstract
Despite the fact that, during the last decade, modern countermeasure systems and preventive medicine have been proven useful in reducing the effects of microgravity upon the human body, they are likely to become outdated in forthcoming space missions. With space becoming gradually more accessible to the general public and with missions usually taking longer than six months, the risk of severe medical conditions increases significantly. In this context, medical autonomy will be the cornerstone for achieving good healthcare outcomes, and adequate medical equipment will be a determinant factor influencing both diagnosis and treatment. Reliable dedicated haemodynamic monitoring systems must therefore be available in orbit so as to guide patient management in critical medical situations. The equipment available in orbit, however, is unsuitable for emergency health care, either providing incomplete haemodynamic information or delivering it in an intermittent fashion. Furthermore, there exist a number of haemodynamic monitoring systems approved for terrestrial use which have the potential to bring about significant benefits for space medicine and which have never been tested in microgravity. This paper means to provide an overview of the physiological determinants of cardiovascular function and its adaptation to weightlessness, as well as précis the pathophysiological phenomena that define shock states. It also aims to review the existing haemodynamic monitoring capabilities in orbit and to explore new points for their improvement.
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Monitorização Hemodinâmica no Espaço
RESUMO: Ainda que durante a última década os sistemas de contramedida modernos e a medicina preventiva tenham se provado úteis na redução dos efeitos da microgravidade sobre o corpo humano, é provável que os mesmos acabem ultrapassados nas próximas missões espaciais. Com o espaço se tornando gradualmente mais acessível para o público geral e com as missões normalmente levando mais de seis meses, o risco de sofrer de condições clínicas graves aumenta de forma significativa. Neste contexto, a autonomia médica será o alicerce para que se atinjam bons resultados em termos de assistência médica, e o equipamento médico adequado será um fator determinante que influenciará tanto o diagnóstico quanto o tratamento. Sistemas de monitorização hemodinâmica dedicados confiáveis devem, portanto, estar disponíveis em órbita para orientar a gestão de pacientes em situações clínicas críticas. O equipamento disponível em órbita é, entretanto, impróprio para tratamento médico de emergência, fornecendo informações hemodinâmicas incompletas ou apresentando estas de forma intermitente. Além disso, existem vários sistemas de monitorização hemodinâmica aprovados para uso terrestre que têm potencial para gerar benefícios significativos para a medicina espacial e que nunca foram testados em ambiente de microgravidade. Este trabalho intenciona proporcionar uma visão geral dos determinantes fisiológicos da função cardiovascular e sua adaptação à ausência de gravidade, fazer um resumo dos fenômenos fisiopatológicos que definem os estados de choque, revisar as capacidades de monitorização hemodinâmica existentes em órbita e explorar novos ângulos para promover sua melhora.
PALAVRAS-CHAVE: sistema cardiovascular; choque; ausência de gravidade; microgravidade; medicina espacial.
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