Direct demonstration that blood flow through intrapulmonary arteriovenous anastomoses worsens pulmonary gas exchange efficiency

Blood flow through intrapulmonary arteriovenous anastomoses (QIPAVA) occurs in healthy humans at rest and during exercise when breathing hypoxic gas mixtures at sea level and may be a source of right-to-left shunt. However, at high altitudes, QIPAVA is reduced compared with sea level, as detected using transthoracic saline contrast echocardiography (TTSCE). It remains unknown whether the reduction in QIPAVA (i.e., lower bubble scores) at high altitude is due to a reduction in bubble stability resulting from the lower barometric pressure (PB) or represents an actual reduction in QIPAVA. To this end, QIPAVA, pulmonary artery systolic pressure (PASP), cardiac output (QT), and the alveolar-to-arterial oxygen difference (AaDO2) were assessed at rest and during exercise (70–190 W) in the field (5,260 m) and in the laboratory (1,668 m) during four conditions: normobaric normoxia (NN; [Formula: see text] = 121 mmHg, PB = 625 mmHg; n = 8), normobaric hypoxia (NH; [Formula: see text] = 76 mmHg, PB = 625 mmHg; n = 7), hypobaric normoxia (HN; [Formula: see text] = 121 mmHg, PB = 410 mmHg; n = 8), and hypobaric hypoxia (HH; [Formula: see text] = 75 mmHg, PB = 410 mmHg; n = 7). We hypothesized QIPAVA would be reduced during exercise in isooxic hypobaria compared with normobaria and that the AaDO2 would be reduced in isooxic hypobaria compared with normobaria. Bubble scores were greater in normobaric conditions, but the AaDO2 was similar in both isooxic hypobaria and normobaria. Total pulmonary resistance (PASP/QT) was elevated in HN and HH. Using mathematical modeling, we found no effect of hypobaria on bubble dissolution time within the pulmonary transit times under consideration (<5 s). Consequently, our data suggest an effect of hypobaria alone on pulmonary blood flow. NEW & NOTEWORTHY Blood flow through intrapulmonary arteriovenous anastomoses, detected by transthoracic saline contrast echocardiography, was reduced during exercise in acute hypobaria compared with normobaria, independent of oxygen tension, whereas pulmonary gas exchange efficiency was unaffected. Modeling the effect(s) of reduced air density on contrast bubble lifetime did not result in a significantly reduced contrast stability. Interestingly, total pulmonary resistance was increased by hypobaria, independent of oxygen tension, suggesting that pulmonary blood flow may be changed by hypobaria.

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Mechanisms of improvement in pulmonary gas exchange during isovolemic hemodilution

Journal of Applied Physiology ◽

10.1152/jappl.1999.87.1.132 ◽

1999 ◽

Vol 87 (1) ◽

pp. 132-141 ◽

Cited By ~ 39

Author(s):

Steven Deem ◽

Richard G. Hedges ◽

Steven McKinney ◽

Nayak L. Polissar ◽

Michael K. Alberts ◽

...

Keyword(s):

Blood Flow ◽

Fractal Dimension ◽

Gas Exchange ◽

Spatial Correlation ◽

Pulmonary Blood Flow ◽

Minute Ventilation ◽

Flow Distribution ◽

Pulmonary Gas Exchange ◽

Normal Lung ◽

Blood Flow Distribution

Severe anemia is associated with remarkable stability of pulmonary gas exchange (S. Deem, M. K. Alberts, M. J. Bishop, A. Bidani, and E. R. Swenson. J. Appl. Physiol. 83: 240–246, 1997), although the factors that contribute to this stability have not been studied in detail. In the present study, 10 Flemish Giant rabbits were anesthetized, paralyzed, and mechanically ventilated at a fixed minute ventilation. Serial hemodilution was performed in five rabbits by simultaneous withdrawal of blood and infusion of an equal volume of 6% hetastarch; five rabbits were followed over a comparable time. Ventilation-perfusion (V˙a/Q˙) relationships were studied by using the multiple inert-gas-elimination technique, and pulmonary blood flow distribution was assessed by using fluorescent microspheres. Expired nitric oxide (NO) was measured by chemiluminescence. Hemodilution resulted in a linear fall in hematocrit over time, from 30 ± 1.6 to 11 ± 1%. Anemia was associated with an increase in arterial [Formula: see text] in comparison with controls ( P < 0.01 between groups). The improvement in O2 exchange was associated with reducedV˙a/Q˙heterogeneity, a reduction in the fractal dimension of pulmonary blood flow ( P = 0.04), and a relative increase in the spatial correlation of pulmonary blood flow ( P = 0.04). Expired NO increased with anemia, whereas it remained stable in control animals ( P < 0.0001 between groups). Anemia results in improved gas exchange in the normal lung as a result of an improvement in overallV˙a/Q˙matching. In turn, this may be a result of favorable changes in pulmonary blood flow distribution, as assessed by the fractal dimension and spatial correlation of blood flow and as a result of increased NO availability.

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Unilateral lung edema: effects on pulmonary gas exchange, hemodynamics, and pulmonary perfusion distribution

Journal of Applied Physiology ◽

10.1152/jappl.2000.89.4.1513 ◽

2000 ◽

Vol 89 (4) ◽

pp. 1513-1521 ◽

Cited By ~ 8

Author(s):

Klaus Slama ◽

Mareike Gesch ◽

Johannes C. Böck ◽

Sylvia M. Pietschmann ◽

Walter Schaffartzik ◽

...

Keyword(s):

Blood Flow ◽

Gas Exchange ◽

Pulmonary Artery ◽

Venous Pressure ◽

Pulmonary Gas Exchange ◽

The Other ◽

Lung Edema ◽

Pulmonary Perfusion ◽

Central Venous ◽

Fluorescent Microspheres

Two types of unilateral lung edema in sheep were characterized regarding their effects on pulmonary gas exchange, hemodynamics, and distribution of pulmonary perfusion. One edema type was induced with aerosolized HCl (0.15 M, pH 1.0) and the other with NaCl (0.15 M, pH 7.4). Both aerosols were nebulized continuously for 4 h into left lungs. In HCl-treated animals, pulmonary gas exchange deteriorated [from a partial arterial O2 pressure-to-inspired O2 fraction ratio (PaO2 /Fi O2 ) of 254 at baseline to 187 after 4 h HCl]. In addition, pulmonary artery pressure and total pulmonary vascular resistance increased (from 16 to 19 mmHg and from 133 to 154 dyn · s · cm−5, respectively). In NaCl-treated animals, only the central venous pressure significantly increased (from 7 to 9 mmHg). Distribution of pulmonary perfusion (measured with fluorescent microspheres) changed differently in both groups. After HCl application, 6% more blood flow was directed to the treated lung, whereas, after NaCl, 5% more blood flow was directed to the untreated lung. HCl and NaCl treatment both induce an equivalent lung edema, but only HCl treatment is associated with gas exchange alteration and tissue damage. Redistribution of pulmonary perfusion maintains gas exchange during NaCl treatment and decreases it during HCl inhalation.

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The selective closure of feline carotid arteriovenous anastomoses (AVAs) by GR43175

Cephalalgia ◽

10.1111/j.1468-2982.1989.tb00071.x ◽

1989 ◽

Vol 9 (9_suppl) ◽

pp. 41-46

Author(s):

Marion J Perren ◽

Wasyl Feniuk ◽

Patrick Pa Humphrey

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Peripheral Resistance ◽

Haemodynamic Effects ◽

Arterial Blood Flow ◽

Arteriovenous Anastomoses ◽

Arterial Blood ◽

Flow Through ◽

Carotid Arterial ◽

Dose Dependent

The haemodynamic effects of the selective 5-HT1-like agonist GR43175 have been compared with that of ergotamine in anaesthetized cats. Both GR43175 (30–1000 μg/kg intravenously) and ergotamine (0.3–30 μg/kg intravenously) caused a dose-dependent reduction in the proportion of cardiac output passing through arteriovenous anastomoses (AVAs). However, unlike GR43175, the effect of ergotamine (30 μg/kg intravenously) was associated with marked increases in diastolic blood pressure and total peripheral resistance. In further studies, the effect of GR43175 on the distribution of blood flow within the carotid bed has been examined. GR43175 caused a reduction in total carotid arterial blood flow which was entirely due to a reduction in flow through carotid AVAs. These results demonstrate that GR43175, unlike ergotamine, has a highly selective vasoconstrictor action on AVAs within the cranial circulation of anaesthetized cats. Such a mechanism may be important in its antimigraine activity.

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Pulmonary gas exchange response to exercise- and mannitol-induced bronchoconstriction in mild asthma

Journal of Applied Physiology ◽

10.1152/japplphysiol.00108.2008 ◽

2008 ◽

Vol 105 (5) ◽

pp. 1477-1485 ◽

Cited By ~ 27

Author(s):

Phillip A. Muñoz ◽

Federico P. Gómez ◽

Hernán A. Manrique ◽

Josep Roca ◽

Joan A. Barberà ◽

...

Keyword(s):

Blood Flow ◽

Gas Exchange ◽

Minute Ventilation ◽

Forced Expiratory Volume ◽

Pulmonary Gas Exchange ◽

Slow Recovery ◽

Airway Narrowing ◽

Asthmatic Patients ◽

Response To Exercise ◽

Blood Flow Redistribution

Both exercise (EIB) and mannitol challenges were performed in asthmatic patients to assess and compare their pulmonary gas exchange responses for an equivalent degree of bronchoconstriction. In 11 subjects with EIB [27 ± 4 (SD) yr; forced expiratory volume in 1 s (FEV1), 86 ± 8% predicted], ventilation-perfusion (V̇a/Q̇) distributions (using multiple inert gas elimination technique) were measured 5, 15, and 45 min after cycling exercise (FEV1 fall, 35 ± 12%) and after mannitol (33 ± 10%), 1 wk apart. Five minutes after EIB, minute ventilation (V̇e; by 123 ± 60%), cardiac output (Q̇t, by 48 ± 29%), and oxygen uptake (V̇o2; by 54 ± 25%) increased, whereas arterial Po2 (PaO2; by 14 ± 11 Torr) decreased due to moderate V̇a/Q̇ imbalance, assessed by increases in dispersions of pulmonary blood flow (log SDQ̇; by 0.53 ± 0.16) and alveolar ventilation (log SDV̇; by 0.28 ± 0.15) (dimensionless) ( P < 0.01 each). In contrast, for an equivalent degree of bronchoconstriction and minor increases in V̇e, Q̇t, and V̇o2, mannitol decreased PaO2 more intensely (by 24 ± 9 Torr) despite fewer disturbances in log SDQ̇ (by 0.27 ± 0.12). Notwithstanding, mannitol-induced increase in log SDV̇ at 5 min (by 0.35 ± 0.15) was similar to that observed during EIB, as was the slow recovery in log SDV̇ and high V̇a/Q̇ ratio areas, at variance with the faster recovery of log SDQ̇ and low V̇a/Q̇ ratio areas. In asthmatic individuals, EIB provokes more V̇a/Q̇ imbalance but less hypoxemia than mannitol, primarily due to postexercise increases in V̇e and Q̇t benefiting PaO2. V̇a/Q̇ inequalities during both challenges most likely reflect uneven airway narrowing and blood flow redistribution generating distinctive V̇a/Q̇ patterns, including the development of areas with low and high V̇a/Q̇ ratios.

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