Skip to main content
PMC home page
The Journal of Clinical Investigation logoLink to The Journal of Clinical Investigation
. 1979 Oct;64(4):1050–1055. doi: 10.1172/JCI109542

Mechanisms of gas exchange abnormality in patients with chronic obliterative pulmonary vascular disease.

D R Dantzker, J S Bower
PMCID: PMC372215  PMID: 479367

Abstract

We have examined the mechanisms of abnormal gas exchange in seven patients with chronic obliteration of the pulmonary vascular bed secondary to recurrent pulmonary emboli or idiopathic pulmonary hypertension. All of the patients had a widened alveolar-arterial oxygen gradient and four were significantly hypoxemic with arterial partial presssures of oxygen less than 80 torr. Using the technique of multiple inert gas elimination, we found that ventilation-perfusion (VA/Q) relationships were only minimally abnormal with a mean of 10% (range, 2--19%) of cardiac output perfusing abnormal units. These units consisted of shunt and units with VA/Q ratios less than 0.1. In addition, the dead space was found to be normal in each patient. There was no evidence for diffusion impairment, and the widened alveolar-arterial oxygen gradient was completely explained by VA/ inequality. Significant hypoxemia occurred only when VA/Q inequality was combined with a low mixed venous oxygen content.

Full text

PDF
1055

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Albert R. K., Lakshminarayan S., Huang T. W., Butler J. Fluid leaks from extra-alveolar vessels in living dog lungs. J Appl Physiol Respir Environ Exerc Physiol. 1978 May;44(5):759–762. doi: 10.1152/jappl.1978.44.5.759. [DOI] [PubMed] [Google Scholar]
  2. BLAKEMORE W. S., FORSTER R. E., MORTON J. W., OGILVIE C. M. A standardized breath holding technique for the clinical measurement of the diffusing capacity of the lung for carbon monoxide. J Clin Invest. 1957 Jan;36(1 Pt 1):1–17. doi: 10.1172/JCI103402. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. BURCHELL H. B., EDWARDS J. E., SHEPHERD J. T., SWAN H. J., WOOD E. H. Clinical, physiological, and pathological considerations in patients with idiopathic pulmonary hypertension. Br Heart J. 1957 Jan;19(1):70–82. doi: 10.1136/hrt.19.1.70. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Caldini P., Leith J. D., Brennan M. J. Effect of continuous postive-pressure ventilation (CPPV) on edema formation in dog lung. J Appl Physiol. 1975 Oct;39(4):672–679. doi: 10.1152/jappl.1975.39.4.672. [DOI] [PubMed] [Google Scholar]
  5. DODGE H. T., LORD J. D., SANDLER H. Cardiovascular effects of isoproterenol in normal subjects and subjects with congestive heart failure. Am Heart J. 1960 Jul;60:94–105. doi: 10.1016/0002-8703(60)90063-6. [DOI] [PubMed] [Google Scholar]
  6. Dantzker D. R., Wagner P. D., Tornabene V. W., Alazraki N. P., West J. B. Gas exchange after pulmonary thromboemoblization in dogs. Circ Res. 1978 Jan;42(1):92–103. doi: 10.1161/01.res.42.1.92. [DOI] [PubMed] [Google Scholar]
  7. Daoud F. S., Reeves J. T., Kelly D. B. Isoproterenol as a potential pulmonary vasodilator in primary pulmonary hypertension. Am J Cardiol. 1978 Nov;42(5):817–822. doi: 10.1016/0002-9149(78)90102-9. [DOI] [PubMed] [Google Scholar]
  8. Evans J. W., Wagner P. D. Limits on VA/Q distributions from analysis of experimental inert gas elimination. J Appl Physiol Respir Environ Exerc Physiol. 1977 Jun;42(6):889–898. doi: 10.1152/jappl.1977.42.6.889. [DOI] [PubMed] [Google Scholar]
  9. GOLDMAN H. I., BECKLAKE M. R. Respiratory function tests; normal values at median altitudes and the prediction of normal results. Am Rev Tuberc. 1959 Apr;79(4):457–467. doi: 10.1164/artpd.1959.79.4.457. [DOI] [PubMed] [Google Scholar]
  10. Gazetopoulos N., Salonikides N., Davies H. Cardiopulmonary function in patients with pulmonary hypertension. Br Heart J. 1974 Jan;36(1):19–28. doi: 10.1136/hrt.36.1.19. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Hlastala M. P., Robertson H. T., Ross B. K. Gas exchange abnormalities produced by venous gas emboli. Respir Physiol. 1979 Jan;36(1):1–17. doi: 10.1016/0034-5687(79)90011-2. [DOI] [PubMed] [Google Scholar]
  12. Kafer E. R. Respiratory function in pulmonary thromboembolic disease. Am J Med. 1969 Dec;47(6):904–915. doi: 10.1016/0002-9343(69)90204-6. [DOI] [PubMed] [Google Scholar]
  13. Levy S. E., Simmons D. H. Mechanism of arterial hypoxemia following pulmonary thromboembolism in dogs. J Appl Physiol. 1975 Jul;39(1):41–46. doi: 10.1152/jappl.1975.39.1.41. [DOI] [PubMed] [Google Scholar]
  14. Levy S. E., Simmons D. H. Redistribution of alveolar ventilation following pulmonary thromboembolism in the dog. J Appl Physiol. 1974 Jan;36(1):60–68. doi: 10.1152/jappl.1974.36.1.60. [DOI] [PubMed] [Google Scholar]
  15. Lynch J. P., Mhyre J. G., Dantzker D. R. Influence of cardiac output on intrapulmonary shunt. J Appl Physiol Respir Environ Exerc Physiol. 1979 Feb;46(2):315–321. doi: 10.1152/jappl.1979.46.2.315. [DOI] [PubMed] [Google Scholar]
  16. McGRATH M. W., THOMSON M. L. The effect of age, body size and lung volume change on alveolar-capillary permeability and diffusing capacity in man. J Physiol. 1959 Jun 11;146(3):572–582. doi: 10.1113/jphysiol.1959.sp006212. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Mookherjee S., Keighley J. F., Warner R. A., Bowser M. A., Obeid A. I. Hemodynamic, ventilatory and blood gas changes during infusion of sodium nitroferricyanide (nitroprusside). Studies in patients with congestive heart failure. Chest. 1977 Sep;72(3):273–278. doi: 10.1378/chest.72.3.273. [DOI] [PubMed] [Google Scholar]
  18. SEVERINGHAUS J. W., STUPFEL M. Alveolar dead space as an index of distribution of blood flow in pulmonary capillaries. J Appl Physiol. 1957 May;10(3):335–348. doi: 10.1152/jappl.1957.10.3.335. [DOI] [PubMed] [Google Scholar]
  19. SWENSON E. W., FINLEY T. N., GUZMAN S. V. Unilateral hypoventilation in man during temporary occlusion of one pulmonary artery. J Clin Invest. 1961 May;40:828–835. doi: 10.1172/JCI104316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Shettigar U. R., Hultgren H. N., Specter M., Martin R., Davies D. H. Primary pulmonary hypertension favorable effect of isoproterenol. N Engl J Med. 1976 Dec 16;295(25):1414–1415. doi: 10.1056/NEJM197612162952506. [DOI] [PubMed] [Google Scholar]
  21. Stanger P., Lucas R. V., Jr, Edwards J. E. Anatomic factors causing respiratory distress in acyanotic congenital cardiac disease. Special reference to bronchial obstruction. Pediatrics. 1969 May;43(5):760–769. [PubMed] [Google Scholar]
  22. WEST J. B., DOLLERY C. T., HEARD B. E. INCREASED VASCULAR RESISTANCE IN THE LOWER ZONE OF THE LUNG CAUSED BY PERIVASCULAR OEDEMA. Lancet. 1964 Jul 25;2(7352):181–183. doi: 10.1016/s0140-6736(64)90236-3. [DOI] [PubMed] [Google Scholar]
  23. WILLIAMS M. H., Jr Mechanical vs. reflex effects of diffuse pulmonary embolism in anesthetized dogs. Circ Res. 1956 May;4(3):325–331. doi: 10.1161/01.res.4.3.325. [DOI] [PubMed] [Google Scholar]
  24. Wagner P. D., Dantzker D. R., Iacovoni V. E., Tomlin W. C., West J. B. Ventilation-perfusion inequality in asymptomatic asthma. Am Rev Respir Dis. 1978 Sep;118(3):511–524. doi: 10.1164/arrd.1978.118.3.511. [DOI] [PubMed] [Google Scholar]
  25. Wagner P. D., Laravuso R. B., Uhl R. R., West J. B. Continuous distributions of ventilation-perfusion ratios in normal subjects breathing air and 100 per cent O2. J Clin Invest. 1974 Jul;54(1):54–68. doi: 10.1172/JCI107750. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Wagner P. D., Naumann P. F., Laravuso R. B. Simultaneous measurement of eight foreign gases in blood by gas chromatography. J Appl Physiol. 1974 May;36(5):600–605. doi: 10.1152/jappl.1974.36.5.600. [DOI] [PubMed] [Google Scholar]
  27. Wagner P. D., Saltzman H. A., West J. B. Measurement of continuous distributions of ventilation-perfusion ratios: theory. J Appl Physiol. 1974 May;36(5):588–599. doi: 10.1152/jappl.1974.36.5.588. [DOI] [PubMed] [Google Scholar]
  28. Walcott G., Burchell H. B., Brown A. L., Jr Primary pulmonary hypertension. Am J Med. 1970 Jul;49(1):70–79. doi: 10.1016/s0002-9343(70)80115-2. [DOI] [PubMed] [Google Scholar]
  29. Wang S. W., Pohl J. E., Rowlands D. J., Wade E. G. Diazoxide in treatment of primary pulmonary hypertension. Br Heart J. 1978 May;40(5):572–574. doi: 10.1136/hrt.40.5.572. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. West J. B. State of the art: ventilation-perfusion relationships. Am Rev Respir Dis. 1977 Nov;116(5):919–943. doi: 10.1164/arrd.1977.116.5.919. [DOI] [PubMed] [Google Scholar]
  31. Whayne T. F., Jr, Severinghaus J. W. Experimental hypoxic pulmonary edema in the rat. J Appl Physiol. 1968 Dec;25(6):729–732. doi: 10.1152/jappl.1968.25.6.729. [DOI] [PubMed] [Google Scholar]
  32. Wilson J. E., 3rd, Pierce A. K., Johnson R. L., Jr, Winga E. R., Harrell W. R., Curry G. C., Mullins C. B. Hypoxemia in pulmonary embolism, a clinical study. J Clin Invest. 1971 Mar;50(3):481–491. doi: 10.1172/JCI106516. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Clinical Investigation are provided here courtesy of American Society for Clinical Investigation

RESOURCES