Lung water is increased in regions of higher neutrophil retention after acute bead embolization

Gas exchange and pulmonary hypertension following acute pulmonary thromboembolism: has the emperor got some new clothes yet?

Patients present with a wide range of hypoxemia after acute pulmonary thromboembolism (APTE). Recent studies using fluorescent microspheres demonstrated that the scattering of regional blood flows after APTE, created by the embolic obstruction unique in each patient, significantly worsened regional ventilation/perfusion (V/Q) heterogeneity and explained the variability in gas exchange. Furthermore, earlier investigators suggested the roles of released vasoactive mediators in affecting pulmonary hypertension after APTE, but their quantification remained challenging. The latest study reported that mechanical obstruction by clots accounted for most of the increase in pulmonary vascular resistance, but that endothelin-mediated vasoconstriction also persisted at significant level during the early phase.

Spatial pattern of ventilation-perfusion mismatch following acute pulmonary thromboembolism in pigs

We studied the spatial distribution of the abnormal ventilation-perfusion (Va/Q) units in a porcine model of acute pulmonary thromboembolism (APTE), using the fluorescent microsphere (FMS) technique. Four piglets ( approximately 22 kg) were anesthetized and ventilated with room air in the prone position. Each received approximately 20 g of preformed blood clots at time t = 0 min via a large-bore central venous catheter, until the mean pulmonary arterial pressure reached 2.5 times baseline. The distributions of regional Va and blood flow (Q) at five time points (t = -30, -5, 30, 60, 120 min) were mapped by FMS of 10 distinct colors, i.e., aerosolization of 1-mum FMS for labeling Va and intravenous injection of 15-mum FMS for labeling Q. Our results showed that, at t = 30 min following APTE, mean Va/Q (Va/Q = 2.48 +/- 1.12) and Va/Q heterogeneity (log SD Va/Q = 1.76 +/- 0.23) were significantly increased. There were also significant increases in physiological dead space (11.2 +/- 12.7% at 60 min), but the shunt fraction (Va/Q = 0) remained minimal. Cluster analyses showed that the low Va/Q units were mainly seen in the least embolized regions, whereas the high Va/Q units and dead space were found in the peripheral subpleural regions distal to the clots. At 60 and 120 min, there were modest recoveries in the hemodynamics and gas exchange toward baseline. Redistribution pattern was mostly seen in regional Q, whereas Va remained relatively unchanged. We concluded that the hypoxemia seen after APTE could be explained by the mechanical diversion of Q to the less embolized regions because of the vascular obstruction by clots elsewhere. These low Va/Q units created by high flow, rather than low Va, accounted for most of the resultant hypoxemia.

Triolein increases microvascular permeability in isolated perfused rabbit lungs: role of neutrophils

BACKGROUND

Pathophysiologic mechanisms of the fat embolism syndrome are poorly understood. Neutrophils are thought to play a role in the development of many forms of acute lung injury. The objective of this study was to examine the role of intrapulmonary neutrophils in lung injury resulting from fat infusion.

METHODS

Triolein (0.08 mL/kg) was infused into isolated rabbit lungs perfused with Krebs-Henseleit buffer. Pulmonary arterial pressure was monitored, and pulmonary vascular resistance and microvascular permeability (Kf) were measured at baseline and 60 minutes after triolein infusion.

RESULTS

Triolein produced increases in pulmonary arterial pressure, pulmonary vascular resistance, and Kf. Neutrophil depletion or inhibition of neutrophil elastase prevented the increase in Kf after triolein, and catalase partially blocked this Kf increase.

CONCLUSION

These results suggest that activated intrapulmonary neutrophils play a major role in developing triolein-induced lung injury, intrapulmonary neutrophils act chiefly via neutrophil elastase release, and reactive oxygen species are involved in the lung injury.

Ventilation heterogeneity does not change following pulmonary microembolism

By using the multiple-breath helium washout technique, ventilation heterogeneity (VH) after embolic injury in the lung can be quantitatively partitioned into the conductive and acinar components. Total VH, represented by the normalized slope of the phase III alveolar plateau, Sn(III (total)), was studied for 120 min in three groups of anesthetized and paralyzed mongrel dogs. Group 1 (n = 3) received only normal saline and served as controls. Group 2 (n = 4) received repeated infusions of polystyrene beads (250 microm) into the right atrium at 10, 40, 80, and 120 min. Group 3 (n = 3) was similarly treated, except that the embolic beads used were 1,000 microm in diameter. The data show that, despite repeated embolic injury by polystyrene beads of different diameters, there was no significant increase in total VH. The acinar component of Sn(III), which represents VH in the distal airways, accounts for over 90% of the total VH. The conductive component of Sn(III), which represents VH between larger conductive airways, remains relatively constant and a minor component. We conclude that pulmonary microembolism does not result in significant redistribution of ventilation.