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Departments of Medicine and Environmental Health Sciences, The Johns Hopkins University, Baltimore, Maryland 21224
The lymphatic vessels of the
lung provide an important route for clearance of interstitial edema
fluid filtered from pulmonary blood vessels. However, the importance of
lung lymphatics for the removal of airway liquid filtered from the
systemic circulation of the lung has not been demonstrated. We studied
the contribution of the bronchial vasculature to lung lymph flow in
anesthetized, ventilated sheep (n = 35). With the bronchial artery cannulated and perfused (control flow = 0.6 ml · min
1 · kg
1),
lymph flow from the efferent duct of the caudal mediastinal lymph node
was measured 1) during increased
bronchial vascular perfusion (300% of control flow);
2) with a hydrated interstitium induced by a 1-h period of left atrial hypertension and subsequent recovery, both with and without bronchial perfusion; and
3) during infusion (directly into
the bronchial artery) of bradykinin, an inflammatory mediator known to
cause changes in bronchial vascular permeability. Increased bronchial
perfusion for 90 min resulted in an average 35% increase in lung lymph
flow. During left atrial hypertension, the increase in lung lymph flow
was significantly greater with bronchial perfusion (339% increase over
baseline) than without bronchial perfusion (138% increase).
Furthermore, recovery after left atrial hypertension was more complete
after 90 min without bronchial perfusion (91%) than with bronchial
perfusion (63%). Infusion of bradykinin into the bronchial artery
resulted in a prompt and prolonged 107% increase in lung lymph flow.
This was not seen if the same dose was infused into the pulmonary
artery. Thus bronchial vascular transudate contributes significantly to lymph flow from the efferent duct of the caudal mediastinal lymph node.
These results demonstrate that lymph vessels clear excess fluid from
the airway wall and should be considered when evaluating the effect of
vascular leak in airway obstruction.
bradykinin; bronchial artery; hydrostatic edema; hyperpermeability; lung water
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