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J Appl Physiol 87: 132-141, 1999;
8750-7587/99 $5.00
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Vol. 87, Issue 1, 132-141, July 1999

Mechanisms of improvement in pulmonary gas exchange during isovolemic hemodilution

Steven Deem1, Richard G. Hedges1, Steven McKinney1, Nayak L. Polissar1,3, Michael K. Alberts1, and Erik R. Swenson1,2

1 Departments of Anesthesiology and Medicine, University of Washington, Seattle 98195; 2 Veterans Affairs Puget Sound Health Care System, Seattle 98108 and 3 The Mountain-Whisper-Light Statistical Consulting, Seattle, Washington 98112

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 (VA/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 PO2 in comparison with controls (P < 0.01 between groups). The improvement in O2 exchange was associated with reduced VA/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 overall VA/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.

anemia; oxygen; carbon dioxide; rabbits


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