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Departments of Medicine and Anesthesia and the Cardiovascular Research Institute, University of California, San Francisco, California 94143-0130
To characterize the rate and regulation of
alveolar fluid clearance in the uninjured human lung, pulmonary edema
fluid and plasma were sampled within the first 4 h after tracheal
intubation in 65 mechanically ventilated patients with severe
hydrostatic pulmonary edema. Alveolar fluid clearance was calculated
from the change in pulmonary edema fluid protein concentration over time. Overall, 75% of patients had intact alveolar fluid clearance (
3%/h). Maximal alveolar fluid clearance (14%/h) was present in
38% of patients, with a mean rate of 25 ± 12%/h. Hemodynamic factors (including pulmonary arterial wedge pressure and left ventricular ejection fraction) and plasma epinephrine levels did not
correlate with impaired or intact alveolar fluid clearance. Impaired
alveolar fluid clearance was associated with a lower arterial pH and a
higher Simplified Acute Physiology Score II. These factors may be
markers of systemic hypoperfusion, which has been reported to impair
alveolar fluid clearance by oxidant-mediated mechanisms. Finally,
intact alveolar fluid clearance was associated with a greater
improvement in oxygenation at 24 h along with a trend toward shorter
duration of mechanical ventilation and an 18% lower hospital
mortality. In summary, alveolar fluid clearance in humans may be rapid
in the absence of alveolar epithelial injury. Catecholamine-independent
factors are important in the regulation of alveolar fluid clearance in
patients with severe hydrostatic pulmonary edema.
-agonist; congestive heart failure; alveolar fluid clearance; mechanical ventilation; left atrial hypertension
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S. ZHU, L. B. WARE, T. GEISER, M. A. MATTHAY, and S. MATALON Increased Levels of Nitrate and Surfactant Protein A Nitration in the Pulmonary Edema Fluid of Patients with Acute Lung Injury Am. J. Respir. Crit. Care Med., January 1, 2001; 163(1): 166 - 172. [Abstract] [Full Text]
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N. B. Viget, B. P. H. Guery, F. Ader, R. Neviere, S. Alfandari, C. Creuzy, M. Roussel-Delvallez, C. Foucher, C. M. Mason, G. Beaucaire, et al. Keratinocyte growth factor protects against Pseudomonas aeruginosa-induced lung injury Am J Physiol Lung Cell Mol Physiol, December 1, 2000; 279(6): L1199 - L1209. [Abstract] [Full Text] [PDF]
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J. A. Frank, Y. Wang, O. Osorio, and M. A. Matthay beta -Adrenergic agonist therapy accelerates the resolution of hydrostatic pulmonary edema in sheep and rats J Appl Physiol, October 1, 2000; 89(4): 1255 - 1265. [Abstract] [Full Text] [PDF]
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N. Fukuda, H. G. Folkesson, and M. A. Matthay Relationship of interstitial fluid volume to alveolar fluid clearance in mice: ventilated vs. in situ studies J Appl Physiol, August 1, 2000; 89(2): 672 - 679. [Abstract] [Full Text] [PDF]
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A. K. Kurdowska, T. K. Geiser, S. M. Alden, B. R. Dziadek, J. M. Noble, T. J. Nuckton, and M. A. Matthay Activity of pulmonary edema fluid interleukin-8 bound to alpha 2-macroglobulin in patients with acute lung injury Am J Physiol Lung Cell Mol Physiol, May 1, 2002; 282(5): L1092 - L1098. [Abstract] [Full Text] [PDF]
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 V. Dumasius, J. I. Sznajder, Z. S. Azzam, J. Boja, G. M. Mutlu, M. B. Maron, and P. Factor {beta}2-Adrenergic Receptor Overexpression Increases Alveolar Fluid Clearance and Responsiveness to Endogenous Catecholamines in Rats Circ. Res., November 9, 2001; 89(10): 907 - 914. [Abstract] [Full Text] [PDF]
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