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The John B. Pierce Laboratory and Department of Epidemiology and Public Health, Yale University, New Haven, Connecticut 06519
The effects of posture on the lymphatic outflow
pressure and lymphatic return of albumin were examined in 10 volunteers. Lymph flow was stimulated with a bolus infusion of isotonic
saline (0.9%, 12.6 ml/kg body wt) under four separate conditions:
upright rest (Up), upright rest with lower body positive pressure
(LBPP), supine rest (Sup), and supine rest with lower body negative
pressure (LBNP). The increase in plasma albumin content (
Alb) during
the 2 h after bolus saline infusion was greater in Up than in
LBPP: 82.9 ± 18.5 vs.
28.4 mg/kg body wt.
Alb was greater in
LBNP than in Sup: 92.6 vs.
22.5 ± 18.9 mg/kg body wt
(P < 0.05). The greater
Alb in Up and Sup with LBNP
were associated with a lower estimated lymphatic outflow pressure on
the basis of the difference in central venous pressure (
CVP). During
LBPP, CVP was increased compared with Up: 3.8 ± 1.4 vs.
1.2 ± 1.2 mmHg. During LBNP, CVP was reduced compared with Sup:
3.0 ± 2.2 vs. 1.7 ± 1.0 mmHg. The translocation of
protein into the vascular space after bolus saline infusion reflects
lymph return of protein and is higher in Up than in Sup. Modulation of
CVP with LBPP or LBNP in Up and Sup, respectively, reversed the impact
of posture on lymphatic outflow pressure. Thus posture-dependent
changes in lymphatic protein transport are modulated by changes in CVP
through its mechanical impact on lymphatic outflow pressure.
posture; lower body positive pressure; lower body negative pressure
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