Journal of Applied Physiology AJP: Lung Cellular and Molecular Physiology
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J Appl Physiol 92: 745-762, 2002; doi:10.1152/japplphysiol.00377.2001
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Vol. 92, Issue 2, 745-762, February 2002

Spatial distribution of ventilation and perfusion in anesthetized dogs in lateral postures

Hung Chang1,5, Stephen J. Lai-Fook4, Karen B. Domino3, Carmel Schimmel2, Jack Hildebrandt1,2, H. Thomas Robertson1,2, Robb W. Glenny1,2, and Michael P. Hlastala1,2

Departments of 1 Physiology and Biophysics, 2 Medicine, and 3 Anesthesiology, University of Washington, Seattle, Washington 98195; 4 Center for Biomedical Engineering, University of Kentucky, Lexington, Kentucky 40506; and 5 Division of Chest Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical School, Taipei, Taiwan

We aimed to assess the influence of lateral decubitus postures and positive end-expiratory pressure (PEEP) on the regional distribution of ventilation and perfusion. We measured regional ventilation (VA) and regional blood flow (Q) in six anesthetized, mechanically ventilated dogs in the left (LLD) and right lateral decubitus (RLD) postures with and without 10 cmH2O PEEP. Q was measured by use of intravenously injected 15-µm fluorescent microspheres, and VA was measured by aerosolized 1-µm fluorescent microspheres. Fluorescence was analyzed in lung pieces ~1.7 cm3 in volume. Multiple linear regression analysis was used to evaluate three-dimensional spatial gradients of Q, VA, the ratio VA/Q, and regional PO2 (PrO2) in both lungs. In the LLD posture, a gravity-dependent vertical gradient in Q was observed in both lungs in conjunction with a reduced blood flow and PrO2 to the dependent left lung. Change from the LLD to the RLD or 10 cmH2O PEEP increased local VA/Q and PrO2 in the left lung and minimized any role of hypoxia. The greatest reduction in individual lung volume occurred to the left lung in the LLD posture. We conclude that lung distortion caused by the weight of the heart and abdomen is greater in the LLD posture and influences both Q and VA, and ultimately gas exchange. In this respect, the smaller left lung was the most susceptible to impaired gas exchange in the LLD posture.

pulmonary gas exchange; spatial gradients; fluorescent microspheres; mediastinal shift; regional blood flow; positive end-expiratory pressure


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