| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
INVITED REVIEW
HIGHLIGHTED TOPICS
Pulmonary Circulation and Hypoxia
1Division of Sports Medicine, Department of Internal Medicine, Medical University Hospital, Heidelberg, Germany; and 2Department of Cardiology, Medical Clinic, Zurich, Switzerland; and 3Veterans Affairs Puget Sound Health Care System, Seattle, Washington
High-altitude pulmonary edema (HAPE) develops in rapidly ascending nonacclimatized healthy individuals at altitudes above 3,000 m. An excessive rise in pulmonary artery pressure (PAP) preceding edema formation is the crucial pathophysiological factor because drugs that lower PAP prevent HAPE. Measurements of nitric oxide (NO) in exhaled air, of nitrites and nitrates in bronchoalveolar lavage (BAL) fluid, and forearm NO-dependent endothelial function all point to a reduced NO availability in hypoxia as a major cause of the excessive hypoxic PAP rise in HAPE-susceptible individuals. Studies using right heart catheterization or BAL in incipient HAPE have demonstrated that edema is caused by an increased microvascular hydrostatic pressure in the presence of normal left atrial pressure, resulting in leakage of large-molecular-weight proteins and erythrocytes across the alveolarcapillary barrier in the absence of any evidence of inflammation. These studies confirm in humans that high capillary pressure induces a high-permeability-type lung edema in the absence of inflammation, a concept first introduced under the term "stress failure." Recent studies using microspheres in swine and magnetic resonance imaging in humans strongly support the concept and primacy of nonuniform hypoxic arteriolar vasoconstriction to explain how hypoxic pulmonary vasoconstriction occurring predominantly at the arteriolar level can cause leakage. This compelling but as yet unproven mechanism predicts that edema occurs in areas of high blood flow due to lesser vasoconstriction. The combination of high flow at higher pressure results in pressures, which exceed the structural and dynamic capacity of the alveolar capillary barrier to maintain normal alveolar fluid balance.
pulmonary artery pressure; hypoxic pulmonary vasoconstriction; nitric oxide; inflammation; alveolar fluid clearance; pathophysiology; review
This article has been cited by other articles:
|
|
 |
|
  T. G. Smith, N. P. Talbot, C. Privat, M. Rivera-Ch, A. H. Nickol, P. J. Ratcliffe, K. L. Dorrington, F. Leon-Velarde, and P. A. Robbins Effects of Iron Supplementation and Depletion on Hypoxic Pulmonary Hypertension: Two Randomized Controlled Trials JAMA, October 7, 2009; 302(13): 1444 - 1450. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. X. L. Zhang, J. J. Miller, D. B. Stolz, L. D. Serpero, W. Zhao, D. Gozal, and Y. Wang Type I Epithelial Cells Are the Main Target of Whole-Body Hypoxic Preconditioning in the Lung Am. J. Respir. Cell Mol. Biol., March 1, 2009; 40(3): 332 - 339. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Bailey, K. A. Evans, P. E. James, J. McEneny, I. S. Young, L. Fall, M. Gutowski, E. Kewley, J. M. McCord, K. Moller, et al. Altered free radical metabolism in acute mountain sickness: implications for dynamic cerebral autoregulation and blood-brain barrier function J. Physiol., January 1, 2009; 587(1): 73 - 85. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Luks, R. J. Johnson, and E. R. Swenson Chronic Kidney Disease at High Altitude J. Am. Soc. Nephrol., December 1, 2008; 19(12): 2262 - 2271. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Kriemler, C. Jansen, A. Linka, A. Kessel-Schaefer, M. Zehnder, T. Schurmann, M. Kohler, K. Bloch, and H. P. Brunner-La Rocca Higher pulmonary artery pressure in children than in adults upon fast ascent to high altitude Eur. Respir. J., September 1, 2008; 32(3): 664 - 669. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Sarada, P. Himadri, C. Mishra, P. Geetali, M. S. Ram, and G. Ilavazhagan Role of Oxidative Stress and NFkB in Hypoxia-Induced Pulmonary Edema Experimental Biology and Medicine, September 1, 2008; 233(9): 1088 - 1098. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. B. Schoene Illnesses at High Altitude Chest, August 1, 2008; 134(2): 402 - 416. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. P. Gomez, M. J. Moreno, R. M. Baldrich, and A. Hernandez Endothelin-1 Molecular Ribonucleic Acid Expression in Pulmonary Hypertensive and Nonhypertensive Chickens Poult. Sci., July 1, 2008; 87(7): 1395 - 1401. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Zhou, L. A. Dada, and J. I. Sznajder Regulation of alveolar epithelial function by hypoxia Eur. Respir. J., May 1, 2008; 31(5): 1107 - 1113. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Luks and E. R. Swenson Medication and Dosage Considerations in the Prophylaxis and Treatment of High-Altitude Illness Chest, March 1, 2008; 133(3): 744 - 755. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. R. Hopkins, A. Kleinsasser, S. Bernard, A. Loeckinger, E. Falor, B. Neradilek, N. L. Polissar, and M. P. Hlastala Hypoxia has a greater effect than exercise on the redistribution of pulmonary blood flow in swine J Appl Physiol, December 1, 2007; 103(6): 2112 - 2119. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Bartsch and J. S. R. Gibbs Effect of Altitude on the Heart and the Lungs Circulation, November 6, 2007; 116(19): 2191 - 2202. [Full Text] [PDF]
|
|
|
|
|
|
A. P. Gomez, M. J. Moreno, A. Iglesias, P. X. Coral, and A. Hernandez Endothelin 1, its Endothelin Type A Receptor, Connective Tissue Growth Factor, Platelet-Derived Growth Factor, and Adrenomedullin Expression in Lungs of Pulmonary Hypertensive and Nonhypertensive Chickens Poult. Sci., May 1, 2007; 86(5): 909 - 916. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Luks and E. R. Swenson Travel to high altitude with pre-existing lung disease Eur. Respir. J., April 1, 2007; 29(4): 770 - 792. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. A. Shimoda, T. Luke, J. T. Sylvester, H.-W. Shih, A. Jain, and E. R. Swenson Inhibition of hypoxia-induced calcium responses in pulmonary arterial smooth muscle by acetazolamide is independent of carbonic anhydrase inhibition Am J Physiol Lung Cell Mol Physiol, April 1, 2007; 292(4): L1002 - L1012. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. J. Teppema, G. M. Balanos, C. D. Steinback, A. D. Brown, G. E. Foster, H. J. Duff, R. Leigh, and M. J. Poulin Effects of Acetazolamide on Ventilatory, Cerebrovascular, and Pulmonary Vascular Responses to Hypoxia Am. J. Respir. Crit. Care Med., February 1, 2007; 175(3): 277 - 281. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. M. Snyder, K. C. Beck, M. L. Hulsebus, J. F. Breen, E. A. Hoffman, and B. D. Johnson Short-term hypoxic exposure at rest and during exercise reduces lung water in healthy humans J Appl Physiol, December 1, 2006; 101(6): 1623 - 1632. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. R. Swenson Hypoxic lung whiteout: further clearing but more questions from on high. Ann Intern Med, October 3, 2006; 145(7): 550 - 552. [Full Text] [PDF]
|
|
|
|
 |
|
 E. K. Weir and A. Olschewski Role of ion channels in acute and chronic responses of the pulmonary vasculature to hypoxia Cardiovasc Res, September 1, 2006; 71(4): 630 - 641. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Dehler, E. Zessin, P. Bartsch, and H. Mairbaurl Hypoxia causes permeability oedema in the constant-pressure perfused rat lung. Eur. Respir. J., March 1, 2006; 27(3): 600 - 606. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Lehmann, H. Mairbaurl, B. Pleisch, M. Maggiorini, P. Bartsch, and W. H. Reinhart Platelet count and function at high altitude and in high-altitude pulmonary edema J Appl Physiol, February 1, 2006; 100(2): 690 - 694. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| Visit Other APS Journals Online |
