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Marked differences between prone and supine sheep in effect of PEEP on perfusion distribution in zone II lung

¹Department of Intensive Care, Ullevål University Hospital, Oslo, Norway; ²Section of Anesthesiology, Department of Medicine and Care, University of Linköping, Linköping, Sweden; and ³Department of Physiology, University of Oslo, Oslo, Norway

Submitted 16 December 2004 ; accepted in final form 11 March 2005

The classic four-zone model of lung blood flow distribution has been questioned. We asked whether the effect of positive end-expiratory pressure (PEEP) is different between the prone and supine position for lung tissue in the same zonal condition. Anesthetized and mechanically ventilated prone (n = 6) and supine (n = 5) sheep were studied at 0, 10, and 20 cmH₂O PEEP. Perfusion was measured with intravenous infusion of radiolabeled 15-µm microspheres. The right lung was dried at total lung capacity and diced into pieces (1.5 cm³), keeping track of the spatial location of each piece. Radioactivity per unit weight was determined and normalized to the mean value for each condition and animal. In the supine posture, perfusion to nondependent lung regions decreased with little relative perfusion in nondependent horizontal lung planes at 10 and 20 cmH₂O PEEP. In the prone position, the effect of PEEP was markedly different with substantial perfusion remaining in nondependent lung regions and even increasing in these regions with 20 cmH₂O PEEP. Vertical blood flow gradients in zone II lung were large in supine, but surprisingly absent in prone, animals. Isogravitational perfusion heterogeneity was smaller in prone than in supine animals at all PEEP levels. Redistribution of pulmonary perfusion by PEEP ventilation in supine was largely as predicted by the zonal model in marked contrast to the findings in prone. The differences between postures in blood flow distribution within zone II strongly indicate that factors in addition to pulmonary arterial, venous, and alveolar pressure play important roles in determining perfusion distribution in the in situ lung. We suggest that regional variation in lung volume through the effect on vascular resistance is one such factor and that chest wall conformation and thoracic contents determine regional lung volume.

regional blood flow; perfusion heterogeneity; microspheres; pulmonary circulation; gravity; positive end-expiratory pressure

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