Journal of Applied Physiology
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J Appl Physiol 93: 1115-1122, 2002. First published March 29, 2002; doi:10.1152/japplphysiol.00911.2001
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Vol. 93, Issue 3, 1115-1122, September 2002

Alterations in regional ventilation, perfusion, and shunt after smoke inhalation measured by PET

Donna Beth Willey-Courand1,3,6,7, R. Scott Harris4,7, Gaetano G. Galletti2, C. A. Hales4,7, Alan Fischman1,5,7, and Jose G. Venegas1,2,7

1 Shriners Burn Institute; 2 Departments of Anesthesia and Critical Care, 3 Pediatrics-Pulmonary Division, 4 Pulmonary and Critical Care Medicine and 5 Radiology and 6 Center for Engineering in Medicine, Massachusetts General Hospital; and 7 Harvard Medical School, Boston, Massachusetts 02114

Regional changes in ventilation and perfusion occurring in the early hours after smoke inhalation injury were evaluated through the use of positron emission tomography. Five lambs were imaged before and 1, 2, and 4 h after receiving 100 breaths of cotton smoke. Utilizing a recently developed model of 13N tracer kinetics (3), we evaluated changes in ventilation, perfusion, shunt, and regional gas content in nondependent, middle, and dependent lung zones. The data demonstrated a progressive development of regional shunt in dependent (dorsal) regions in which perfusion remained the highest throughout the study. These findings, together with decreasing regional ventilation and fractional gas content in the dependent regions, correlated with decreasing arterial PaO2 values over the course of the study. A negative correlation between regional shunt fraction and regional gas content in dependent and middle regions suggests that shunt was caused by progressive alveolar derecruitment or flooding.

positron emission tomography


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