Effects of regional perfusion block in healthy and injured lungs

Abstract

Background: Severe hypoperfusion can cause lung damage. We studied the effects of regional perfusion block in normal lungs and in the lungs that had been conditioned by lavage with 500 ml saline and high V _T (20 ml kg^-1) ventilation.

Methods: Nineteen pigs (61.2 ± 2.5 kg) were randomized to five groups: controls (n = 3), the right lower lobe block alone (n = 3), lavage and high V _T (n = 4), lung lavage, and high V _T plus perfusion block of the right (n = 5) or left (n = 4) lower lobe. Gas exchange, respiratory mechanics, and hemodynamics were measured hourly. After an 8-h observation period, CT scans were obtained at 0 and 15 cmH₂O airway pressure.

Results: Perfusion block did not damage healthy lungs. In conditioned lungs, the left perfusion block caused more edema in the contralateral lung (777 ± 62 g right lung vs 484 ± 204 g left; p < 0.05) than the right perfusion block did (581 ± 103 g right lung vs 484 ± 204 g left; p n.s.). The gas/tissue ratio, however, was similar (0.5 ± 0.3 and 0.8 ± 0.5; p n.s.). The lobes with perfusion block were not affected (gas/tissue ratio right 1.6 ± 0.9; left 1.7 ± 0.5, respectively). Pulmonary artery pressure, PaO₂/FiO₂, dead space, and lung mechanics were more markedly affected in animals with left perfusion block, while the gas/tissue ratios were similar in the non-occluded lobes.

Conclusions: The right and left perfusion blocks caused the same "intensity" of edema in conditioned lungs. The total amount of edema in the two lungs differed because of differences in lung size. If capillary permeability is altered, increased blood flow may induce or increase edema.

Keywords: Computed tomography (CT); Experimental animal model; Lung injury; Pulmonary circulation; Pulmonary embolism; Ventilator-induced lung injury.

Fig. 1

Time course of venous admixture (a) and of alveolar dead space (b). Data presented as mean ± standard error. Group 1, control, empty circle; group 2, one insult (perfusion block of the right lower lobe), dotted circle; group 3, two insults (500 ml lung lavage and 20 ml/kg tidal volume ventilation), empty diamond; group 4, three insults (500 ml lung lavage and 20 ml/kg tidal volume ventilation with perfusion block of the right lower lobe), left-dotted diamond; group 5, three insults (500 ml lung lavage and 20 ml/kg tidal volume ventilation with perfusion block of the left lower lobe), right-dotted diamond

Fig. 2

Time course of the left to right ratio of end-expiratory resistivity. Data presented as means ± standard error. Group 1, control, empty circle; group 2, one insult (perfusion block of the right lower lobe), dotted circle; group 3, two insults (500 ml lung lavage and 20 ml/kg tidal volume ventilation), empty diamond; group 4, three insults (500 ml lung lavage and 20 ml/kg tidal volume ventilation with perfusion block of the right lower lobe), left-dotted diamond; group 5, three insults (500 ml lung lavage and 20 ml/kg tidal volume ventilation with perfusion block of the left lower lobe), right-dotted diamond

Fig. 3

Representative CT scans of the five experimental groups