Increased atelectatic pulmonary shunt during hemorrhagic shock in dogs

Wahrenbrock, Eric A.; Carrico, C. James; Amundsen, D. A.; Trummer, Max J.; Severinghaus, John W.

doi:10.1152/jappl.1970.29.5.615

Cited by 29 publications

(11 citation statements)

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“…[8] and Wahrenbrock el al. [23] have demonstrated that Qs/Qt rises during hemorrhagic shock when lung atelectasis is present, but falls when atelectasis has disappeared. These findings are in agreement with our results.…”

Section: Discussionmentioning

confidence: 99%

“…This procedure might have been responsible for the absence of morphological changes in the lungs. M ackay et al [11], as well as several others [2,5,23], have shown that the incidence of morphological lung changes during hemorrhagic shock can be reduced or even completely avoided by using regular manual lung inflation. Our more recent not yet published results make us believe that lung inflation does not give the full explanation.…”

Section: Discussionmentioning

confidence: 99%

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Hemorrhagic Shock in Dogs Without Major Pulmonary Changes

Silberschmid¹,

Szczepanski²

1975

Eur Surg Res

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Dogs were submitted to one of three hemorrhagic shock procedures: normovolemic shock, oligemic hypotension or posthemorrhagic hypotension. 13 animals fulfilled well-defined criteria of irreversible hemorrhagic shock, based on mortality, take-up volume and metabolic changes. Lung function was measured at regular intervals. Lungs were fixed by infusion fixation. The macroscopical aspect of the lungs was not different from that of six control dogs which were anesthetized for the same period. Minor microscopical changes were found, but the only histological parameter which was significantly different from the controls was accumulation of granulocytes. Gas exchange remained normal, ventilation was increased with an enlarged dead space and veno-arterial shunting was reduced. Pulmonary vascular resistance was not different from the control group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Hemorrhagic Shock in Dogs Without Major Pulmonary Changes

Silberschmid¹,

Szczepanski²

1975

Eur Surg Res

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“…An increase in alveolar dead space may be caused by gravity-dependen t relative hypoperfusion of non-dependent lung regions owing to pulmonary hypotension (27). Wahrenbrock et al (28) could not show a n increase in shunt i n anaesthetized dogs during haemorrhagic hypotension. There is evidence that hypotension alone d o r s not alfect the hypoxir pulmonary vasoconstrictor t.esponse.…”

Section: Surgerymentioning

confidence: 93%

Ventilation-Perfusion Relationships During Anaesthesia and Abdominal Surgery

Lundh

Hedenstierna

1984

Survey of Anesthesiology

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Nine patienth, 61-72 yearb old, wcrc stitdied awake anti during halothane anaesthesia Iiclorc and during upper ahdoniinal 5iiIge1 ) . (:cn~ral cii.rulalion Was rvaluated by nieaw (11' pulmonary artery i~athrteci/.a~ioci and ga5 cxc.haiige 1 , ) micltiiile i i c e r~ gas c:limina~ion ~cchnic~uc'. <\Make a i d sicpine, a rathcr wide dis!14~111iori o f \ '~/ Q was observed, with regions of low VA/Qin five patients and a small shunt (I-3%) in three patients. The overall dispersion of blood flow was log s.d. 0.93. With anaesthesia and mechanical ventilation, cardiac output fell by 30%, whereas pulmonary vascular pressures remained unaltered. The dispersion of pulmonary blood Ilow against V~l Q r a t i o s was further increased with a log s.d. of 1.67. Perfusion of regions with a low VA/Qwas significantly increased. With surgery, no significant changes were seen in cardiac output or vascular pressures. True shunt appeared or increased in seven patients, ranging from 1.3 to 17%. Perfusion to regions with low irA/Qdid not change. It is concluded that abdominal surgery interferes with gas exchange, presumably because of a cranial shift of the diaphragm which lowers FRC and thereby promotes airway closure. 39: 573-583. 33. Sybrecht G W, Garret I., Anthonisen N R. Eft'ect of chest strapping on regional lung function. J Appl Physiol39: 707-713. 34. Scheidt M, Hyatt R E, Rehder K. Effects ofrib cage or abdominal restrictiononlungmechanics.JA~plPhy.iiolI981:51: 1115-1121. 35. Klineberg P I,, Rehder K, Hyatt R E. Pulmonary mechanics and gas exchange in seated normal man with chest restriction. 3 Appl Plpiol

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“…Following reinfusion, the intrapulmonary shunt fraction did not differ from that of the controls. Intrapulmonary shunt is not increased in acute traumatic-hemorrhagic shock when atelectasis is prevented by PEEP and intermittent overinflation of the lungs [13,15,26]. This finding argues against a deleterious effect of intermittent oxygen breathing on pulmonary shunting.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary pressure-flow relation after trauma and hemorrhagic shock

1986

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The significance of pulmonary pressure-flow relation and its correlation to alveolar dead space and histological lesions of the lung were evaluated in ten mongrel dogs, which were subjected to standardized bone trauma and hemorrhagic hypotension at 40 mm Hg for 3h. These results were compared with those of 5 control dogs without trauma and shock. Two different pressure-flow curves were obtained by consecutive measurements of cardiac output and mean pulmonary artery pressure during stepwise arterial hemorrhage and reinfusion. In each experiment, the difference between the two curves at CO of 100 ml/kg min was obtained and represents an increase in pulmonary artery pressure (delta MPP). This increase in pulmonary artery pressure is flow-independent and, therefore, can be used as a quantitative indicator of pulmonary vasoconstriction or vascular obstruction. Severity of shock (uptake) as well as grade of early histological lesions of the lung (microthrombi, edema, hemorrhage) and increased alveolar dead space after reinfusion were associated with a more pronounced shift of the pulmonary pressure-flow curve. In severe experimental shock, therefore, a consistent pattern of pulmonary hemodynamics, lung histology, and respiratory function was demonstrated by the pulmonary pressure-flow relation. This approach permits estimation of the effects of therapeutic interventions and may be suitable for assessing postshock pulmonary impairment.

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Increased atelectatic pulmonary shunt during hemorrhagic shock in dogs

Cited by 29 publications

References 0 publications

Hemorrhagic Shock in Dogs Without Major Pulmonary Changes

Hemorrhagic Shock in Dogs Without Major Pulmonary Changes

Ventilation-Perfusion Relationships During Anaesthesia and Abdominal Surgery

Pulmonary pressure-flow relation after trauma and hemorrhagic shock

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