Bshouty Z, Younes M
Respiratory Investigation Unit, University of Manitoba, Winnipeg, Canada.
Am Rev Respir Dis. 1992 Feb;145(2 Pt 1):372-6. doi: 10.1164/ajrccm/145.2_Pt_1.372.
The effect of breathing pattern and level of ventilation on fluid filtration in the lung under edema forming conditions was studied in an in situ left upper lobe (LUL) canine preparation. LUL weight was continuously monitored. In Group 1, rate of edema formation (delta W/delta t) was measured In seven dogs at two vascular pressures (35 and 45 mm Hg) while the LUL was randomly ventilated under six conditions. At equivalent vascular pressures and mean airway pressures (Paw) (and hence, mean operating lung volume), increasing respiratory frequency (f) enhanced delta W/delta t. This was reversed when minute ventilation (VE) was returned to baseline by reducing tidal volume (VT), even when Paw were matched to baseline. Increasing VT also enhanced delta W/delta t whether VE was increased (J Appl Physiol 1988; 64:1900) or not (present study) and whether Paw was matched to baseline. In Group 2 delta W/delta t was measured at fixed VT and f while inspiratory/expiratory time ratio (TI/TE) was switched from 1:1 to 1:6. Shortening inspiratory time by increasing inspiratory flow rate had no effect on delta W/delta t. We conclude that increasing VE, whether by raising VT or f, promotes greater edema formation by mechanisms that are independent of vascular pressure or operating lung volume. Increasing VT appears to have an additional adverse effect over and above that of increased VE.
在犬原位左上叶(LUL)制备模型中,研究了水肿形成条件下呼吸模式和通气水平对肺内液体滤过的影响。持续监测LUL重量。在第1组中,在两种血管压力(35和45 mmHg)下,对7只犬测量水肿形成速率(ΔW/Δt),同时LUL在六种条件下随机通气。在相等的血管压力和平均气道压力(Paw)(因此,平均工作肺容积)下,增加呼吸频率(f)会提高ΔW/Δt。当通过减少潮气量(VT)使分钟通气量(VE)恢复到基线时,这种情况会逆转,即使Paw与基线匹配。无论VE是否增加(《应用生理学杂志》1988年;64:1900)以及Paw是否与基线匹配,增加VT也会提高ΔW/Δt。在第2组中,在固定的VT和f下测量ΔW/Δt,同时将吸气/呼气时间比(TI/TE)从1:1切换到1:6。通过增加吸气流量来缩短吸气时间对ΔW/Δt没有影响。我们得出结论,增加VE,无论是通过提高VT还是f,都会通过独立于血管压力或工作肺容积的机制促进更大程度的水肿形成。增加VT似乎比增加VE有额外的不利影响。