A new theory of pulmonary blood flow in zone 2 condition.

In pulmonary blood flow, if arterial pressure (Pa) and pleural pressure (Ppl) were fixed, the flow increases with decreasing venous pressure (Pv) only when venule pressure (Pven) greater than airway pressure (PA) (i.e., in zone 3). When Pven less than or equal to PA (i.e., in zone 2), with Pa fixed, the flow decreases with decreasing Pv. The pressure-flow relationship has a hysteresis loop. This phenomenon can be explained by conservation of mass and momentum and the morphology and material properties of the lung, including the observation that reseparation of adhered cells requires an extra force. The key mathematical observation is that the solution h = 0 (h being the blood sheet thickness in the interalveolar septa) can coexist with the solution h not equal to 0 in zone 2 condition, resulting in "patchy" filling of the alveolar walls. When h = 0, the sheet is collapsed and endothelial cells adhere. Experimental results show that the adhered endothelial cells do not reseparate by raising Pv in zone 2 but can be accomplished under zone 3 condition.