Alterations in gas exchange associated with lobar atelectasis in young piglets.

Lobar atelectasis is common among infants and children with obstructive lung diseases. However, the effect of lobar collapse in the presence of diffuse lung disease on gas exchange in the pediatric age group has not been described. We developed an infant model of lobar atelectasis using piglets and tested the hypothesis that diffuse alveolar hypoxia increases shunt fraction (Qs/QT) associated with lobar atelectasis by redirecting pulmonary blood from the well-ventilated portion of the lung into the collapsed region. Shunt fraction was determined using the multiple inert gas elimination technique. The proportion of pulmonary blood flow perfusing the left lower lobe was measured with microspheres. Qs/QT increased significantly but by a variable amount to an average value (+/- SD) of 5.9 +/- 4.2% following lobar collapse. The percentage of cardiac output perfusing the left lower lobe fell by an average of 70 +/- 17% in response to lobar collapse. When animals were ventilated with 12% oxygen, shunt fraction increased to 18.7 +/- 7.1% and blood flow to the collapsed left lower lobe increased from 9 +/- 3 to 22 +/- 3% of cardiac output. Lobar atelectasis in conditions where diffuse alveolar hypoxia is present may be associated with a significantly greater intrapulmonary shunt than lobar atelectasis in children with otherwise normal lungs.