No abstract

Ventilation-perfusion relationships (VA/Q), assessed by a multiple inert-gas elimination technique, were studied during halothane anaesthesia and mechanical ventilation at different inspiratory oxygen fractions (FIO2). All nine patients (mean age 65 years, five smokers) displayed unaltered VA/Q distributions with increasing FIO2 from a mean of 29% to 53%. A further increase in FIO2 to a mean of 85% caused an increase in true shunt (VA/Q = 0) from 7 to 10% of cardiac output (P less than 0.01), but no increase in "low" VA/Q (VA/Q less than 0.1). On the return to FIO2 of 29%, true shunt was reduced to the initial level. The findings may fit in with release of hypoxic vasoconstriction when FIO2 is increased to 85%, or the opening up of a certain population of shunt vessels.

Alveolar stability was studied during prolonged enflurane anaesthesia by using a multiple inert-gas elimination technique for the assessment of the "continuous" distribution of ventilation-perfusion ratios (VA/Q). All 10 patients (mean age: 61 years, six smokers) presented with increased VA/Q mismatching during anaesthesia, with a redistribution of lung blood flow to regions with low or high VA/Q. Five patients had perfusion of units with VA/Q less than or equal to 0.07 which may cause unstable alveoli with the presently used inspiratory gas mixture. However, only two patients displayed increasing shunting suggestive of alveolar collapse during the 3.5 h observation period. This lower than expected incidence may indicate protective mechanisms against atelectasis, such as mechanical interdependence between lung units, or collateral ventilation.