Time Course and Pattern of Pulmonary Flow Distribution following Unilateral Airway Occlusion in Sheep

Abstract

1. Unilateral bronchial occlusion causes ipsilateral hypoxic pulmonary vasoconstriction, which shifts blood flow towards the other lung. We studied the time course of flow diversion following acute bronchial occlusion, and the temporal effect of the latter on blood gases and vertical distribution of blood flow within the two lungs. 2. Serial infusion of radioactive or fluorescent microspheres were given to each of seven adult standing sheep before, during occlusion of the left mainstem bronchus for up to 6 min, and after release of occlusion. Pulmonary and systemic arterial pressures were recorded continuously and arterial and mixed venous blood gases were determined intermittently. Post-mortem, the lungs were inflated, dried and cut into slices. Relative blood flow at the time of infusion was expressed as the weight-normalized intensity of each tracer in each slice or lung divided by the weight-normalized intensity in the two lungs. 3. Within 30 s, 1 min and 2 min after onset of occlusion, flow in the occluded lung had decreased to 68-84% (range), 51-78% and 43-79% respectively, of the initial value. In the contralateral lung, flow increased by 10-24%, 14-37% and 23-39% respectively. The distribution of flow along the gravitational axis within each lung varied widely between animals, both before and during occlusion. The during-occlusion profiles in the occluded lung differed from those in the non-occluded lung. In either lung, during-occlusion profiles could not be predicted with certainty from the pre-occlusion profiles. Two minutes post-occlusion, inter- and intra-lung flow distribution were nearly the same as before occlusion. Arterial oxygen tension fell in the first minute of occlusion, but never below 7.5 kPa, and increased slowly thereafter. Arterial carbon dioxide tension increased slightly throughout the occlusion period. No appreciable changes in systemic or pulmonary artery pressure were observed. Post-occlusion, arterial oxygen tension was still sub-normal, while carbon dioxide tension continued to increase. 4. We conclude that acute unilateral bronchial occlusion diverts blood flow within 30 s towards the contralateral lung. This rapidly occurring flow diversion prevents the development of severe arterial hypoxaemia. The variable and largely unpredictable distribution of blood flow in the hyperfused non-occluded lung might explain some of the gas-exchange abnormalities observed in physiologically hyperfused lungs and in patients with one hyperfused lung.

Pulmonary Pathophysiology and Lung Mechanics in Anesthesiology

“…Hypoxic pulmonary vasoconstriction (HPV) counteracts this hypoxemia, by increases pulmonary vascular resistance and diverting blood flow to the ventilated lung. Animal studies have shown that such flow diversion occurs within 30 s of unilateral bronchial occlusion, and blood flow to the occluded lung is approximately half that during double lung ventilation by two minutes 35 . If HPV is intact, shunt fraction during single-lung ventilation may be only 20%–30% of cardiac output, as opposed to the 50% that might be expected in its absence.…”

Thermal Ablation of Lung Tumors

“…Although the effect is larger with pulmonary artery occlusion, bronchial occlusion is much more practical to apply clinically. 14,20,21 …”