Blood flow and pulmonary ventilation: New paradigm?
Keywords:
Ventilation, Perfusion, Fractalas, Gravitation, Lung
Abstract
Gravity was established as the determinant factor regarding differences in the distribution of ventilation and perfusion in the lung by John West, concept that continue to be exposed, up to day, as a basic principle of the lung physiology.
The modern diagnostic images permit to demonstrate that gravity is not the determinant factor of these differences, a fact that generate big questions about concepts, among many others, support mechanical ventilations, ventilatory modes and one lung ventilation in lateral position during thoracic surgery.
This article reflects on the recent findings of perfusion and ventilation studies that question the paradigm of gravity as its main determinant, and their clinical implications.
References
1. West JB, Dollery CT, Naimark A. Distribution of blood flow in isolated lung: Relation to vascular and alveolar pressures. J Appl Physiol. 1964;19:713-24.
2. West JB, Dollery CT. Distribution of blood flow and ventilation-perfusion ratio in the lung, measured with radioactive carbon dioxide. J Appl Physiol. 1960;15:405-10.
3. Milic-Emili J, Henderson JAM, Dolovich MB, Trop D, Kaneko K. Regional distribution of inspired gas in the lung. J Appl Physiol. 1966;21:749-59.
4. Moreno R, Ramases F. Manual de anestesia y medicina perioperatoria en cirugía torácica. Madrid: Ergon; 2009.
5. Benumoff J. Anesthesia for Thoracic Surgery. 2nd ed. Philadelphia: WB Saunders; 1995.
6. Hughes JM, Glazier JB, Maloney JE, West JB. Effect of lung volume on the distribution of pulmonary blood flow in man. Respir Physiol. 1968;4:58-72.
7. Galvin I, Drummond GB, Nirmalan M. Distribution of blood flow and ventilation in the lung: Gravity is not the only factor. BrJ Anaesth. 2007;98:420-8.
8. Borrowes K, Tawhai M. Computational predictions of pulmonary blood flow gradients: Gravity versus structure. Respir Physiol Neurobiol. 2006;154:515-23.
9. Petersson J, Rohdin M, Sánchez A, Nyrén S, Jacobsson H, Larsson S, et al. Regional lung blood flow and ventilation in upright humans studied with quantitative SPECT. Respir Physiol Neurobiol. 2009;166:54-60.
10. Petersson J, Rohdin M, Sánchez A, Hans SN, Larsson S,Lindhal S, et al. Posture primarily affects lung tissue distribution with minor effect on blood flow and ventilation. Respir Physiol Neurobiol. 2007;156:293-303.
11. West JB. Ventilation-perfusion inequality and overall gas exchange in computer models of the lung. Respir Physiol Neurobiol. 1969;7:88-110.
12. Montmerle S, Sundblad P, Linnarsson D. Residual heterogeneity of intra and interregional pulmonary perfusion in short term microgravity. J Appl Physiol. 2005;98:2268-77.
13. Hlastala MP, Chormuck MA, Self DA. Pulmonary blood flow redistribution by increased gravitational force. J Appl Physiol. 1998;84:1278-88.
14. Altemeier WA, McKinney S, Krueger M, Glenny R. Effect of posture on regional gas exchange in pigs. J Appl Physiol. 2004;97:2104-11.
15. Hopkins S, Cortney-Henderson A, Levin D, Yamada K, Arai T, Buxton R, et al. Vertical gradients in regional lung density and perfusion in the supine human lung: The Slinky effect. J Appl Physiol. 2007;103:240-8.
16. Altemeier W, McKinney S, Glenny R. Fractal nature of regional ventilation distribution. J Appl Physiol. 2000;88:1551-7.
17. Wagner W, Todoran T, Tanabe N, Wagner T, Tanner J, Glenny R, et al. Pulmonary capillary perfusion: Intra-alveolar fractal patterns and interalveolar dependence. J Appl Physiol. 1999;86:825-31.
18. Capra F. The Web of Life - A New Scientific Understanding of Living Systems. New York: Anchor Books; 1996.
2. West JB, Dollery CT. Distribution of blood flow and ventilation-perfusion ratio in the lung, measured with radioactive carbon dioxide. J Appl Physiol. 1960;15:405-10.
3. Milic-Emili J, Henderson JAM, Dolovich MB, Trop D, Kaneko K. Regional distribution of inspired gas in the lung. J Appl Physiol. 1966;21:749-59.
4. Moreno R, Ramases F. Manual de anestesia y medicina perioperatoria en cirugía torácica. Madrid: Ergon; 2009.
5. Benumoff J. Anesthesia for Thoracic Surgery. 2nd ed. Philadelphia: WB Saunders; 1995.
6. Hughes JM, Glazier JB, Maloney JE, West JB. Effect of lung volume on the distribution of pulmonary blood flow in man. Respir Physiol. 1968;4:58-72.
7. Galvin I, Drummond GB, Nirmalan M. Distribution of blood flow and ventilation in the lung: Gravity is not the only factor. BrJ Anaesth. 2007;98:420-8.
8. Borrowes K, Tawhai M. Computational predictions of pulmonary blood flow gradients: Gravity versus structure. Respir Physiol Neurobiol. 2006;154:515-23.
9. Petersson J, Rohdin M, Sánchez A, Nyrén S, Jacobsson H, Larsson S, et al. Regional lung blood flow and ventilation in upright humans studied with quantitative SPECT. Respir Physiol Neurobiol. 2009;166:54-60.
10. Petersson J, Rohdin M, Sánchez A, Hans SN, Larsson S,Lindhal S, et al. Posture primarily affects lung tissue distribution with minor effect on blood flow and ventilation. Respir Physiol Neurobiol. 2007;156:293-303.
11. West JB. Ventilation-perfusion inequality and overall gas exchange in computer models of the lung. Respir Physiol Neurobiol. 1969;7:88-110.
12. Montmerle S, Sundblad P, Linnarsson D. Residual heterogeneity of intra and interregional pulmonary perfusion in short term microgravity. J Appl Physiol. 2005;98:2268-77.
13. Hlastala MP, Chormuck MA, Self DA. Pulmonary blood flow redistribution by increased gravitational force. J Appl Physiol. 1998;84:1278-88.
14. Altemeier WA, McKinney S, Krueger M, Glenny R. Effect of posture on regional gas exchange in pigs. J Appl Physiol. 2004;97:2104-11.
15. Hopkins S, Cortney-Henderson A, Levin D, Yamada K, Arai T, Buxton R, et al. Vertical gradients in regional lung density and perfusion in the supine human lung: The Slinky effect. J Appl Physiol. 2007;103:240-8.
16. Altemeier W, McKinney S, Glenny R. Fractal nature of regional ventilation distribution. J Appl Physiol. 2000;88:1551-7.
17. Wagner W, Todoran T, Tanabe N, Wagner T, Tanner J, Glenny R, et al. Pulmonary capillary perfusion: Intra-alveolar fractal patterns and interalveolar dependence. J Appl Physiol. 1999;86:825-31.
18. Capra F. The Web of Life - A New Scientific Understanding of Living Systems. New York: Anchor Books; 1996.
How to Cite
1.
Herrera Gómez PJ, Duarte G. Blood flow and pulmonary ventilation: New paradigm?. Colomb. J. Anesthesiol. [Internet]. 2013 Oct. 1 [cited 2024 Apr. 20];41(4):280-2. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/655
Downloads
Download data is not yet available.
Published
2013-10-01
How to Cite
1.
Herrera Gómez PJ, Duarte G. Blood flow and pulmonary ventilation: New paradigm?. Colomb. J. Anesthesiol. [Internet]. 2013 Oct. 1 [cited 2024 Apr. 20];41(4):280-2. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/655
Issue
Section
Essay
Altmetric
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
