Abstract
In a normal individual, pulmonary arterial blood is diverted from alveoli that are not being ventilated and perfuses the alveoli that are being ventilated [1, 2]. The mechanism that is responsible for this physiological shunt in blood flow is called hypoxic pulmonary vasoconstriction (HPV). When the PaO2 falls, the smooth muscle of the pulmonary arterioles contracts. The only non-oxygenated blood that enters the pulmonary veins is from the bronchial and thebesian vessels with this perfect match of ventilation and perfusion [3, 4]. With atelectasis, airway obstruction, alveolar edema and abnormalities of nitric oxide (NO) production, there can be a disruption of the pulmonary microcirculation. We will discuss the physiological processes that are responsible for HPV and how they can be disrupted by various pulmonary problems commonly encountered in the intensive care unit (ICU).
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References
Marshall BE, Hanson CW, Frasch F, Marshall C (1994) Role of hypoxic pulmonary vasoconstriction in pulmonary gas exchange and blood flow distribution. 2. Pathophysiology. Intensive Care Med 20: 379–389
Sweeney M, Yuan JX (2001) Hypoxic pulmonary vasoconstriction: role of voltage-gated potassium channels. Respir Res 1: 40–48
Lakshminarayan S, Kowalski TF, Kirk W, Graham MM, Butler J (1990) The drainage routes of the bronchial blood flow in anesthetized dogs. Respir Physiol 82: 65–73
Agostoni PG, Doria E, Bortone F, Antona C, Moruzzi P (1995) Systemic to pulmonary bronchial blood flow in heart failure. Chest 107: 1247–1252
Hulme JT, Coppock EA, Felipe A, et al (1999) Oxygen sensitivity of cloned voltage-gated K(+) channels expressed in the pulmonary vasculature. Circ Res 85: 489–497
Wang Z, Jin N, Ganguli S, et al (2001) Rho-kinase activation is involved in hypoxia-induced pulmonary vasoconstriction. Am J Respir Cell Mol Biol 25: 628–635
Moncada S (1999) Nitric oxide: discovery and impact on clinical medicine. JR Soc Med 92: 164–169
Moncada S (1997) Nitric oxide in the vasculature: physiology and pathophysiology. Ann N Y Acad Sci 811: 60–67
Furchgott RF (1999) Endothelium-derived relaxing factor: discovery, early studies, and identification as nitric oxide. Biosci Rep 19: 235–251
Furchgott RF (1996) The 1996 Albert Lasker Medical Research Awards. The discovery of endothelium-derived relaxing factor and its importance in the identification of nitric oxide. JAMA 276: 1186–1188
Deves R, Angelo S, Rojas AM (1998) System y+L: the broad scope and cation modulated amino acid transporter. Exp Physiol 83: 211–220
Guo FH, Uetani K, Hague SJ, et al (1997) Interferon gamma and interleukin 4 stimulate prolonged expression of inducible nitric oxide synthase in human airway epithelium through synthesis of soluble mediators. J Clin Invest 100: 829–838
Lundberg JO, Weitzberg E, Rinder J, et al (1996) Calcium-independent and steroid-resistant nitric oxide synthase activity in human paranasal sinus mucosa. Eur Respir J 9: 1344–1347
Punjabi CJ, Laskin JD, Pendino KJ, et al (1994) Production of nitric oxide by rat type II pneumocytes: increased expression of inducible nitric oxide synthase following inhalation of a pulmonary irritant. Am J Respir Cell Mol Biol 11: 165–172
Gow AJ, Stamler JS (1998) Reactions between nitric oxide and haemoglobin under physiological conditions. Nature 391: 169–173
Fischer SR, Deyo DJ, Bone HG, et al (1997) Nitric oxide synthase inhibition restores hypoxic pulmonary vasoconstriction in sepsis. Am J Respir Crit Care Med 156: 833–839
Soejima K, McGuire R, Snyder N, et al (2000) The effect of inducible nitric oxide synthase (iNOS) inhibition on smoke inhalation injury in sheep. Shock 13: 261–266
Lingnau W, McGuire R, Dehring DJ, et al (1996) Change in regional hemodynamics after nitric oxide inhibition during ovine bacteremia. Am J Physiol 39: R207 - R216
Meyer J, Lentz CW, Stothert JC, et al (1994) Effects of nitric oxide synthesis inhibition in hyperdynamic endotoxemia. Crit Care Med 22: 306–312
Meyer J, Hinder F, Stothert J Jr, et al (1994) Increased organ blood flow in chronic endotoxemia is reversed by nitric oxide synthase inhibition. J Appl Physiol 76: 2785–2793
Brunston RL,Jr., Zwischenberger JB, Tao W, et al (1997) Total arteriovenous CO2 removal: simplifying extracorporeal support for respiratory failure. Ann Thorac Surg 64: 1599–1604
Cox RA, Murakami K, Katahira J, et al (2001) Measurement of airway obstruction in sheep after smoke inhalation and burn injury. J Burn Care Rehabil 22: S127 (Abst)
Theissen JL, Herndon DN, Traber LD, et al (1990) Smoke inhalation and pulmonary blood flow. Prog Respir Res 26: 77–84
Isago T, Traber LD, Herndon DN, et al (1990) Pulmonary capillary pressure changes following smoke inhalation in sheep. Anesthesiology 73:Al234 (Abst)
Doerschuk CM, Allard MF, Martin BA, MacKenzie A, Autor AP, Hogg JC (1987) Marginated pool of neutrophils in rabbit lungs. J Appl Physiol 63: 1806–1815
Hogg JC, Doerschuk CM (1995) Leukocyte traffic in the lung. Annu Rev Physiol 57: 97–114
Wiggs BR, English D, Quinlan WM, et al (1994) Contributions of capillary pathway size and neutrophil deformability to neutrophil transit through rabbit lungs. J Appl Physiol 77: 463–470
Thommasen HV, Martin BA, Wiggs BR, Quiroga M, Baile EM, Hogg JC (1984) Effect of pulmonary blood flow on leukocyte uptake and release by dog lung. J Appl Physiol 56: 966–974
Herndon DN, Traber DL, Traber LD (1986) The effect of resuscitation on inhalation injury. Surgery 100: 248–251
Goldman G, Welbourn R, Kobzik L, et al (1992) Reactive oxygen species and elastase mediate lung permeability after acid aspiration. J Appl Physiol 73: 571–575
Charan NB, Turk GM, Dhand R (1984) Gross and subgross anatomy of bronchial circulation in sheep. J Appl Physiol 57: 658–664
Abdi S, Herndon D, Mcguire J, Traber L, Traber DL (1990) Time course of alterations in lung lymph and bronchial blood flows after inhalation injury. J Burn Care Rehabil 11: 510–515
Koppenol WH, Moreno JJ, Pryor WA, et al (1992) Peroxynitrite, a cloaked oxidant formed by nitric oxide and superoxide. Chem Res Toxicol 5: 834–842
Zharikov SI, Herrera H, Block ER (1997) Role of membrane potential in hypoxic inhibition of L-arginine uptake by lung endothelial cells. Am J Physiol 272: L78 - L84
Xia Y, Dawson VL, Dawson TM, et al (1996) Nitric oxide synthase generates superoxide and nitric oxide in arginine-depleted cells leading to peroxynitrite-mediated cellular injury. Proc Natl Acad Sci USA 93: 6770–6774
Nakayama M, Murray PA (1999) Ketamine preserves and propofol potentiates hypoxic pulmonary vasoconstriction compared with the conscious state in chronically instrumented dogs. Anesthesiology 91: 760–771
Karzai W, Haberstroh J, Priebe HJ (1999) The effects of increasing concentrations of desflurane on systemic oxygenation during one-lung ventilation in pigs. Anesth Analg 89: 215–217
Satoh D, Sato M, Kaise A, et al (1998) Effects of isoflurane on oxygenation during one-lung ventilation in pulmonary emphysema patients. Acta Anaesthesiol Scand 42: 1145–1148
Sustronck B, Van Loon G, Deprez P, Muylle, Gasthuys F, Foubert L (1997) Effect of inhaled nitric oxide on the hypoxic pulmonary vasoconstrictor response in anaesthetised calves. Res Vet Sci 63: 193–197
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Traber, D.L., Traber, L.D. (2002). Hypoxic Pulmonary Vasoconstriction and the Pulmonary Microcirculation. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-5551-0_8
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DOI: https://doi.org/10.1007/978-1-4757-5551-0_8
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