Abstract
Two cases of massive pulmonary embolism, confirmed by angiographic or necropsy findings, were remarkable by the absence of arterial hypoxaemia. The various mechanisms responsible for arterial hypoxaemia in pulmonary embolism are discussed. It is suggested that in patients with massive pulmonary embolism a markedly decreased cardiac output might account for the absence of arterial hypoxaemia. In the light of these two cases the finding of a normal PaO2 does not rule out the diagnosis of pulmonary embolism.
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Dalen, J. E., Banas, J. S., Brooks, H. L., Evans, G. L., Paraskos, J. A., Dexter, L.: Resolution rate of acute pulmonary embolism in man. New Engl. J. Med. 280, 1194 (1969)
Dexter, L.: Clinical aspects of pulmonary embolism and their relation to pathophysiology. Bull. Physiol. Path. Resp. 6, 21 (1970)
Letac, B., Pascal, P. Y., Bourdarias, J. P., Benaim, R., Gerbaux, A., Lissac, J.: Les embolies pulmonaires massives vues par le Réanimateur. In: Réanimation et Médecine d'Urgence. Paris: L'Expansion 1969
McIntyre, K. M., Sasahara, A. A.: The hemodynamic responses to pulmonary embolism in patients without prior cardio-pulmonary disease. Amer. J. Cardiol. 28, 288 (1971)
Witchitz, S., Benaim, R., Beaufils, Ph.: L'hypoxemie des embolies pulmonaires massives. In: Hypoxemies refractaires. Paris, Arnette 1973
Kafer, E. R.: Respiratory function in Pulmonary thromboembolic disease. Amer. J. Med. 47, 901–915, (1969)
Robin, E. D., Forkner, C. R., Bromberg, P. A., Crotteau J. R., Travis, D. M.: Alveolar gas exchange in clinical pulmonary embolism. New Engl. J. Med. 262 (1960)
Wilson, J. P., Pierce, A. K., Johnson, R. L., Winga, E. R., Harrek, W. R., Curry, G. C., Mullins, C. B.: Hypoxemia in pulmonary embolism, a clinical study. J. clin. Invest. 50, 481 (1971)
Hirsh, J., Hale, G. S., McDonald I. G., McCarthy, R. A., Pitt, A.: Streptokinase therapy in acute major pulmonary embolism: effectiveness and problems. Brit. Med. J. 4, 729 (1968)
Dalen, J. E., Dexter, L.: Pulmonary embolism. J. Amer. Med. Ass. 207, 1505 (1969)
Szucs, M.M., Brooks, H. L., Crossman, W., Banas, J. S., Weister, S. G., Dexter, L., Dalen, J. E.: Diagnostic sensitivity of laboratory findings in acute pulmonary embolism. Ann. Int. Med. 74, 161 (1971)
McIntyre, K. M., Sasahara, A. A.: Determinants of cardiovascular responses to pulmonary embolism. In: Moser, K. M., Stein, M.: Pulmonary thromboembolism. Chicago: Year Book Medical Publishers 1973
U.P.E.T.: The urokinase pulmonary embolism trial — A national cooperative study of the National Heart and Lung Institute. Circulation 47, suppl. 2, I (1973)
Sorbini, C.A., Grassi, V., Solinas, E., Muiesan, G.: Arterial oxygen tension in relation to age in healthy subjects. Respiration 25, 3 (1968)
Bass, H., Banas, J. S. Jr., Dalen, J. E.: Pulmonary function studies — Aid to diagnosis of pulmonary embolism. Arch. Intern. Med. 126, 266 (1970)
Farhi, L. E., Rahn, H.: A theoretical analysis of the alveolararterial O2 difference with special reference to the distribution effect. J. appl. Physiol. 7, 699 (1975)
Siler, J. N., Rosenberg, H. R., Mull, T. D., Kaplan, J. A.: Hypoxemia after upper abdominal surgery: comparaison of venous admixture and ventilation perfusion components using a digital computer. Ann. Surg. 179, 2 149 (1974)
Del Guercio, L. R. M., Cohn, J. D., Feins, N. R., Coomaraswamy, R. P., Mantle, L.: Pulmonary embolism shock. J. Amer. Med. Ass. 196, 751 (1966)
Gazzaniga, A. B., Dalen, J. E.: Paradoxical embolism: its pathophysiology and clinical recognition. Ann. Surg. 171, 137 (1970)
Rioux, C., Neveux, J. Y., Hazan, E., Bloch, G., Dequirot, A., Cornu, P., Mathey, J.: Embolies pulmonaires graves, et chirurgie à coeur ouvert. Coeur Méd. int. 12, 21 (1973)
West, J. B.: Blood flow to the lung and gaz exchange. Anesth., 41, 124 (1974)
Mills, J., Drew, D.: Pulmonary Embolism without arterial hypoxemia. Ann. int. Med. 75, 972 (1971)
Morganroth, J., Deisseroth, A., Winokur, S.: Laboratory findings in pulmonary embolism. Ann. int. Med. 75, 138 (1971)
Sasahara, A. A., Cannilla, J. E., Morse, R. L., Sidd, J. J., Tremblay, G. M.: Clinical and physiologic studies in pulmonary thromboembolism. Amer. J. Cardiol. 20, 10 (1967)
Sasahara, A. A., Sidd, J. J., Tremblay, G., Leland, O. S.: Les consequences cardiaques et pulmonaires de l'embolie pulmonaire au stade aigu. Acqu. Nouv. Path. Cardio. Vasc. 9, 281 (1966)
Sutton, G. C., Miller, G. A., Gibson, R. V., Howey, N., Paneth, M.: Diagnosis of acute pulmonary embolism. Circulation 38, suppl. 6, 192 (1968)
McIntyre, K. M., Sasahara, A. A.: Determinants of right ventricular function and hemodynamics after pulmonary embolism. Chest 65, 534 (1974)
Miler, G. A., Sutton, G. C.: Acute massive pulmonary embolism — Clinical and heamodynamic findings in 23 patients studied by cardiac catheterization and pulmonary arteeriography. Brit. Heat. 32, 518 (1970)
Binet, J. P., Marion, P.: A propos des embolies pulmonaries graves. Rev. Prat. 24, 3611 (1974)
Kelman, G. R., Nunn, J. F., Prys-Roberts, C., Greenbaum, R.: The influence of cardiac output on arterial oxygenation: a theoretical study. Brit. J. Anaesth. 39, 450 (1967)
Hill, J. D., Ratliff, J. L., Fallat, R. J., Tucker, H. J., Lamy, M., Dietrich, H. P., Gerbode, F.: Pronosic factors in the treatment of acute respiratory insufficiency with long term extracorporeal oxygenation. J. thorac. cardiovasc. Surg. 68, 905 (1974)
Lemaire, F., Teisseire, B., Harari, A., Loisance, D.: La PaO2 en oxygène pur est-elle un critere fieble du transfert pulmonaire d'oxygène au cours des assistances respiratoires par poumon à membrarne. Nouv. Pres. méd. 3, 1815 (1974)
Sanchez, A., Jardin, F., Bardet, J., Dongradi, J., Margairaz, A.: Evolution d une hypoxemie par oedéme pulmonaire aigu de type lèsionnel sous circulation extra-dorporelle prolongee. In: Les pneumopathies inflammatoires. Paris:L'Expansion 1975
Walsh, P. N., Greenspan, R. H., Simon, M., Simon, A. L., Hyers, Th., Woosley, P. C., Cole, C. M.: An angiographic severity index for pulmonary embolism. Circulation suppl. 11, 101 (1973)
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Jardin, F., Bardet, J., Sanchez, A. et al. Massive pulmonary embolism without arterial hypoxaemia. Intensive Care Med 3, 77–80 (1977). https://doi.org/10.1007/BF01683065
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DOI: https://doi.org/10.1007/BF01683065