Intensive Care Medicine

, Volume 20, Issue 5, pp 379–389 | Cite as

Role of hypoxic pulmonary vasoconstriction in pulmonary gas exchange and blood flow distribution

2. Pathophysiology
  • B. E. Marshall
  • C. W. Hanson
  • F. Frasch
  • C. Marshall
Basic Science Series


In this review, the second of a two part series, the analytic techniques introduced in the first part are applied to a broad range of pulmonary pathophysiologic conditions. The contributions of hypoxic pulmonary vasoconstriction to both homeostasis and pathophysiology are quantitated for atelectasis, pneumonia, sepsis, pulmonary embolism, chronic obstructive pulmonary disease and adult respiratory distress syndrome. For each disease state the influence of principle variables, including inspired oxygen concentration, cardiac output and severity of pathology are explored and the actions of selected drugs including inhaled nitric oxide and infused vasodilators are illustrated. It is concluded that hypoxic pulmonary vasoconstriction is often a critical determinant of hypoxemia and/or pulmonary hypertension. Furthermore this analysis demonstrates the value of computer simulation to reveal which of the many variables are most responsible for pathophysiologic results.

Key words

Atelectasis Chronic lung disease Adult respiratory distress Nitric oxide Computer model 


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  1. 1.
    Marshall BE, Hanson CW, Frasch F, Marshall C (1994) Role of hypoxic pulmonary vasoconstriction in pulmonary gas exchange and blood flow distribution: I. Physiologic concepts. Intensive Care Med 20:291–297Google Scholar
  2. 2.
    Glasser SA, Domino KB, Lindgren L, Parcella P, Marshall C, Marshall B (1982) Pulmonary blood pressure and flow during atelectasis in the dog. Anesthesiology 58:225–231Google Scholar
  3. 3.
    Domino KB, Wetstein L, Glasser SA, Lindgren L, Marshall C, Harken AH, Marshall B (1983) Influence of\(P_{\bar VO_2 } \) on blood flow to atelectatic lung. Anesthesiology 59:428–434Google Scholar
  4. 4.
    Benumof JL (1988) Mechanism of decreased blood flow in atelectatic lung. J Appl Physiol 64:68–77Google Scholar
  5. 5.
    Graham LM, Vasil A, Vasil ML, Voelkel NF, Stenmark KR (1990) Decreased pulmonary vasoreactivity in an animal model of chronic Pseudomonas pneumonia. Am Rev Respir Dis 142:221–229Google Scholar
  6. 6.
    Spapen H, Vincken W (1992) Pulmonary arterial hypertension in sepsis and the adult respiratory distress syndrome. Acta Clin Belg 47:30–41Google Scholar
  7. 7.
    Reeves JT, Grover RF (1974) Blockade of acute hypoxic pulmonary hypertension by endotoxin. J Appl Physiol 36:328–332Google Scholar
  8. 8.
    Newman JH, McMurtry IF, Reeves JT (1980) Blunted pulmonary pressor responses to hypoxia in perfused, ventilated lungs from oxygen toxic rats: possible role of prostaglandins. Prostaglandins 22:1–20Google Scholar
  9. 9.
    Demling RH, Smith M, Gunther R (1981) The effects of prostacyclin infusion on endotoxin induced lung injury. Surgery 89:257–263Google Scholar
  10. 10.
    Minnear FL, Moon DG, Kaplan JE, Malik AB (1982) Effect of ADP induced platelet aggregation on lung fluid balance. Am J Physiol 11:H645–661Google Scholar
  11. 11.
    Vaage J (1982) Intravascular platlet aggregation and pulmonary injury. Ann NY Acad Sci 384:301–318Google Scholar
  12. 12.
    Sasahara AA, Sidd JJ, Tremblay G, Leland Jr OS (1966) Cardiopulmonary consequences of acute pulmonary embolism. Prog Cardiovasc Dis 9:259–274Google Scholar
  13. 13.
    Marshall BE, Marshall C (1991) Pulmonary hypertension. In: Crystal RG, West JB (eds) The lung: scientific foundations. Raven Press, New York, pp 1177–1188Google Scholar
  14. 14.
    Edward WD (1988) Pathology of pulmonary hypertension. Cardiovasc Clin 18:321–359Google Scholar
  15. 15.
    Kawakami Y, Kishi F, Yamamoto H, Miyamoto K (1983) Relation of oxygen delivery, mixed venous oxygenation, and pulmonary hemodynamics to prognosis in chronic obstructive pulmonary disease. N Engl J Med 308:1045–1049Google Scholar
  16. 16.
    Jones R, Reid LM, Zapol WM, Tomashefski JF, Kirton OC, Kobayashi K (1985) Pulmonary vascular pathology. In: Zapol WM, Falke KJ (eds) Acute respiratory failure. Dekker, New York, pp 23–160Google Scholar
  17. 17.
    Dantzker DR, Brook LJ, Dehart JP, Weg JG (1979) Ventilation-perfusion distributions in ARDS. Am Rev Respir Dis 120:1039–1052Google Scholar
  18. 18.
    Pison U, Lopez FA, Heidelmeyer CF, Rossaint R, Falke KJ (1993) Inhaled nitric oxide reverses hypoxic pulmonary vasoconstriction without impairing gas exchange. J Appl Physiol 74:1287–1292Google Scholar
  19. 19.
    Naeije R, Melot C, Mols P, Hallemans R (1982) Effects of vasodilators on hypoxic pulmonary vasoconstriction in normal man. Chest 82:404–410Google Scholar
  20. 20.
    Radermacher P, Santak B, Wust HJ, Tarnow J, Falke KJ (1990) Prostacyclin for the treatment of pulmonary hypertension in the adult respiratory distress syndrome: effect on pulmonary capillary pressure and ventilation-perfusion distribution. Anesthesiology 72:238–244Google Scholar
  21. 21.
    Frostell C, Fratacci MD, Wain JC, Jones R, Zapol WM (1991) Inhaled nitric oxide: a selective pulmonary vasodilator reversing hypoxic pulmonary vasoconstriction. Circulation 83:2038–2047Google Scholar
  22. 22.
    Rossaint R, Falke KJ, Lopez F, Slama K, Pison U, Zapol WM (1993) Inhaled nitric oxide for the adult respiratory distress syndrome. N Engl J Med 328:399–405Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • B. E. Marshall
    • 1
  • C. W. Hanson
    • 1
  • F. Frasch
    • 1
  • C. Marshall
    • 1
  1. 1.Center for Anesthesia ResearchUniversity of Pennsylvania School of MedicinePhiladelphiaUSA

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