Spatial distribution of ventilation and perfusion in anesthetized dogs in lateral postures

Abstract

We aimed to assess the influence of lateral decubitus postures and positive end-expiratory pressure (PEEP) on the regional distribution of ventilation and perfusion. We measured regional ventilation (V˙a) and regional blood flow (Q˙) in six anesthetized, mechanically ventilated dogs in the left (LLD) and right lateral decubitus (RLD) postures with and without 10 cmH2O PEEP. Q˙ was measured by use of intravenously injected 15-μm fluorescent microspheres, and V˙a was measured by aerosolized 1-μm fluorescent microspheres. Fluorescence was analyzed in lung pieces ∼1.7 cm3 in volume. Multiple linear regression analysis was used to evaluate three-dimensional spatial gradients ofQ˙, V˙a, the ratio V˙a/Q˙, and regional Po 2 (PrO2 ) in both lungs. In the LLD posture, a gravity-dependent vertical gradient in Q˙ was observed in both lungs in conjunction with a reduced blood flow and PrO2 to the dependent left lung. Change from the LLD to the RLD or 10 cmH2O PEEP increased localV˙a/Q˙ and PrO2 in the left lung and minimized any role of hypoxia. The greatest reduction in individual lung volume occurred to the left lung in the LLD posture. We conclude that lung distortion caused by the weight of the heart and abdomen is greater in the LLD posture and influences both Q˙ andV˙a, and ultimately gas exchange. In this respect, the smaller left lung was the most susceptible to impaired gas exchange in the LLD posture.