VA/Q abnormalities during gram negative sepsis.

Published

Journal Article

Hypoxemia in bacterial sepsis develops by mechanisms which are incompletely understood. In this study, we measured pulmonary gas exchange in eight baboons to determine the causes of hypoxemia after infusion of live Escherichia coli (1 x 10(10) CFU/kg) followed by resuscitation with intravenous fluid. VA/Q distributions were measured periodically using the multiple inert gas elimination technique until death or for a maximum of 42 h. After E. coli infusion, dispersion of perfusion (logSDq) increased rapidly and a transient rise in dead space was observed at 6 h coinciding with systemic hypotension and acidosis. The intrapulmonary shunt developed later and reached 27 +/- 6% at 24 h. PaO2 began to decrease at 12 h and correlated with increases in intrapulmonary shunt and logSDq. There was no evidence of diffusion limitation. Lung edema was mild despite aggressive fluid resuscitation. Morphometric analysis of postmortem lungs revealed dramatic intravascular accumulation of granulocytes. There were increases in arithmetic mean thicknesses of epithelium and interstitium. These data indicate that gram negative sepsis with fluid resuscitation causes progressive hypoxemia, primarily due to the development of intrapulmonary shunt and very low VA/Q regions in the lung. The VA/Q abnormalities occur early and likely reflect ongoing cellular responses in pulmonary vasculature and smaller airways in sepsis.

Full Text

Duke Authors

Cited Authors

  • Huang, YC; Fracica, PJ; Simonson, SG; Crapo, JD; Young, SL; Welty-Wolf, KE; Moon, RE; Piantadosi, CA

Published Date

  • August 1996

Published In

Volume / Issue

  • 105 / 1-2

Start / End Page

  • 109 - 121

PubMed ID

  • 8897657

Pubmed Central ID

  • 8897657

International Standard Serial Number (ISSN)

  • 0034-5687

Digital Object Identifier (DOI)

  • 10.1016/0034-5687(96)00039-4

Language

  • eng

Conference Location

  • Netherlands