Seminars in respiratory and critical care medicine
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The pulmonary and cardiovascular systems have profound effects on each other. Overall cardiac function is determined by heart rate, preload, contractility, and afterload. Changes in lung volume, intrathoracic pressure (ITP), and hypoxemia can simultaneously change all of these four hemodynamic determinants for both ventricles and can even lead to cardiovascular collapse. ⋯ Heart-lung interaction is very dynamic and changes in lung volume, ITP, and oxygen level can have various effects on the cardiovascular system depending on preexisting cardiovascular function and volume status. Heart failure and either hypo or hypervolemia predispose to greater effects of ventilation of cardiovascular function and gas exchange. This review is an overview of the basics of heart-lung interaction.
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Semin Respir Crit Care Med · Oct 2023
Blood Gas Transport: Carriage of Oxygen and Carbon Dioxide in Blood.
The ways in which oxygen (O2) and carbon dioxide (CO2) are carried in the blood are well known and well understood, with a plethora of textbooks, both general and lung specific, all presenting the topic in a very similar manner. This first of two companion chapters similarly summarizes this information. ⋯ However, what available texts have not emphasized is why knowing how gases are carried in blood matters, and the second, companion, chapter specifically addresses that critical aspect of gas exchange physiology. In fact, each of the chapters in this volume describes physiological behavior that depends more or less directly on the dissociation curves of O2 and CO2.
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Semin Respir Crit Care Med · Oct 2023
Blood Gas Transport: Implications for O2 and CO2 Exchange in Lungs and Tissues.
The well-known ways in which O2 and CO2 (and other gases) are carried in the blood were presented in the preceding chapter. However, what the many available texts about O2 and CO2 transport do not emphasize is why knowing how gases are carried in blood matters, and this second, companion, article specifically addresses that critical aspect of gas exchange physiology. ⋯ Dissociation curve shape and slope differences explain most of the differences between O2 and CO2 in both diffusive exchange in the lungs and tissues and convective exchange/transport in, and between, the lungs and tissues. In fact, each of the chapters in this volume describes physiological behavior that depends more or less directly on the dissociation curves of O2 and CO2.
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The pulmonary circulation is a low-pressure, low-resistance circuit whose primary function is to deliver deoxygenated blood to, and oxygenated blood from, the pulmonary capillary bed enabling gas exchange. The distribution of pulmonary blood flow is regulated by several factors including effects of vascular branching structure, large-scale forces related to gravity, and finer scale factors related to local control. Hypoxic pulmonary vasoconstriction is one such important regulatory mechanism. ⋯ Pulmonary vascular resistance describes the flow-resistive properties of the pulmonary circulation and arises from both precapillary and postcapillary resistances. The pulmonary circulation is also distensible in response to an increase in transmural pressure and this distention, in addition to recruitment, moderates pulmonary arterial pressure and vascular resistance. This article reviews the physiology of the pulmonary vasculature and briefly discusses how this physiology is altered by common circumstances.
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Gas exchange in the lung depends on tidal breathing, which brings new oxygen to and removes carbon dioxide from alveolar gas. This maintains alveolar partial pressures that promote passive diffusion to add oxygen and remove carbon dioxide from blood in alveolar capillaries. In a lung model without ventilation and perfusion (V̇AQ̇) mismatch, alveolar partial pressures of oxygen and carbon dioxide are primarily determined by inspiratory pressures and alveolar ventilation. ⋯ Although less common, diffusion limitation might cause hypoxemia in some situations. This review covers the principles of lung gas exchange and therefore mechanisms of hypoxemia or hypercapnia. In addition, we discuss different metrics that quantify the deviation from ideal gas exchange.