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Pressure and resistance in pulmonary circulation Active and passive influences on pulmonary vascular resistance Distribution of pulmonary blood flow Water balance in the lung Metabolic functions of the lung

Pressure in pulmonary circulation

Walls of pul.artery and its branches are remarkably thin and contain little mooth muscle
Arteriole Venule

Pulmonary vascular resistance (PVR)

Vascular resistance = input pressure output pressure blood flow

Pulmonary vascular resistance = Pulmonary artery p. left atrium p. cardiac output = (15-5)/6 1.7-1.8 mmHg/l/min g ( 1/10 systemic vascular resistance)
Pulmonary circulation is: A low-pressure (1/6 of systemic circulation), low-resistance system Able to recruit more vessels with only a slight increase in arterial pulmonary pressure

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Pulmonary vascular p.

Transmural p. gradient

(Hydrostatic p.)

PVR

Transmural p. gradient = p. inside p. outside Driving pressure: difference between p. at one point and p. at other point

Transmural p. gradient

Vessel diameter & Resistance

Recruitment of pulmonary capillaries occurs with small increases in pulmonary vascular pressure and Distension at higher pressure

Pressure around pulmonary blood vessels

Alveolar vessels : pulmonary capillaries : p. around alveolar vessels

Effect of lung volume on pulmonary vascular resistance

alveolar p.

Extraalveolar vessels : pulmonry arteries pulmonary veins : p. around alveolar vessels intrapleural p.

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Active influences on PVR

Increased pulmonary vascular resistance - Stimulation of sympathetic innervasion - -adrenergic agonists - PGF2, PGE2 - Thromboxane - Angiotensin II - Alveolar hypoxia - Alveolar hypercapnia Decreased pulmonary vascular resistance - Stimulation of parasympathetic innervasion - Acetylcholine - -adrenergic agonists - PGE1 - Prostacyclin (PGI2) - Nitric oxide - Bradykinin

Passive influences on PVR

Distribution of pulmonary blood flow

Measurement of the distribution of blood flow in the upright human lung, using radioactive xenon

H Hypoxic i pulmonary l vasoconstriction (HPV)

PAO2

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Three-zone model
Effect of gravity and alveolar p. on distribution of pul. blood flow

Water balance in the lung

Parameter Symbol K Pc Pi c I Mean values 0.2 ml/min.100 g.mmHg 9 mmHg -4 mmHg 0.8 24 mmHg 14 mmHg

Under normal circumstances, pul. arterial p. is usually sufficient to raise blood to the h top of f lungs l and d to overcome PA Severe hemorrhage, dehydration PA > Pa & Pv Alveolar dead space
Driving p. for blood flow is determined by Pa PA PA Zone 2, Pa

- Infiltration coefficient - Capillary hydrostatic pressure - Interstitial fluid hydrostatic pressure - Reflection coefficient - Capillary oncotic pressure - Interstitial fluid oncotic pressure

zone 2

Factors predisposing to pulmonary edema Q = K[(Pc-Pi) - (c-i)]

Fluid
Factor in Starling equation - Increased capillary permeability (K, ) -Increased capillary hydrostatic pressure (Pc) - Decreased interstitial hydrostatic pressure (Pi) - Decreased colloid osmotic pressure (c) Clinical problems - Acute respiratory distress syndrome - Oxygen toxicity - Inhaled or circulating toxins - Increased left atrial pressure resulting from left ventricular infarction or mitral stenosis - Overadministration of intravenous fluids - Too rapid evacuation of pneumothorax or hemothorax - Protein starvation - Dilution of blood proteins by intravenous solutions problems resulting g in urinary y protein p - Renal p loss (proteinuria) Clinical problems - Tumors - Interstitial fibrosing diseases - High-altitude pulmonary edema

interstitium of alvolar wall

Perivascular and peribronchial space

Hilar lymph node

Other etiologies

Filtration rate > draining rate

pulmonary edema

- Insuffincient pulmonary lymphatic drainage - Unknown etiology

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Metabolic functions of the lung

Substance in mixed venous blood Result of a single pass through the lung

Substance in mixed venous blood

Result of a single pass through the lung

-Prostaglandins E1, E2, F2 -Prostaglandins A1, A2, I2 -Leukotrienes -Serotonin -Acetylcholine -Histamine -Epinephrine -Norepinephrine -Isoproterenol

-Almost completely removed -Not affected -Almost completely removed -85-95 % removed -Inactivated by cholinesterases in blood -Not affected -Not affected -Approximately 30% removed -Not affected

-Dopamine -Bradykinin -Angiotensin Angiotensin I -Angiotensin II -Vasopressin -Oxytocin -Gastrin -ATP, AMP

-Not affected -Approximately 80 % inactivated -Approximately Approximately 70 % converted to angiotensin II -Not affected -Not affected -Not affected -Not affected -40-90 % removed
breakdown

Proteases are liberated from leukocytes

collagen & elastin emphysema

Synthesis of mucins & proteoglycans of bronchial mucus