Uneven ventilation within and between regions of the normal measured with nitrogen-13

Effect of age on the regional perfusion and washouts of injected xenon in normal men

The aim of this work was to localize the alveoli with low ventilation-perfusion ratio which are responsible for the age related increase of the ideal alveolar-arterial O2 partial pressure difference. For this purpose, we measured: (1) the washouts of perfused 133 Xenon (Xe) in the whole lung and in 6 horizontal slices of the right lung, and (2) the topographical distribution of perfusion (Qi) in 27 healthy, non-smoking seated men, between 18 and 65 years. The distribution of Qi is unaffected by age. The global and regional washouts slowed with age, the trends being the same in the 6 investigated regions. This data was interpreted as indicating that in our subjects the low VA/Q units are not situated predominantly at the base, but are scattered throughout the lung.

Measurements of regional ventilation using nitrogen-13 and krypton-81m in mechanically ventilated dogs

13N2 and 81Krm were used to measure changes in upper/lower (U/L) ratios of regional ventilation in supine anaesthetised dogs mechanically ventilated at different tidal volumes and the results compared. Analysis of the slopes of the 13N2 washout curves indicated that U/L specific ventilation was less than unity at low tidal volumes and decreased as tidal volume increased. U/L total ventilation, measured using the specific ventilation results and estimations of relative lung using 13N2, also decreased with increase in tidal volume. Preferential distribution of ventilation to dependent lung regions thus increased with tidal volume despite the opposing hydrostatic forces from the abdomen. Regional count density distributions in 81Krm images of the lungs were analysed. At high specific ventilation rates, correction of 81Krm count density is required in order to obtain correct regional ventilation information. The specific ventilation rates in this series were such that the uncorrected U/L count ratios of 81Krm increased as tidal volume increased in contrast to the decrease in U/L total ventilation recorded by the 13N2 method. When corrections using the 13N2 specific ventilation results were applied, the changes in U/L 81Krm count ratios with tidal volume showed a similar trend to the changes in total ventilation measured with 13N2. Sources of error in the two techniques are briefly discussed.

Uneven perfusion and ventilation within lung regions studied with nitrogen-13

The clearance of nitrogen-13 (13N) from the upper, mid and lower zones was measured with a gamma camera during spontaneous breathing in 10 seated subjects. The clearance was monitored after (a) an intravenous injection of 13N dissolved in saline and (b) equilibration with 13N gas in closed circuit. Subjects breathed air first, and then a 30 or 11% oxygen mixture. For any region, the time for 90% elimination (T90) was related to the volume expired by the whole lung during that time (VE90). For the mid and lower zones, the clearance was faster (VE90 smaller) after intravenous 13N than after equilibration with 13N gas. This difference persisted when 30% or 11% oxygen was inspired. For the lung overall, the physiological dead space for a mean tidal volume of 884 ml was 277 ml for intravenous 13N clearance, and 384 ml for 13N clearance after equilibration. The conclusions drawn for this study are (1) ventilation in relation to volume is uneven within lung regions (2) intraregional perfusion in relation to volume is also uneven (3) at a local level the well-ventilated units are better perfused (4) these inhomogeneities are not affected by raising or lowering the inspired oxygen concentration.

Functional imaging of lung ventilation using the concept of mean transit time

This paper describes a new way of expressing local ventilation using a scintillation gamma camera interfaced to a digital computer. From the ratio of the first to the zeroth moment of the lung clearance curve for 13N gas, a mean transit time is calculated and displayed for different regions of the lung. Lung clearance curves following intravenously administered 13N solutions, or after equilibration with 13N gas, are measured during normal breathing. Describing regional ventilation by mean transit time during clearance uses all the counts in the lung clearance curve and the improvement in statistical accuracy compared with the height over area method using a Stewart-Hamilton equation is significant. In normal subjects the average mean transit time for clearance from the total lung field is t = (61 +/- 4) s, from the upper zone tuz = (64 +/- 4) s and from the lower zone tlz = (54 +/- 5) s. These results show uneven ventilation between regions of the normal lung in general agreement with that described by previous authors. In addition, the functional image gives the mean transit time for each cell of the 64 X 64 matrix of the computer display. The fractional error in mean transit time is 3% for an area of 2-2 cm2 corresponding to 12 cells in the display. This display provides a sensitive method, functionally and spatially, of investigating local differences in ventilation, including vertical and horizontal gradients in narrow strips of lung.

Distribution of extravascular fluid volumes in isolated perfused lungs measured with H215O

The distributions per unit volume of extravascular water (EVLW), blood volume, and blood flow were measured in isolated perfused vertical dog lungs. A steady-state tracer technique was employed using oxygen-15, carbon-11, and nitrogen-13 isotopes and external scintillation counting of the 511-KeV annihilation radiation common to all three radionuclides. EVLW, and blood volume and flow increased from apex to base in all preparations, but the gradient of increasing flow exceeded that for blood and EVLW volumes. The regional distributions of EVLW and blood volume were almost identical. With increasing edema, lower-zone EVLW increased slightly relative to that in the upper zone. There was no change in the distribution of blood volume or flow until gross edema (100% wt gain) occurred when lower zone values were reduced. In four lungs the distribution of EVLW was compared with wet-to-dry ratios from lung biopsies taken immediately afterwards. Whereas the isotopically measured EVLW increased from apex to base, the wet-to-dry weight ratios remained essentially uniform. We concluded that isotopic methods measure only an "exchangeable" water pool whose volume is dependent on regional blood flow and capillary recruitment. Second, the isolated perfused lung can accommodate up to 60% wt gain without much change in the regional distribution of EVLW, volume, or flow.