Analysis of the effects of pulsatile capillary blood flow and volume on gas exchange

Pulsatile flow in venous perforators of the lower limb

Teaching traditionally asserts that the arterial pressure pulse is dampened across the capillary bed to the extent that pulsatility is non-existent in the venous circulation of the lower limbs. Herein, we present evidence of transmission of arterial pulsations across the capillary network into perforator veins in the lower limbs of healthy, heat-stressed humans. Perforator veins are connections from the superficial veins that drain into the deep veins. When assessed using ultrasound at rest, they infrequently demonstrate flow and a pulsatile flow waveform is not described. We investigated perforator vein pulsatility in ten young, healthy volunteers who underwent passive heating by +2 ºC deep body temperature via a hot-water-perfused suit, and five who also underwent active heating by +2 ºC via low-intensity cycling while wearing the hot-water-perfused suit. At +0.5 ºC increments in temperature, blood velocity in an ankle perforator vein was measured using duplex ultrasound. In all perforators with heating, sustained flow was demonstrated, with a pulsatile waveform that was synchronous with the cardiac cycle. The maximum velocity was 29 ± 14 cm/s with passive heating and approximately half with active heating (P=0.04). The small veins of the skin at the ankle also demonstrated increased perfusion with pulsatility, seen with low-velocity microvascular imaging technology. We consider explanations for this pulsatility and conclude that it is propagated from the arterial inflow through the skin microcirculation as a result of increased dilatation and flow volume, and that this a normal response to increased skin blood flow.

Pulmonary Vascular Dynamics

The pulmonary circulation carries deoxygenated blood from the systemic veins through the pulmonary arteries to be oxygenated in the capillaries that line the walls of the pulmonary alveoli. The pulmonary circulation carries the cardiac output with a relatively low driving pressure, and so differs considerably in structure and function from the systemic circulation to maintain a low-resistance vascular system. The pulmonary circulation is often considered to be a quasi-static system in both experimental and computational studies of pulmonary perfusion and its matching to ventilation (air flow) for exchange. However, the system is highly dynamic, with cardiac output and regional perfusion changing with posture, exercise, and over time. Here we review this dynamic system, with a focus on understanding the physiology of pulmonary vascular dynamics across spatial and temporal scales, and the changes to these dynamics that are reflective of disease. © 2019 American Physiological Society. Compr Physiol 9:1081-1100, 2019.

Anatomical backgrounds on gas exchange parameters in the lung

Many problems regarding structure-function relationships have remained unsolved in the field of respiratory physiology. In the present review, we highlighted these uncertain issues from a variety of anatomical and physiological viewpoints. Model A of Weibel in which dichotomously branching airways are incorporated should be used for analyzing gas mixing in conducting and acinar airways. Acinus of Loeschcke is taken as an anatomical gas-exchange unit. Although it is difficult to define functional gas-exchange unit in a way entirely consistent with anatomical structures, acinus of Aschoff may serve as a functional gas-exchange unit in a first approximation. Based on anatomical and physiological perspectives, the multiple inert-gas elimination technique is thought to be highly effective for predicting ventilation-perfusion heterogeneity between acini of Aschoff under steady-state condition. Changes in effective alveolar P_O2, the most important parameter in classical gas-exchange theory, are coherent with those in mixed alveolar P_O2 decided from the multiple inert-gas elimination technique. Therefore, effective alveolar-arterial P_O2 difference is considered useful for assessing gas-exchange abnormalities in lung periphery. However, one should be aware that although alveolar-arterial P_O2 difference sensitively detects moderately low ventilation-perfusion regions causing hypoxemia, it is insensitive to abnormal gas exchange evoked by very low and high ventilation-perfusion regions. Pulmonary diffusing capacity for CO (D_LCO) and the value corrected for alveolar volume (V_AV), i.e., D_LCO/V_AV (K_CO), are thought to be crucial for diagnosing alveolar-wall damages. D_LCO-related parameters have higher sensitivity to detecting abnormalities in pulmonary microcirculation than those in the alveolocapillary membrane. We would like to recommend four categories derived from combining behaviors of D_LCO with those of K_CO for differential diagnosis on anatomically morbid states in alveolar walls: type-1 abnormality defined by decrease in both D_LCO and K_CO; type-2 abnormality by decrease in D_LCO but increase in K_CO; type-3 abnormality by decrease in D_LCO but restricted rise in K_CO; and type-4 abnormality by increase in both D_LCO and K_CO.

Multiscale model for pulmonary oxygen uptake and its application to quantify hypoxemia in hepatopulmonary syndrome

This paper presents a novel multiscale methodology for quantitative analysis of pulmonary gas exchange. The process of oxygen uptake in the lungs is a complex multiscale process, characterized by multiple time and length scales which are coupled nonlinearly through the processes of diffusion, convection and reaction, and the overall oxygen uptake is significantly influenced by the transport and reaction rate processes at the small-scales. Based on the separation of length scales, we characterize these disparate scales by three representative ones, namely micro (red blood cell), meso (capillary and alveolus) and macro (lung). We start with the fundamental convection-diffusion-reaction (CDR) equation that quantifies transport and reaction rates at each scale and apply spatial averaging techniques to reduce the dimensionality of these models. The resultant low-dimensional models embed each scale hierarchically within the other while retaining the important parameters of the small-scales in the averaged equations, and drastically reduce the computational efforts involved in solving them. We use our multiscale model for pulmonary gas exchange to quantify the oxygen uptake abnormalities in patients with hepatopulmonary syndrome (HPS), a disease which is characterized by coupled abnormalities in multiple length scales. Based on our multiscale modeling, we suggest a strategy to stratify patients with HPS into two categories--those who are oxygen-responsive and those who are oxygen non-responsive with intractable hypoxemia.

Diffusing capacity reexamined: relative roles of diffusion and chemical reaction in red cell uptake of O2, CO, CO2, and NO

This paper presents an analytical expression for the diffusing capacity (Θt) of the red blood cell (RBC) for any reactive gas in terms of size and shape of the RBC, thickness of the unstirred plasma layer surrounding the RBC, diffusivities and solubilities of the gas in RBC and boundary layer, hematocrit, and the slope of the dissociation curve. The expression for Θthas been derived by spatial averaging of the fundamental convection-diffusion-reaction equation for O2in the RBC and has been generalized to all cell shapes and for other reactive gases such as CO, NO, and CO2. The effects of size and shape of the RBC, thickness of the unstirred plasma layer, hemoglobin concentration, and hematocrit on Θthave been analyzed, and the analytically obtained expression for Θthas been validated by comparison with different sets of existing experimental data for O2and CO2. Our results indicate that the discoidal shape of the human RBC with average dimensions of 1.6-μm thickness and 8-μm diameter is close to optimal design for O2uptake and that the true reaction velocity in the RBC is suppressed significantly by the mass transfer resistance in the surrounding unstirred layer. In vitro measurements using rapid-mixing technique, which measures Θtin the presence of artificially created large boundary layers, substantially underpredicts the in vivo diffusing capacity of the RBC in the diffusion-controlled regime. Depending on the conditions in the RBC, uptake of less reactive gases (such as CO) undergoes transition from reaction-limited to diffusion-limited regime. For a constant set of morphological parameters, the theoretical expression for Θtpredicts that Θt,NO> Θt,CO2> Θt,O2> Θt,CO.

Airway mechanics, gas exchange, and blood flow in a nonlinear model of the normal human lung

A model integrating airway/lung mechanics, pulmonary blood flow, and gas exchange for a normal human subject executing the forced vital capacity (FVC) maneuver is presented. It requires as input the intrapleural pressure measured during the maneuver. Selected model-generated output variables are compared against measured data (flow at the mouth, change in lung volume, and expired O2 and CO2 concentrations at the mouth). A nonlinear parameter-estimation algorithm is employed to vary selected sensitive model parameters to obtain reasonable least squares fits to the data. This study indicates that 1) all three components of the respiratory model are necessary to characterize the FVC maneuver; 2) changes in pulmonary blood flow rate are associated with changes in alveolar and intrapleural pressures and affect gas exchange and the time course of expired gas concentrations; and 3) a collapsible midairway segment must be included to match airflow during a forced expiration. Model simulations suggest that the resistances to airflow offered by the collapsible segment and the small airways are significant throughout forced expiration; their combined effect is needed to adequately match the inspiratory and expiratory flow-volume loops. Despite the limitations of this lumped single-compartment model, a remarkable agreement with airflow and expired gas concentration measurements is obtained for normal subjects. Furthermore, the model provides insight into the important dynamic interactions between ventilation and perfusion during the FVC maneuver.

Effect of pulsatile flow on gas exchange in the fish gill: theory and experimental data

A model for gas exchange in the fish gill allowing for time-varying water and blood flow is presented. An analysis based on this mathematical model shows that pulsatile water and blood flow potentially may reduce the efficiency of gas exchange significantly. The degree of inefficiency imposed on gas exchange is, however, determined by the physical dimensions of the gill and the gas capacitance coefficients of water and blood. Using anatomical and physiological data it is shown to be likely that for a large group of fishes, including the salmonids, pulsatility of water and blood flow affects gas exchange efficiency only marginally. A close coupling between cardiac and respiratory rhythms is therefore only of marginal advantage to gas exchange efficiency. Due to their exceptional gill dimensions tunas, and to a lesser extent mackerels, are susceptible to the negative effect of pulsatility on gas exchange, which may be one of the factors favouring ram ventilation in these species.

A mathematical model for gas exchange in the fish gill based on non-linear blood gas equilibrium curves

A mathematical model for gas exchange in fish gills is presented, which makes allowance for the non-linear nature of the oxygen and carbon dioxide equilibrium curves of blood, for the uneven distribution of diffusion conductance along the secondary lamellae, and for coupling of oxygen and carbon dioxide exchange through the Bohr and Haldane effects. The model demonstrates that for oxygen loading in the gill the sigmoid equilibrium curve is superior to a linear one, whereas the non-linearity of the carbon dioxide equilibrium curve does not significantly affect carbon dioxide exchange and that the Bohr and Haldane effects have importance only for carbon dioxide exchange. It is also shown that the arterial and expired gas tensions and concentrations are unaffected by whether the bulk of the diffusion conductance is at either the afferent or the efferent end of the individual lamellae, provided that the total conductance is unchanged.

Pulmonary O2 transfer during pulsatile and non-pulsatile perfusion

The importance of the perfusion pattern for the oxygen transfer has been examined in isolated rabbit lungs perfused with plasma at constant volume inflow. The lungs were ventilated with constant tidal volume and constant end-expiratory pressure. Following a standardized rise in FIO2 the rate of rise in pulmonary venous PO2 (delta PO2/delta t) was measured during alternately pulsatile and non-pulsatile perfusion in normal lungs and in lungs made edematous by elevation of left atrial pressure. In normal lungs there was no difference in delta PO2/delta t when the two modes of perfusion were compared. In edematous lungs delta PO/delta t was statistically higher during pulsatile perfusion, indicating a beneficial effect of flow- and pressure pulsations, e.g. a better distribution of V/Q ratios throughout the lungs. In a separate series of expts. the advancement of a high O2 front through the airways was measured, and the two perfusion patterns compared. Since no difference was found, we suggest that the phenomenon of "cardiogenic gas mixing" in the airways in vivo is a result of a direct action of the heart on the lungs rather than arterial pulsations.