Alveolar liquid pressures in nonedematous and kerosene-washed rabbit lung by micropuncture

Surface tension in situ in flooded alveolus unaltered by albumin

In the acute respiratory distress syndrome, plasma proteins in alveolar edema liquid are thought to inactivate lung surfactant and raise surface tension, T. However, plasma protein-surfactant interaction has been assessed only in vitro, during unphysiologically large surface area compression (%ΔA). Here, we investigate whether plasma proteins raise T in situ in the isolated rat lung under physiologic conditions. We flood alveoli with liquid that omits/includes plasma proteins. We ventilate the lung between transpulmonary pressures of 5 and 15 cmH2O to apply a near-maximal physiologic %ΔA, comparable to that of severe mechanical ventilation, or between 1 and 30 cmH2O, to apply a supraphysiologic %ΔA. We pause ventilation for 20 min and determine T at the meniscus that is present at the flooded alveolar mouth. We determine alveolar air pressure at the trachea, alveolar liquid phase pressure by servo-nulling pressure measurement, and meniscus radius by confocal microscopy, and we calculate T according to the Laplace relation. Over 60 ventilation cycles, application of maximal physiologic %ΔA to alveoli flooded with 4.6% albumin solution does not alter T; supraphysiologic %ΔA raise T, transiently, by 51 ± 4%. In separate experiments, we find that addition of exogenous surfactant to the alveolar liquid can, with two cycles of maximal physiologic %ΔA, reduce T by 29 ± 11% despite the presence of albumin. We interpret that supraphysiologic %ΔA likely collapses the interfacial surfactant monolayer, allowing albumin to raise T. With maximal physiologic %ΔA, the monolayer likely remains intact such that albumin, blocked from the interface, cannot interfere with native or exogenous surfactant activity.

Pleural mechanics and fluid exchange

The pleural space separating the lung and chest wall of mammals contains a small amount of liquid that lubricates the pleural surfaces during breathing. Recent studies have pointed to a conceptual understanding of the pleural space that is different from the one advocated some 30 years ago in this journal. The fundamental concept is that pleural surface pressure, the result of the opposing recoils of the lung and chest wall, is the major determinant of the pressure in the pleural liquid. Pleural liquid is not in hydrostatic equilibrium because the vertical gradient in pleural liquid pressure, determined by the vertical gradient in pleural surface pressure, does not equal the hydrostatic gradient. As a result, a viscous flow of pleural liquid occurs in the pleural space. Ventilatory and cardiogenic motions serve to redistribute pleural liquid and minimize contact between the pleural surfaces. Pleural liquid is a microvascular filtrate from parietal pleural capillaries in the chest wall. Homeostasis in pleural liquid volume is achieved by an adjustment of the pleural liquid thickness to the filtration rate that is matched by an outflow via lymphatic stomata.

Effect of hyaluronidase on interstitial pressure response to edema in air-inflated rabbit lung

The response in perivascular interstitial pressure to water accumulation was measured in air-inflated isolated rabbit lungs. The blood vessels and trachea of isolated lungs were cannulated and the vascular cannulas were connected to a reservoir filled either with a 3% albumin in saline solution (control) or with hyaluronidase in the albumin solution (treated). The lungs were inflated to 5 cmH2O transpulmonary pressure and the vascular reservoir elevated to a height of 7-10 cm above the lung base. The reservoir was suspended by a load cell which measured liquid accumulation in the lung. As the lung gained weight, interstitial pressure was measured by the micropuncture technique in the interstitium surrounding a vein near the hilum of an upper lobe. In control lungs, interstitial pressure increased monotonically with time from a value slightly below 0 cmH2O (pleural pressure) to a value of approx. 3.0 cmH2O by 5 h. In treated lungs, interstitial pressure increased more slowly to a value of approx. 1.5 cmH2O by 5 h. Interstitial compliance, the change in weight gain divided by the change in interstitial pressure, was 1.2 g.(g lobe wt)-1.cmH2O-1 for the control lungs and 2.9 for the treated lungs. A two-compartment electrical analog model representing the perivascular interstitium and alveolar liquid space was developed to simulate the data. The analysis indicated that in the control lungs, perivascular interstitial conductance and compliance were 5-fold and 15-fold smaller than those of the alveolar liquid space, respectively. The slower rise in interstitial pressure with water accumulation in the treated lungs was attributed to an increased compliance of the alveolar liquid space. The effect of hyaluronidase on the alveolar liquid space was to increase its compliance 2.4-fold with little change in its fluid resistance.