Pulmonary and Peripheral Gas Exchange in Health and Disease

by Roca,Josep

• ISBN13: 9780824703356
• ISBN10: 0824703359
• Format: Hardcover
• Copyright: 2000-07-28
• Publisher: CRC Press

Summary

Featuring a comprehensive analysis of gas exchange in healthy and diseased states and addressing functions of peripheral gas delivery, this detailed reference presents an interdisciplinary approach to understanding and studying oxygen transport throughout the body. More than 30 internationally renowned experts combine techniques from clinical medicine, pathophysiology, and therapy to deliver the latest research in an integrative manner on pulmonary gas exchange in the body. Pulmonary and Peripheral Gas Exchange in Health and Disease examines the effects of damaged lungs and the abnormal functions of body tissues and organs on pulmonary circulation reviews the behavior and mechanisms of gas exchange in the heart, skeletal muscle, gut, brain, and kidneys describes the requirements and behavior of homeostasis investigates conditions in normal physiology-during exercise, and at sea level, high altitude, and microgravity analyzes the performance of gas exchange in bronchial asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, and acute respiratory disease syndrome highlights peripheral transport of oxygen from the capillaries into the mitochondria targets prescient directions for future research and more! Containing over 2800 literature references, drawings, photographs, and equations, Pulmonary and Peripheral Gas Exchange in Health and Disease makes an excellent reference for pulmonologists; physiologists; anesthesiologists; chest, intensive care, thoracic, and emergency room physicians; and medical school students in these disciplines.

Table of Contents

Introduction	p. iii
Preface	p. v
Contributors	p. vii
Basic Principles
Pulmonary and Peripheral Gas Exchange and Their Interactions	p. 1
Introduction	p. 1
The Gas Transport Pathway: Environment to Mitochondria	p. 2
Mechanisms of O[subscript 2] Transport Impairment in the Lungs and Tissues	p. 22
Integration of Lungs and Tissues in Gas Transport and Exchange	p. 23
Conclusion	p. 25
References	p. 25
Oxygen and Metabolic Homeostasis During Large-Scale Change in Tissue Work Rates	p. 29
Contrasting Requirements of Homeostasis and Tissue Work	p. 29
Human Muscle Metabolism During Work	p. 30
Widespread Stability of Metabolites During Changes in Metabolic Rates	p. 36
Demands of Homeostasis Take Precedence During Changes in Work Rates of Tissues	p. 37
Oxygen Delivery and Metabolic Regulation	p. 39
Transducing the Oxygen Signal in Working Tissue	p. 39
An Unsolved Regulatory Problem	p. 40
Summary	p. 41
References	p. 41
Experimental Approaches to the Study of Gas Exchange	p. 45
Introduction	p. 45
Total Respiratory Gas Exchange	p. 46
Gas Exchange in the Lung	p. 49
Peripheral Gas Exchange	p. 88
Summary	p. 107
References	p. 108
Pulmonary Gas Exchange
Gas Exchange in Health: Rest, Exercise, and Aging	p. 121
Heterogeneity of Pulmonary Gas Exchange at Rest	p. 122
Determinants of O[subscript 2] and CO[subscript 2] Exchange at Rest	p. 136
Pulmonary Gas Exchange During Exercise	p. 137
Effects of Aging on Pulmonary Gas Exchange	p. 138
Summary	p. 143
References	p. 143
Gas Exchange in Health: Altitude and Microgravity	p. 149
Introduction	p. 149
High Altitude	p. 149
Microgravity	p. 162
References	p. 171
Anesthesia and Gas Exchange	p. 177
Introduction	p. 177
Oxygenation and Venous Admixture	p. 178
Distributions of Ventilation and Perfusion	p. 179
Alveolar Hypoventilation and Diffusion Limitation	p. 181
Morphologic Correlates of Shunt and Low Va/Q	p. 182
Prevention of Atelectasis During Anesthesia	p. 185
Hypoxic Pulmonary Vasoconstriction	p. 189
Obstructive Lung Disease	p. 190
One-Lung Ventilation	p. 191
Postoperative Lung Function	p. 192
Conclusion	p. 193
References	p. 193
Asthma	p. 199
Introduction	p. 199
Arterial Blood Gas Abnormalities	p. 201
Topographical Distribution of Ventilation and Blood Flow	p. 206
Functional Maldistribution of Ventilation	p. 208
Functional Distributions of Va/Q Ratios	p. 210
Summary and Conclusions	p. 221
References	p. 223
Chronic Obstructive Pulmonary Disease	p. 229
Introduction	p. 229
Physiological Basis of Abnormal Gas Exchange in COPD	p. 230
Structure and Function Correlations	p. 237
Gas Exchange in the Natural History of COPD	p. 241
Gas Exchange During Exercise	p. 246
Effect of Therapeutic Interventions on Gas Exchange	p. 250
Conclusions	p. 256
References	p. 256
Interstitial Lung Diseases	p. 263
Introduction	p. 263
Resting Pulmonary Gas Exchange	p. 264
Pulmonary Gas Exchange During Exercise	p. 265
Integrated View: The Mechanisms of Abnormal Exercise Performance in ILD	p. 271
Relationship Between Diffusing Capacity for Carbon Monoxide and the Mechanisms of Abnormal Pulmonary Gas Exchange in ILD	p. 278
Conclusions	p. 280
References	p. 280
Pulmonary Vascular Diseases	p. 285
Introduction	p. 285
Acute Pulmonary Arterial Obstruction: Pulmonary Embolism	p. 286
Chronic Pulmonary Vascular Obstruction	p. 296
Conclusions	p. 299
References	p. 300
Acute Lung Injury	p. 303
Introduction	p. 303
Acute Injury of the Lungs	p. 304
Pulmonary Gas Exchange in ARDS	p. 305
Therapeutic Concepts to Improve Va/Q Matching in ARDS	p. 313
Conclusion	p. 322
References	p. 323
Gas Exchange in the Periphery: Organs and Systems
Whole-Body Oxygen Transport and Use	p. 331
Introduction	p. 331
The Interrelationship Between Oxygen Transport and Use in Health	p. 332
Matching of Oxygen Transport to Use in Health	p. 337
Matching of Oxygen Transport to Use in Disease	p. 347
Summary	p. 352
References	p. 353
Gas Exchange in the Heart	p. 359
Introduction	p. 359
Coronary Circulation	p. 362
Determinants of Myocardial Oxygen Demand	p. 363
Determinants of Myocardial Oxygen Supply	p. 368
Myocardial Oxygen Extraction	p. 371
Relationship of Blood Flow Heterogeneity to Oxygen Extraction	p. 373
Myocardial Oxygen Extraction in Sepsis	p. 374
Myocardial Oxygen Extraction in Coronary Occlusive Disease	p. 375
Summary	p. 376
References	p. 376
Localization and Dispersion of Oxygen Demand and Supply in Skeletal Muscle	p. 383
Introduction	p. 383
Muscle Blood Flow and Oxygen Uptake	p. 385
Oxygen Flux Within Muscle Fibers	p. 387
Oxygen Flux from Microvessels to Muscle Fibers	p. 389
Intramuscular Dispersion of Metabolic Demand	p. 396
Conclusions	p. 400
References	p. 401
The Gut: Oxygen Transport and Gas Exchange Function	p. 409
Introduction	p. 409
Structure and Function of the Gut Vascular Anatomy	p. 410
Vascular Models of the Gut Microcirculation	p. 411
Role of Extrinsic Autonomic Neurohumoral Control of Gut Blood Flow	p. 412
Metabolic Control of the Gut Microcirculation	p. 413
Oxygen Delivery--Consumption Relationships	p. 414
Physiological Shunting of Oxygen in the Gut Microcirculation	p. 416
Perfusion Heterogeneity in the Gut Microcirculation	p. 420
Pathophysiology of Gas Transport	p. 423
Mechanisms of Impaired Tissue Oxygen Extraction	p. 425
Pathological Oxygen Supply Dependency in Critical Illness and Sepsis	p. 427
Summary	p. 429
References	p. 430
The Brain	p. 435
Cerebral Blood Flow and Metabolism	p. 435
Neurovascular Coupling: The Link Between Cerebral Blood Flow, Metabolism, and Function	p. 437
Cerebral Hypoxia	p. 443
Summary	p. 444
References	p. 445
The Kidney	p. 447
Introduction	p. 447
The Renal Circulation	p. 448
Intrarenal Oxygen Gradient	p. 451
Outer Medullary Oxygen Balance	p. 451
Control of Medullary Oxygen Balance	p. 453
Acute Tubular Necrosis and Distal Tubular Injury in Humans	p. 457
Distal Tubular Injury: Experimental Evidence for Oxygen Insufficiency	p. 457
Medical Conditions Predisposing to Acute Tubular Necrosis: Implications for Medullary Oxygen Imbalance	p. 458
Animal Models of Acute Renal Failure with Hypoxic Outer Medullary Necrosis	p. 460
Disparate Mechanisms for Hypoxic Injury in Different Nephron Segments	p. 462
Medullary Hypoxia and Chronic Tubulointerstitial Disease	p. 462
Medullary Oxygen Balance and the Prevention/Treatment of Acute Tubular Necrosis	p. 463
Control of Erythropoietin Production: A Role for Renal Parenchymal Oxygen Insufficiency	p. 464
References	p. 465
Integrated Gas Exchange Responses
Pulmonary and Peripheral Gas Exchange During Exercise	p. 469
Introduction	p. 469
Pulmonary and Muscle Gas Exchange	p. 470
Cardiovascular System	p. 488
Muscle Microcirculation	p. 495
Maximum Oxygen Consumption in Health and Disease	p. 509
Summary and Conclusions	p. 516
References	p. 517
Gas Exchange in Lung and Muscle at High Altitude	p. 525
Introduction	p. 525
The Problem	p. 526
The Lung	p. 526
Gas Exchange in the Tissues	p. 535
High Altitude	p. 536
Blood Flow	p. 537
The Role of Hemoglobin	p. 540
Oxygen-Hemoglobin Affinity	p. 542
Diffusion of Oxygen from Blood to the Tissue	p. 543
Summary	p. 546
References	p. 547
Systemic Gas Exchange and Exercise Performance in Chronic Pulmonary Disease	p. 553
Introduction	p. 553
Respiratory Responses	p. 555
Cardiovascular Responses	p. 565
Skeletal Muscle Responses	p. 566
Exercise Limitation	p. 567
Conclusion	p. 573
References	p. 573
Cardiopulmonary and Peripheral Vascular Alterations in Chronic Congestive Heart Failure	p. 581
Introduction	p. 581
Pathophysiology of Heart Failure: Cardiac Adaptations	p. 582
Peripheral Vascular and Skeletal Muscle Adaptations in Congestive Heart Failure	p. 585
Pulmonary Adaptation in Congestive Heart Failure	p. 594
Exercise Training in Congestive Heart Failure	p. 602
References	p. 606
Role of Hemoglobin in the Delivery of Oxygen to Tissues	p. 617
Introduction	p. 617
Autoregulation of Tissue Oxygen Delivery	p. 629
Nitric Oxide as the Endothelium-Derived Relaxing Factor	p. 632
Cell-Free Hemoglobin: New Tools to Study Oxygen Transport	p. 634
Summary and Hypothesis: The OEC Is a Critical Link in Oxygen Signal Transduction	p. 640
References	p. 641
Integrated Gas Exchange Response: Chronic Renal Failure	p. 649
Introduction	p. 649
Oxygen Transport Factors Affecting Aerobic Capacity	p. 653
Integrated Oxygen Transport	p. 662
Interactions Between Systems	p. 667
Systemic Factors	p. 668
Conclusions	p. 673
References	p. 676
Multiple Organ Failure	p. 685
Introduction	p. 685
Definitions and Epidemiology of Multiple Organ Dysfunction/Failure	p. 685
Hypothesis	p. 687
Mechanisms of Imbalance Between Oxygen Delivery and Consumption that Could Cause Multiple System Organ Failure	p. 689
The Oxygen Delivery/Consumption Relationship: Physiology	p. 695
Evidence for Occult Tissue Hypoxia as a Cause of Multiple System Organ Failure	p. 697
Evidence Against Occult Tissue Hypoxia as a Cause of Multiple System Organ Failure	p. 708
Alternative Mechanisms of Multiple Organ Failure	p. 723
Facilitative Role for Tissue Hypoxia in MSOF	p. 725
Summary	p. 725
References	p. 727
Author Index	p. 743
Subject Index	p. 805
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