Cardiac output and regional oxygen transport in the acutely hypoxic conscious sheep.

We have studied the effects of severe acute hypoxemia (PaO2 = 25 torr) on cardiac output (Q), heart rate (HR), left ventricular contractility ((dP/dt)max/P), intravascular pressures and blood flow to the heart, brain, abdominal viscera, skin and respiratory and non-respiratory muscles in twelve conscious ewes that breathed a mixture of 8% O2 and 92% N2 for 20 min. Q, HR, (dP/dt)max/P) and systemic and pulmonary arterial pressures increased. Total peripheral resistance decreased while pulmonary vascular resistance remained unchanged. Coronary, cerebral, respiratory and nonrespiratory muscle and adrenal flows increased, in association with a decrease in regional vascular resistances, while the flows to the kidney and other abdominal viscera remained unchanged. The concentration of total plasma catecholamines doubled, indicating that the sympathetic nervous system plays a major role in the hemodynamic response to this level of hypoxia. Increased oxygen delivery to the heart (31%) and respiratory muscles (44%) were brought about by increases in both the magnitude and the redistribution of Q, the latter being the more important of the two mechanisms. In contrast, both mechanisms contributed equally to the amount of oxygen delivered to the brain and nonrespiratory muscles. We concluded that in acute hypoxemia, both the increase in Q and its regional redistribution contribute to the delivery of oxygen to the various tissues.

Effects of acute hypercapnia on the central and peripheral circulation of conscious sheep.

We studied the cardiorespiratory effects of acute hypercapnia in 10 unanesthetized sheep. After a 15-min exposure to either 7.3 or 10% CO2 in air, we measured arterial blood gases, minute ventilation (VE), O2 consumption (VO2), cardiac output (Q), heart rate (HR), an index of left ventricular contractility [(dP/dt)/P], and vascular pressures. In addition, regional flows to all major organs were determined by injecting 15-microns radiolabeled microspheres into the left heart. Exposure to 7.3% CO2 (arterial CO2 partial pressure, PaCO2, 58 Torr) resulted in increased VE, (dP/dt)/P, and higher blood flows to the brain and respiratory muscles. All other variables remained unchanged. Exposure to 10% CO2 (PaCO2 75 Torr) resulted in a further augmentation of VE and a 48% increase in Q, which was associated with a tachycardia, a decrease in systemic vascular resistance, and an increase in VO2. Coronary and respiratory muscle flows increased, but all other variables remained unchanged. Thus the hemodynamic effects of hypercapnia are not related linearly to the level of PaCO2.

Pulmonary and circulatory changes in conscious sheep exposed to 100% O2 at 1 ATA.

We have measured the effects of normobaric hyperoxia on arterial and mixed venous gas tensions, cardiac output, heart rate, right atrial, pulmonary, and aortic pressures in 12 conscious chronically instrumented sheep. Regional blood flow to brain, heart, kidney, intestines, and respiratory muscles was assessed in five sheep by injecting 15-micrometers microspheres labeled with gamma-emitting isotopes. Survival time ranged from 60 to 120 h (mean = 80 h). All variables except arterial O2 partial pressure (PaO2) and mixed venous O2 partial pressure remained at base-line level during the first 40 h of exposure, after which PaO2 decreased gradually but remained above 200 Torr at death. After this there was a progressive uncompensated respiratory acidosis with terminal arterial CO2 partial pressure values exceeding 90 Torr. There was a considerable rise in the brain blood flow, whereas flow to the other organs either remained unchanged or increased in proportion to cardiac output. Our experiments also showed that systemic hyperoxic vasoconstriction did not occur, and any local changes were not of sufficient magnitude to affect perfusion.

Effects of hyperventilation on pulmonary blood flow and recirculation time of humans.

We used direct invasive techniques to measure the effects of hyperventilation on the pulmonary blood flow (Q) and on recirculation time of helium and of carbon dioxide in humans. The subjects hyperventilated with a tidal volume of 1.5 liters (BTPS) and a frequency of 20 or 30 breaths/min. There was no significant change in Q from control at either level of hyperventilation. Helium first appeared in the pulmonary artery within 12 s from the onset of hyperventilation and increased by approximately 0.7% of its equilibrium arterial value per second at both levels of hyperventilation. In contrast, the PVCO2 remained at base-line level until 43 s from the onset of hyperventilation. We conclude that hyperventilation at 30 or 45 l/min with constant tidal volume does not significantly affect the value of Q and that the amount of recirculation of the two gases does not result in underestimation of Q when this variable is measured by indirect respiratory rebreathing techniques.

Cardiac output determination by simple one-step rebreathing technique.

We have developed a rebreathing technique for measuring cardiac output in resting or exercising subjects. The data needed are the subject's CO2 dissociation curve, the initial volume and CO2 fraction of the rebreathing bag, and a record of CO2 at the mouth during the maneuver. From these one can obtain all the values required to solve the Fick equation. The combined error due to inaccuracy in reading the tracings and to the simplifying assumptions was found to be small (mean = 0.5%, SD ;.5%). Cardiac output values determined with this technique in normal subjects were on the average 2% higher than those obtained simultaneously with an acetylene rebreathing method (n = 49, SD = 11%). Among the advantages of the technique are that it requires analysis of a single gas, takes less than thirty seconds per determination, allows one to obtain repeated measurements at rapid intervals, is not affected by the ability of lung tissue to store CO2, and eliminates many of the assumptions usually made in non-invasive measurements of cardiac output.

Pulmonary function in tropical eosinophilia before and after treatment with diethylcarbamazine.

Spirometric and lung volume measurements were carried out before and after treatment with diethylcarbamazine in 19 patients with tropical eosinophilia. The total lung capacity and vital capacity returned to or nearly to normal while the FEV1 and PEFR, though improved, tended to remain below normal, indicating some residual airways obstruction especially in patients whose treatment began more than one month from the onset of symptoms. The time taken for the pulmonary function to return to normal with treatment was found to be much longer than for the clinical and haematological response.