Document Detail


Mechanisms of impaired arterial oxygenation in patients with liver cirrhosis and severe respiratory insufficiency. Effects of indomethacin.
MedLine Citation:
PMID:  8432144     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The mechanisms of impaired arterial oxygenation that occur in certain patients with chronic liver cirrhosis are still debated. In the present study, we investigated nine cirrhotic patients with severe respiratory disability (mean PaO2, 64 +/- 5 mm Hg), using the inert gas elimination technique to assess the distribution of ventilation-perfusion (VA/Q) ratios. We also determined shunt fraction during pure oxygen breathing, both in supine and sitting positions. To test the hypothesis that vasodilating prostaglandins could contribute to alter gas exchange in such patients with cirrhosis, we examined the hemodynamic and gasometric responses to indomethacin, 50 mg IV, in six of them. During baseline conditions, patients had high cardiac index (CI, 4.9 +/- 0.2 L/min/m2), and low pulmonary (PVR, 1.78 +/- 0.37 mm Hg/L/min/m2) or systemic (SVR, 17.7 +/- 1.15 mm Hg/L/min/m2) vascular resistances. Large intrapulmonary shunt fraction was documented in each patient with a mean value of 19.6 +/- 2.7 percent. Small perfusion in low VA/Q areas was associated with shunt in only three patients (2.5 to 5.3 percent of blood flow). Arterial PO2 was negatively related to shunt (p < 0.01) and to the dispersion of blood flow distribution (p < 0.02). There was no difference between measured and predicted PaO2. Shunt estimates from the inert gas and the 100 percent O2 breathing techniques were, respectively, 19.6 +/- 2.7 percent and 21.7 +/- 3.0 percent. During 100 percent oxygen breathing, changing from supine to sitting position decreased PaO2 from 401 +/- 50 to 333 +/- 64 mm Hg (p < 0.02), while O2 shunt remained unchanged, arteriovenous difference widened, and mixed venous PO2 decreased, from 61 +/- 3 to 47 +/- 4 mm Hg (p < 0.001). Indomethacin did not improve gas exchange or VA/Q distribution and did not affect systemic or pulmonary hemodynamics. The results show that in cirrhotic patients with severe respiratory disability, intrapulmonary shunting is the main determinant of impaired gas exchange, with no evidence of a defect in oxygen diffusion or an extrapulmonary shunt. Vasodilating prostaglandins do not appear to contribute to these alterations.
Authors:
P Andrivet; J Cadranel; B Housset; R Herigault; A Harf; S Adnot
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Chest     Volume:  103     ISSN:  0012-3692     ISO Abbreviation:  Chest     Publication Date:  1993 Feb 
Date Detail:
Created Date:  1993-03-12     Completed Date:  1993-03-12     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0231335     Medline TA:  Chest     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  500-7     Citation Subset:  AIM; IM    
Affiliation:
Service d'explorations Fonctionnelles Respiratoires, Hôpital Universitaire Henri Mondor, Creteil, France.
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MeSH Terms
Descriptor/Qualifier:
Aged
Arteries
Carbon Dioxide / blood
Chronic Disease
Female
Hemodynamics / drug effects
Humans
Indomethacin / pharmacology
Liver Cirrhosis / complications*
Male
Middle Aged
Oxygen / blood*
Pulmonary Circulation
Pulmonary Gas Exchange / drug effects
Respiratory Insufficiency / blood*,  complications*,  physiopathology
Ventilation-Perfusion Ratio
Chemical
Reg. No./Substance:
124-38-9/Carbon Dioxide; 53-86-1/Indomethacin; 7782-44-7/Oxygen

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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