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Am. J. Respir. Crit. Care Med., Volume 160, Number 5, November 1999, 1688-1696

Pulmonary Edema Develops after Recurrent Obstructive Apneas

EUGENE C. FLETCHER, MARY PROCTOR, JERRY YU, JUFANG ZHANG, JUAN J. GUARDIOLA, CARLTON HORNUNG, and GANG BAO

Division of Respiratory, Critical Care, and Environmental Medicine, Department of Medicine, Louisville Veterans Affairs Medical Center, and the University of Louisville School of Medicine, Louisville, Kentucky

There are anecdotal reports of pulmonary edema after a night of recurrent obstructive apneas (OAs) in humans, but no data on lung water, gas exchange, filling pressure, or cardiac output (Q) exist in these patients. By clamping the endotracheal tube of eight intubated, anesthesized dogs, we created repetitive OAs of 45-s duration at 30-s intervals, for 8 h. Five additional dogs without apneas, but identically instrumented, were studied simultaneously, serving as nonapneic controls. Sa O2 was measured by intraarterial catheter, pulmonary capillary wedge pressure (Pcw), continuous cardiac output (Q), and mixed venous oxygen saturation (S<OVL>v</OVL>O2) were measured by flotation catheter. Basal and hourly hemodynamics and blood gases (arterial and venous) under steady state respiration were measured. Venous admixture (Q S/Q T) was calculated by standard equations. PaO2 from the beginning to the end of the experiment fell from 89.6 to 82.8 mm Hg in apneic animals and from 92.2 to 85.5 mm Hg in controls. The Q S/Q T increased in both groups but more so in the apnea group (3.3 to 19.4%) than in nonapneic controls (3.1 to 7.9%). Neither Q nor Pcw changed significantly in either group. Lung wet/dry weight was 5.40 ± 0.93 in apneic animals and 5.00 ± 0.67 in controls. Light microscopy showed gross alveolar fluid in three apneic dogs, and electron microscopy showed interstitial fluid in two additional apneic dogs. One of the lung edema dogs expired of acute heart failure in the seventh hour of the experiment. Worsening of gas exchange and histology suggest that lung edema can result from recurrent OAs. Fletcher EC, Proctor M, Yu J, Zhang J, Guardiola JJ, Hornung C, Bao G. Pulmonary edema develops after recurrent obstructive apneas.




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