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Density-dependent reduction of nitric oxide diffusing capacity after pneumonectomy.

Connie C W Hsia1, Xiao Yan, D Merrill Dane

  • 1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas 75390-9034, USA.

Journal of Applied Physiology (Bethesda, Md. : 1985)
|February 4, 2003
PubMed
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Lung diffusing capacity for nitric oxide (Dl(NO)) is more sensitive than for carbon monoxide (Dl(CO)) to changes in airway density after pneumonectomy (PNX). This highlights Dl(NO) as a better indicator of gas mixing resistance in altered lung anatomy.

Area of Science:

  • Pulmonary physiology
  • Respiratory mechanics
  • Gas exchange

Background:

  • Pneumonectomy (PNX) leads to airway lengthening, potentially increasing diffusive resistance to gas mixing.
  • Detecting these changes using lung carbon monoxide diffusing capacity (Dl(CO)) is challenging.
  • Lung nitric oxide diffusing capacity (Dl(NO)) is significantly higher than Dl(CO), with similar diffusive resistance for both gases.

Purpose of the Study:

  • To test the hypothesis that a density-dependent fractional reduction would be greater for Dl(NO) than for Dl(CO) following pneumonectomy.
  • To investigate the impact of altered lung anatomy on gas diffusion and mixing.

Main Methods:

  • Measurement of Dl(NO) and Dl(CO) in immature dogs at two tidal volumes (Vt) and with three background gases (helium, nitrogen, sulfur hexafluoride).

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  • Studies were conducted 3 and 9 months after right pneumonectomy (PNX).
  • Comparison of results between PNX animals and sham controls at maturity.

    • Main Results:

    • In PNX animals, Dl(NO) decreased by 25-50% in sulfur hexafluoride (SF(6)) compared to helium (He) and nitrogen (N(2)).
    • The Dl(NO)-to-Dl(CO) ratio declined approximately 50% in SF(6) relative to He at a Vt of 15 ml/kg in PNX dogs, indicating significant diffusive resistance.
    • In younger PNX dogs, Dl(CO) paradoxically increased in SF(6) compared to N(2) or He, suggesting ventilation redistribution or enhanced convective front penetration.

    Conclusions:

    • Lung diffusing capacity for nitric oxide (Dl(NO)) is more sensitive to increased gas density and diffusive resistance after pneumonectomy than Dl(CO).
    • Findings suggest that sulfur hexafluoride (SF(6)) may influence ventilation distribution and acinar penetration beyond its effect on diffusive resistance.
    • Dl(NO) offers a more sensitive measure for detecting altered gas mixing dynamics in lungs with surgically modified anatomy.