Multiscale model for pulmonary oxygen uptake and its application to quantify hypoxemia in hepatopulmonary syndrome

This paper presents a novel multiscale methodology for quantitative analysis of pulmonary gas exchange. The process of oxygen uptake in the lungs is a complex multiscale process, characterized by multiple time and length scales which are coupled nonlinearly through the processes of diffusion, convection and reaction, and the overall oxygen uptake is significantly influenced by the transport and reaction rate processes at the small-scales. Based on the separation of length scales, we characterize these disparate scales by three representative ones, namely micro (red blood cell), meso (capillary and alveolus) and macro (lung). We start with the fundamental convection-diffusion-reaction (CDR) equation that quantifies transport and reaction rates at each scale and apply spatial averaging techniques to reduce the dimensionality of these models. The resultant low-dimensional models embed each scale hierarchically within the other while retaining the important parameters of the small-scales in the averaged equations, and drastically reduce the computational efforts involved in solving them. We use our multiscale model for pulmonary gas exchange to quantify the oxygen uptake abnormalities in patients with hepatopulmonary syndrome (HPS), a disease which is characterized by coupled abnormalities in multiple length scales. Based on our multiscale modeling, we suggest a strategy to stratify patients with HPS into two categories--those who are oxygen-responsive and those who are oxygen non-responsive with intractable hypoxemia.