Regional pulmonary blood flow during acute pulmonary edema: a PET study

We used positron emission tomography to evaluate the effects of nitroprusside or prostacyclin (NP/Prost) on regional pulmonary blood flow (rPBF) in 21 dogs after oleic acid- (OA) induced acute pulmonary edema and compared the results with data from 11 dogs given OA only and 5 given meclofenamate after OA. After OA only, a progressive decrease in rPBF occurred in edematous gravity-dependent lung regions, but only in 6 of 11 dogs. In these six dogs, rPBF fell 41 +/- 12% compared with base line or with the other five dogs (3 +/- 19%) (P less than 0.05). In the NP/Prost group, the vasodilators failed to reverse any change in rPBF after OA but did prevent additional derecruitment until the drug infusion was stopped, after which rPBF to the edematous regions decreased further. In contrast, meclofenamate after OA temporally accelerated but did not quantitatively enhance rPBF reduction in edematous lung regions. Thus, in this model, vessels in edematous lung regions remain vasoreactive only until derecruited. We speculate that the mechanism of derecruitment involves an interaction between edema accumulation and vasoconstriction, in which the actual pattern of rPBF after lung injury represents a balance between mechanisms responsible for vascular derecruitment and vasodilation from prostacyclin production.