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Ventilation-perfusion distributions and central hemodynamics in chronic obstructive pulmonary disease. Effects of
C V Ringsted1, K Eliasen, J B Andersen
1Department of Anaesthesia and Intensive Care, Herlev Hospital, University of Copenhagen, Denmark.
Abstract:
We studied the effects of intravenous terbutaline on VA/Q distributions and central hemodynamics in 11 patients with mixed-type COPD. Terbutaline caused an increase in VA/Q inequality in patients having PaO2 values greater than 60 mm Hg which resulted in a moderate fall in the PaO2. Patients with PaO2 values less than 60 mm Hg, the highest mean PAPs and the poorest spirometric performances demonstrated no significant changes in VA/Q distributions or PaO2 after terbutaline. Cardiac output increased 40 to 60 percent in all patients after terbutaline with an increase in tissue oxygen delivery. Mean PAP did not change in any patient after terbutaline and pulmonary vasodilatation was indicated by a decrease of calculated static PVR. The decrease of PaO2 after terbutaline in COPD is related to a further deterioration of existing VA/Q relationships. The cause of these effects and lack of such responses in patients with more advanced disease are discussed.