The effect of blood flow and diffusion impairment on pulmonary gas exchange: a computer model

An assumption of the classical three-compartment lung model is that the physiologic shunt fraction (Qs/Qt) remains constant with changes in cardiac output (Qt). As a result, when Qt decreases, both the arterial O2 tension (PaO2) and the mixed venous O2 tension (PvO2) must also decrease. Yet observations in intact dogs with pulmonary edema and humans with the adult respiratory distress syndrome (ARDS) indicate that as Qt decreases, Qs/Qt occasionally declines while the PaO2 increases. The present study was conducted to examine these discordant observations using a computer model of pulmonary gas exchange with a diffusion impairment. A computer model of gas exchange was developed to specifically analyze the effect of changing Qt upon PaO2 and Qs/Qt in the presence of diffusion impairment. Using the classical three-compartment model of gas exchange, a diffusion impairment was inserted by a MIMIC subroutine. The results of this computer simulation indicated that in the presence of a diffusion impairment, lowering Qt caused PaO2 to increase while Qs/Qt and PvO2 decreased. These changes indicated that a diffusion impairment might account for the experimental observations of the effects of Qt on PaO2 in ARDS.