Effects of air embolism on sheep lung fluid volumes

Changes in lung fluid volumes and hyaluronan clearance were measured in six awake sheep during increased microvascular permeability induced by pulmonary air embolism (AE). After a 1- to 2-h baseline, filtered room air was infused through a proximal port of a Swan-Ganz catheter for 2 h at a rate sufficient to double pulmonary vascular resistance. The air infusion was discontinued, and the sheep were monitored for an additional 2 h (recovery). Lung lymph flow and protein flux increased during air infusion and continued to increase during recovery. During AE, lymph-to-plasma ratio for albumin decreased while lymph-to-plasma ratio for large protein remained the same. This would suggest that both microvascular pressure and microvascular permeability increase during AE. Protein clearance increased similarly for all protein sizes during AE and recovery. After 2 h of recovery, interstitial and extravascular volumes were elevated with no change in cellular volume. The volume of the interstitium available to albumin was more than twice control. The fraction of the interstitium that excludes albumin was calculated to be 0.32 +/- 0.04, with a 51% reduction in absolute excluded volume 2 h after AE. Clearance of hyaluronan by the lymphatics (normalized to baseline) increased 6- to 10-fold during and after AE. It was estimated that < 2% of the total hyaluronan in the lung would be cleared in 24 h under baseline conditions. This amount increased to approximately 11% under AE conditions and approximately 15% under recovery conditions. Changes in lung fluid volumes and protein clearance indicate increased microvascular permeability 2 h after AE.(ABSTRACT TRUNCATED AT 250 WORDS)