Pulmonary diffusing capacity for O2 and CO at rest and during exercise. Advantages of rebreathing techniques using stable isotopes.
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The lung volume, the morphometrically determined alveolar and capillary surface area, and the capillary volume of 27 dogs (weight 2.65-57 kg) all were linearly correlated with body weight. The thickness of the air-blood barrier increased only slightly with increasing body size. The structural diffusing capacity, containing these parameters, was used to estimate the gas exchange capabilities of the lung and was also found to scale in direct proportion to body size. This coincides with reports on physiologically estimated diffusing capacity but is obviously different from the interspecies slope for metabolism which scales to the 3/4 power of body weight.
Single breath diffusing capacities for carbon monoxide (DLco) were measured in 12 normal supine subjects before and after ingestion of 15 to 30 ml of 95 percent ethanol (ETOH) to determine if alcohol could acutely change the DLco. Both DLco and specific DLco (DLco/alveolar volume) were significantly decreased 90 minutes after the ingestion of alcohol. This change may be due to a direct effect of alcohol on the alveolar capillary interface by possibly interfering with a carbon monoxide carrier molecule. Another plausible explanation for the reduced diffusing capacity after ingestion of alcohol may be redistribution of blood from the lung to the periphery secondary to the hemodynamic effects of alcohol.
The relation of postural changes to the diffusing capacity of the lung for carbon monoxide (DLCO) was investigated in 12 normal nonsmokers in order to evaluate the influence of body position on several components of lung resistance to gas diffusion. The well-known increase in CO diffusing capacity in the supine position was obtained only for data corrected for alveolar volume (KCO: 6.18 +/- 0.75 vs. 5.45 +/- 0.67 ml/min/mm Hg/l; p less than 0.005). Moreover, only the membrane component (Dm) increased significantly in supine subjects (KDm = 2.81 +/- 1.32 vs. 1.82 +/- 0.54 ml/min/mm Hg/l; p less than 0.05), the increase in capillary blood volume (Vc) being not significant (KVc = 12.54 +/- 4.22 vs. 11.17 +/- 3.79 ml/l; NS). These data could be interpreted as a demonstration of a more homogeneously distributed ventilation with respect to diffusion surface in healthy young people in a supine position. The amount of surface available for diffusion seems therefore to be a limiting factor to gas flow across the lungs in these subjects. Thus a straightforward attribution of posturally influenced changes in CO diffusing capacity exclusively to factors affecting Vc is not recommended, particularly in pathological conditions, if information about variation in distribution of ventilation is unavailable.
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