Micromechanics of alveolar edema

Am J Respir Cell Mol Biol. 2011 Jan;44(1):34-9. doi: 10.1165/rcmb.2009-0005OC. Epub 2010 Jan 29.

Abstract

The decrease of lung compliance in pulmonary edema underlies ventilator-induced lung injury. However, the cause of the decrease in compliance is unknown. We tested the hypothesis that in pulmonary edema, the mechanical effects of liquid-filled alveoli increase tissue stress in adjacent air-filled alveoli. By micropuncture of isolated, perfused rat lungs, we established a single-alveolus model of pulmonary edema that we imaged using confocal microscopy. In this model, we viewed a liquid-filled alveolus together with its air-filled neighbor at different transpulmonary pressures, both before and after liquid-filling. Instilling liquid in an alveolus caused alveolar shrinkage. As a result, the interalveolar septum was stretched, causing the neighboring air-filled alveolus to bulge. Thus, the air-filled alveolus was overexpanded by virtue of its adjacency to a liquid-filled alveolus. Confocal microscopy at different depths of the liquid-filled alveolus revealed a meniscus. Lung inflation to near-total lung capacity (TLC) demonstrated decreased compliance of the air-filled but not liquid-filled alveolus. However, at near TLC, the air-filled alveolus was larger than it was in the pre-edematous control tissue. In pulmonary edema, liquid-filled alveoli induce mechanical stress on air-filled alveoli, reducing the compliance of air-filled alveoli, and hence overall lung compliance. Because of increased mechanical stress, air-filled alveoli may be susceptible to overdistension injury during mechanical ventilation of the edematous lung.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Air Pressure
  • Animals
  • Functional Residual Capacity
  • Lung Compliance
  • Male
  • Microscopy, Confocal
  • Models, Biological
  • Perfusion
  • Pulmonary Alveoli / injuries
  • Pulmonary Alveoli / pathology
  • Pulmonary Alveoli / physiopathology*
  • Pulmonary Edema / pathology
  • Pulmonary Edema / physiopathology*
  • Pulmonary Edema / therapy
  • Rats
  • Rats, Sprague-Dawley
  • Serum Albumin / administration & dosage
  • Stress, Mechanical
  • Surface Tension
  • Total Lung Capacity
  • Ventilator-Induced Lung Injury / etiology
  • Ventilator-Induced Lung Injury / physiopathology

Substances

  • Serum Albumin