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The dynamics of the lung fluid filtration system in dogs with edema.

SUMMARY We studied the relationship between pulmonary microvasculature fluid filtration pressures and lung lymph flow rate (Q L) as filtration pressures increased to determine why lungs with functional lymphatics become edematous and, as filtration pressures decreased, to determine the effect of edema formation on lymphatic function. Edema was induced by rapid intravenous infusion of neutralized Ringer's solution in a volume equivalent to 30% of body weight in seven anesthetized dogs. Pulmonary microvascular pressure (Pmv) and (JL increased to 58 cm H2O and 40 ml/hr, respectively, during the infusion. Initially, QL increased slowly and the estimated net fluid filtration pressure (£p) increased rapidly with infusion. Later in the 30-minute infusion period, small increases in £ P produced greater changes in Q L. Over a 3-hour postinfusion period, Pmv and Q L decreased, but they remained significantly greater than baseline levels. During the postinfusion period, Q L was a linear function of Pmv and a logarithmic function of £P. Extravascular lung water content, measured postmortem, was 70% greater than normal. The relationship between Q L and £P during and after the infusion demonstrated marked hysteresis. These results suggest that extravascular fluid accumulated in the lung in part because the lymphatics responded relatively slowly to rapid increases in £ P. Furthermore, the data suggest that, although the lymphatics may not be a quantitatively important route for removal of edema fluid, the pressure-volume characteristics of the pulmonary interstitium seem to have a major influence on lymphatic function. DURING development of pulmonary edema, lym-phatic function may determine in what manner and to what degree fluid accumulates in the extravas-cular space of the lung. Erdmann et al. (1975) measured lung lymph flow rates in unanesthetized sheep subjected to steady state elevations in left atrial pressure. They found that each cm H 2 O increase in pulmonary microvascular pressure resulted in an increase in lymph flow rate of about 0.5 ml/hr with no apparent maximum in lymph flow rate over the pressure range studied. However, their data suggest that the rapidity of the response of the lymphatics to a change in transvascular fluid dynamics is a factor that must be considered in studying the relationship between lymph formation and the accumulation of pulmonary extravascular fluid. After development of pulmonary edema, the lym-phatics may continue the normal function of conservation of plasma filtrate. In addition, they may function as conduits for removing accumulated ex-travascular fluid (Pine et al., …