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Physiologic shunting in the lung in critically ill or injured patients

1970; Elsevier BV; Volume: 10; Issue: 12 Linguagem: Inglês

10.1016/0022-4804(70)90083-1

1095-8673

Robert F. Wilson, Paul A. Larned, John J. Corr, Edward J. Sarver, David M. Barrett,

Ultrasound in Clinical Applications

Physiologic shunting in the lung was measured in 200 critically ill or injured patients seen by the Shock Unit of the Detroit General Hospital from October, 1967, through October, 1969. There appeared to be some correlation between the degree of physiologic shunting and the incidence of subsequent death from respiratory failure. Shunts above 40% required intensive care and those above 60% were invariably lethal. The main factors which seemed to influence the degree of physiologic shunting were pH, shock, sepsis, and liver disease. Other factors which had a slight tendency to be associated with increased physiologic shunting were an increased cardiac output and anemia. There appeared to be a fairly close numerical relationship between shunting and alveolar—arterial oxygen differences (A-aDO2) on room air. Physiologic shunting in the lung may give early warning of impending respiratory failure, allowing intensive directed pulmonary care before the lung changes become irreversible. It may also serve as a useful tool in our attempts to learn more about respiratory failure.