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* From the Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Correspondence to: Connie C. W. Hsia, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9034; e-mail: Connie.Hsia{at}utsouthwestern.edu
Study objectives: To validate lung diffusing capacity for nitric oxide (DLNO) as an index of conductance of the alveolar-capillary membrane during exercise, we compared DLNO to lung diffusing capacity for carbon monoxide (DLCO) and pulmonary membrane diffusing capacity for carbon monoxide (DMCO), and compared pulmonary capillary blood volume (Vc) calculated by two methods.
Setting and
participants: The study was performed at a university medical
center involving 12 nonsmoking healthy volunteers (age range, 23 to 79
years). DLCO, DLNO, cardiac output (
c),
and lung volume were measured simultaneously at rest and during graded
ergometer exercise by a rebreathing technique. Pulmonary membrane
diffusing capacity and Vc were compared by (1) the classic technique of
Roughton and Forster from DLCO measured at two alveolar
oxygen tension (PAO2) levels, and (2) from
DLNO and DLCO assuming negligible erythrocyte
resistance to nitric oxide (NO) uptake, ie,
DLNO approximately equal to pulmonary membrane diffusing
capacity for nitric oxide.
Results: In all
subjects, DLNO increased linearly from rest to exercise;
age, c, and lung volume were the major determinants of
DLNO by stepwise regression analysis. The
DLNO/DLCO ratio averaged 3.98 ± 0.38
(± SD) and the DLNO/DMCO ratio averaged
2.49 ± 0.28 irrespective of exercise intensity. Changing
PAO2 did not alter DLNO. Brief
exposure to 40 ppm of inhaled NO during 16 s of rebreathing did
not alter either DLCO or c. Estimates of pulmonary
membrane diffusing capacity and Vc by the two methods showed a strong
correlation.
Conclusion: Results support DLNO as a direct measure of pulmonary membrane diffusing capacity, allowing the estimation of Vc in a single rebreathing maneuver during exercise. The DLNO-DLCO rebreathing technique can be applied clinically in the investigation of pulmonary microvascular regulation.
Key Words: carbon monoxide • cardiac output • lung diffusing capacity • pulmonary capillary blood volume • rebreathing technique
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