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Recruitment of Lung Diffusing Capacity^*

Update of Concept and Application

^* From the Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas TX.

Correspondence to: Connie C. W. Hsia, MD, FCCP, Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas TX 75390-9034

Lung diffusing capacity (DL) for carbon monoxide (DLCO), nitric oxide (DLNO) or oxygen (DLO₂) increases from rest to peak exercise without reaching an upper limit; this recruitment results from interactions among alveolar volume (VA), and cardiac output (), as well as changing physical properties and spatial distribution of capillary erythrocytes, and is critical for maintaining a normal arterial oxygen saturation. DLCO and DLNO can be used to interpret the effectiveness of diffusive oxygen transport and track structural alterations of the alveolar-capillary barrier, providing sensitive noninvasive indicators of microvascular integrity in health and disease. Clinical interpretation of DL should take into account in addition to VA and hemoglobin concentration.

Key Words: cardiac output • diffusion-perfusion ratio • erythrocyte • exercise • hypoxemia

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