CIBA Foundation Symposium on Pulmonary Structure and Function

By A. V. S. De Reuck; Maeve O'Connor | Go to book overview

THE DEGREE OF VARIATION OF BLOOD PERFUSION AND OF VENTILATION WITHIN THE EMPHYSEMATOUS LUNG, AND SOME RELATED CONSIDERATIONS

W. A. BRISCOE and A. COURNAND

Department of Medicine, Columbia University, College of Physicians and Surgeons, and the Cardio-Pulmonary Laboratory of the First Medical and Chest Services, Columbia University Division, Bellevne Hospital, New York City

IT has long been known that even in normal lungs there is some degree of uneven ventilation ( Krogh and Lindhard, 1913) and that in emphysematous lungs this unevenness may become extreme ( Siebeck, 1911; Sonne, 1936). This was based on single-breath methods which detect uneven ventilation and empirically assess its degree. The steady-state wash-in washout methods, introduced by Darling, Cournand and Richards ( 1940), extended these observations but they did not begin to be used and interpreted fully, with physical methods of gas analysis and logarithmic plotting of data, until about a decade ago. Only since then has it been realized that this unevenness of ventilation in emphysema is of one particular type ( Robertson, Siri and Jones, 1950; Fowler, Cornish and Kety, 1952; Briscoe, 1952), a large fraction of the functional residual capacity (F.R.C.) being poorly ventilated and a small fraction being well ventilated. Total alveolar ventilation is normal or more than normal, although one must realize that the alveolo-arterial carbon dioxide difference resulting from bad distribution leads those who equate arterial and alveolar carbon dioxide tensions into gross underestimates of alveolar ventilation.

In considerations of the possible variation of function between

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