Chest

Chest

Volume 96, Issue 5, November 1989, Pages 1064-1069
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Clinical Investigations
Hemodynamic Disturbances and Va/Q Matching in Hypoxemic Cirrhotic Patients

https://doi.org/10.1378/chest.96.5.1064Get rights and content

Arterial oxygen desaturation is commonly found in patients with cirrhosis of the liver, but severe hypoxemia is unusual. To investigate the mechanism of the impairment in gas exchange, six severely hypoxemic (mean PaO2, 55.9±5.9 mm Hg) cirrhotic patients (five confirmed by biopsy), without pulmonary or cardiovascular disease and in the absence of acute hepatic disease, were submitted to right heart catheterization. Inequalities of Va/Q were estimated in the respiratory steady state using the multiple inert gas technique. The mean pulmonary arterial pressure was low (7.2±2.3 mm Hg) and the cardiac output high (Q=11.0±2.06 L/min), indicating a low PVR. The Va/Q mismatching of the ventilated and perfused units ranged from mild to moderate, but a large percentage of Q flowed through unventilated areas. Furthermore, there was a significant difference between predicted and measured PaO2 (9.27±5.9 mm Hg; p<0.01), which was attributed to either an unmeasured postpulmonary shunt (between portal and pulmonary vein) or a diffusion defect. The impairment in gas exchange in these patients is thus due primarily to an intrapulmonary, and possibly extrapulmonary, shunt. This was thought to be due mainly to an impaired regulatory mechanism of the microcirculation by the hepatic dysfunction.

Section snippets

Materials and Methods

Six patients (three men and three women) with clinical and laboratory evidence of cirrhosis of the liver (Table 1) were studied. A previous liver biopsy confirmed the diagnosis in five of them. In the sixth case the diagnosis was indicated by the presence of hepatomegaly, splenomegaly, esophageal varices, history of acute hepatic failure with edema, ascites, and biochemical evidence of hepatic deficiency. None of the patients had a history of intrinsic pulmonary or cardiac disease. There was no

Results

Measured gas exchange and hemodynamic data are shown in Table 3. In these patients with severe hypoxemia, the Ve was increased, and V˙o2 was raised, whereas the P v¯O2 was normal. Cardiac output and the CI were extremely high, while the PVR and the SVR were extremely low. Finally, the P50 was increased (29.5±1.5 mm Hg), which was in agreement with other studies.6

The Va/Q distribution of ventilated and perfused units (Fig 1) was little altered. The hypoxemia was mainly due to the large

Discussion

These data support the idea that ventilation/perfusion relationships can be affected by an impaired pulmonary circulation. Although these results were derived from a study of only six patients, they were highly concordant. Apart from the patent cirrhosis of the liver, the only criterion of selection of the patients was the severity of the hypoxemia without any history of pulmonary or cardiac disease. The data on pulmonary function are close to normal limits but indicate a tendency towards

ACKNOWLEDGMENTS

We thank Mrs. A. M. Lomenech for her invaluable technical assistance and Mrs. N. Capdeville for her secretarial help.

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    Copyright © 1989 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.