Do alterations in pulmonary vascular tone result in changes in central blood volumes? An experimental study.

Background: The effects of selective pulmonary vascular tone alterations on cardiac preload have not been previously examined. Therefore, we evaluated whether changing pulmonary vascular tone either by hypoxia or the inhalation of aerosolized prostacyclin (PGI) altered intrathoracic or pulmonary blood volume (ITBV, PBV, respectively), both as surrogate for left ventricular preload. Additionally, the mean systemic filling pressure analogue (Pmsa) and pressure for venous return (Pvr) were calculated as surrogate of right ventricular preload.

Methods: In a randomized controlled animal study in 6 spontaneously breathing dogs, pulmonary vascular tone was increased by controlled moderate hypoxia (FiO about 0.10) and decreased by aerosolized PGI. Also, inhalation of PGI was instituted to induce pulmonary vasodilation during normoxia and hypoxia. PBV, ITBV and circulating blood volume (Vd) were measured using transpulmonary thermo-dye dilution. Pmsa and Pvr were calculated post hoc. Either the Wilcoxon-signed rank test or Friedman ANOVA test was performed.

Results: During hypoxia, mean pulmonary artery pressure (PAP) increased from median [IQR] 12 [8-15] to 19 [17-25] mmHg (p < 0.05). ITBV, PBV and their ratio with Vd remained unaltered, which was also true for Pmsa, Pvr and cardiac output. PGI co-inhalation during hypoxia normalized mean PAP to 13 (12-16) mmHg (p < 0.05), but left cardiac preload surrogates unaltered. PGI inhalation during normoxia further decreased mean PAP to 10 (9-13) mmHg (p < 0.05) without changing any of the other investigated hemodynamic variables.

Conclusions: In spontaneously breathing dogs, changes in pulmonary vascular tone altered PAP but had no effect on cardiac output, central blood volumes or their relation to circulating blood volume, nor on Pmsa and Pvr. These observations suggest that cardiac preload is preserved despite substantial alterations in right ventricular afterload.