J Physiol Volume 586, Number 9, 2381-2391, May 1, 2008 DOI: 10.1113/jphysiol.2007.150128
SKELETAL MUSCLE AND EXERCISE |
The contribution of intrapulmonary shunts to the alveolar-to-arterial oxygen difference during exercise is very small
Ioannis Vogiatzis1,2,
Spyros Zakynthinos1,
Robert Boushel3,
Dimitris Athanasopoulos1,2,
Jordan A. Guenette4,
Harrieth Wagner5,
Charis Roussos1 and
Peter D. Wagner5
1 Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, M. Simou and G.P. Livanos Laboratories, National and Kapodistrian University of Athens, Athens, Greece
2
Department of Physical Education and Sport Sciences, National and Kapodistrian University of Athens, Athens, Greece
3
Department of Exercise Science, Concordia University Montreal, Quebec, Canada
4
School of Human Kinetics, University of British Columbia, Vancouver, Canada
5
Department of Medicine, University of California, San Diego, La Jolla, CA, USA
Exercise is well known to cause arterial
to fall and the alveolar–arterial
difference (Aa
) to increase. Until recently, the physiological basis for this was considered to be mostly ventilation/perfusion
/
inequality and alveolar–capillary diffusion limitation. Recently, arterio-venous shunting through dilated pulmonary blood vessels has been proposed to explain a significant part of the Aa
during exercise. To test this hypothesis we determined venous admixture during 5 min of near-maximal, constant-load, exercise in hypoxia (in inspired O2 fraction,
, 0.13), normoxia (
, 0.21) and hyperoxia (
, 1.0) undertaken in balanced order on the same day in seven fit cyclists (
, 61.3 ± 2.4 ml kg–1 min–1; mean ± S.E.M.). Venous admixture reflects three causes of hypoxaemia combined: true shunt, diffusion limitation and
/
inequality. In hypoxia, venous admixture was 22.8 ± 2.5% of the cardiac output; in normoxia it was 3.5 ± 0.5%; in hyperoxia it was 0.5 ± 0.2%. Since only true shunt accounts for venous admixture while breathing 100% O2, the present study suggests that shunt accounts for only a very small portion of the observed venous admixture, Aa
and hypoxaemia during heavy exercise.
(Received 19 December 2007;
accepted after revision 10 March 2008;
first published online 13 March 2008)
Corresponding author S. Zakynthinos: Medical School of Athens University, Department of Critical Care and Pulmonary Services, Evangelismos Hospital, 45–47 Ipsilandou Str. GR 106 75, Athens, Greece. Email: szakynthinos{at}yahoo.com
Copyright © 2008 The Physiological Society.