Cardiopulmonary effects of unilateral airway pressure changes in intact infant lambs.

Direct effects of airway pressure changes on the pulmonary vascular bed of the intact infant lamb were studied under chloralose anesthesia using a preparation developed to permit independent ventilation of right and left lungs and independent measurement of right and left lung blood flow. A specially designed endobronchial tube eliminated the need for thoracotomy the day of study. Unilateral changes in positive end-expiratory pressure (PEEP) during volume-regulated ventilation increased ipsilateral but not contralateral airway pressure, confirming adequate separation of right and left lungs and suggesting rigidity of the mediastinum. Such interventions ( UPEEP ) at levels of 5, 10, and 15 cmH2O reduced ipsilateral but not contralateral pulmonary blood flow (by 10, 25, and 46%, respectively) but did not alter end-tidal PCO2 of either lung. UPEEP had less effect on cardiac output, stroke volume, right atrial, left atrial, esophageal, and pulmonary arterial pressures than did PEEP applied to both lungs. Because this preparation separates the predominantly direct effects of UPEEP on the ipsilateral lung from its indirect effects on the contralateral lung, it is well suited to studies of direct pulmonary vascular effects of airway pressure changes in an intact closed-chest preparation with reactive pulmonary vasculature.