Surface tension and alveolar changes during ventilation

  • Carl E. Bredenberg
Part of the Developments in Critical Care Medicine and Anaesthesiology book series (DCCA, volume 1)


The clinical experience of the last 20 years has amply demonstrated the importance of acute pulmonary failure and the need for respiratory support in critically ill patients [8, 43, 44]. The importance of pulmonary failure and respiratory care have been emphasized even when the patient’s primary disease does not originate in the lungs. This became apparent to me over 15 years ago while working in a clinical research unit at the Walter Reed Army Hospital. Although the indication for patient admission to this unit was hemodynamic failure (shock), 3/4 of the patients required mechanical ventilatory support, and a direct correlation between severity of pulmonary failure and mortality was demonstrated [7]. Further clinical research activities by United States Military Medical teams functioning in forward hospitals during the Viet Nam conflict confirmed the importance of pulmonary failure in patients suffering major trauma even when the lung was not directly injured [51, 52]. The result of numerous clinical observations such as these provided a powerful impetus to the laboratory study of normal lung function and the impact of disease on the lung. Much has been learned at the bedside and in the laboratory; and as a result the pulmonary care of acutely and critically ill patients has been immensely improved. On the other hand, it may be argued that one of the most important things we have learned both in the laboratory and at the bedside is the depth of our ignorance.


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  1. 1.
    Albert RK, Lakshminarayan S, Butler J: Increased surface tension favors pulmonary edema. Clin Res 26: 134A, 1978.Google Scholar
  2. 2.
    Anthonisen NR: Effect of volume with volume history of the lung on pulmonary shunt flow. Am J Physiol 207: 235–238, 1964.PubMedGoogle Scholar
  3. 3.
    Assimacopoulos A, Guggenheim R, Kapanci Y: Changes in alveolar capillary configuration at different levels of lung inflation in the rat: an ulstructural and morphometric study. Lab Invest 34: 10–22, 1976.PubMedGoogle Scholar
  4. 4.
    Avery MG, Mead J: Surface properties in relation to atelectasis and hyaline membrane disease. Am J Dis Child 97:517 –523, 1969.Google Scholar
  5. 5.
    Bachofen H, Gehr P, Weibel ER: Alterations of mechanical properties and morphology in excised rabbit lungs rinsed with a detergent. J Appl Physiol (Respir Environ Exerc Physiol) 47: 1002–1010, 1979.Google Scholar
  6. 6.
    Boyle J, Englestein ES, Sinoway LI: Mean air space diameter, lung surface area and alveolar surface tension. Respiration 34:241– 249, 1977.PubMedCrossRefGoogle Scholar
  7. 7.
    Bredenberg CE, James PM, Collins J, Anderson RW, Martin AM, Hardaway RM: Respiratory failure in shock. Ann Surg 169: 392–403, 1969.PubMedCrossRefGoogle Scholar
  8. 8.
    Bredenberg CE: Acute respiratory distress. Surg Clin North Am 54: 1043–1066, 1974.PubMedGoogle Scholar
  9. 9.
    Bredenberg CE, Webb WR: Experimental pulmonary edema: the effect of unilateral PEEP on the accumulation of lung water. Ann Surg 189: 433–438, 1979.PubMedGoogle Scholar
  10. 10.
    Brunderman I, Sowers K, Hamilton WK, Tooley WH, Buther J: Effective surface tension on circulation in excised lungs of dogs. J Appl Physiol 19: 707–712, 1964.Google Scholar
  11. 11.
    Clements JA: Dependence of pressure volume characteristics of lungs on intrinsic surface active material. Am J Physiol 187: 592, 1956.Google Scholar
  12. 12.
    Clements JA, Hostead RF, Johasoa RP, Grikotz I: Pulmonary surface tension and alveolar stability. J Appl Physiol 16: 444–450, 1961.PubMedGoogle Scholar
  13. 13.
    Clements JA: Pulmonary edema and permeability of alveolar membranes. AM A Arch Environ Health 2: 280–283, 1961.Google Scholar
  14. 14.
    Daly BDT, Parks GE, Edmonds CH, Hibbs CW, Norman JC: Dynamic alveolar mechanics as studied by video microscopy. Respir Physiol 24: 217–232, 1975.PubMedCrossRefGoogle Scholar
  15. 15.
    D’Angelo E: Local alveolar size and transpulmonary pressure in situ on isolated lungs. Respir Physiol 14: 251, 1972.PubMedCrossRefGoogle Scholar
  16. 16.
    Dunnil MS: Effect of lung inflation on alveolar surface area in the dog. Nature (London) 214: 1013, 1967.CrossRefGoogle Scholar
  17. 17.
    Flicker E, Lee JS: Equilibrium of force of subpleural alveoli: implications to lung mechanics. J Appl Physiol 36: 366 - 374, 1974.PubMedGoogle Scholar
  18. 18.
    Forrest JB: The effects of changes in lung volume on the size and shape of alveoli. J Physiol (London) 210–533, 1970.Google Scholar
  19. 19.
    Forrest JB: Lung tissue plasticity: morphometric analysis of anisotropic strain in liquid filled lungs. Respir Physiol 27: 223–239, 1976.PubMedCrossRefGoogle Scholar
  20. 20.
    Fung YC: Does the surface tension make the lung inherently unstable? Circ Res 37:497– 502, 1975.Google Scholar
  21. 21.
    Gil J, Weibel ER: Morphological study of pressure-volume hysteresis in rat lungs fixed by vascular perfusion. Respir Physiol 15: 190–213, 1972.PubMedCrossRefGoogle Scholar
  22. 22.
    Gil J, Bachoren H, Gehr P, Weibel ER: Alveolar volume-surface area relation in air- and saline-filled lungs fixed by vascular perfusion. J Appl Physiol (Respir Environ Exerc Physiol) 47: 990–1001, 1979.Google Scholar
  23. 23.
    Guyton AC, Taylor AE, Drake RE, Parker JC: Dynamics of subatmospheric pressure in the pulmonary interstitial fluid. Ciba Found Symp 38: 77–100, 1976.PubMedGoogle Scholar
  24. 24.
    Hildebrandt J: Lung surfactant mechanics: some unresolved problems. In: Davies DG, Barnes CD (eds) Regulation of ventilation and gas exchange. New York: Academic Press, 1978, pp 261–297.CrossRefGoogle Scholar
  25. 25.
    Hildebran JN, Goerke J, Clements J A: Pulmonary surface film stability and composition. J Appl Physiol 47: 604–611, 1979.PubMedGoogle Scholar
  26. 26.
    Hopewell PC: Failure of positive and end-expiratory pressure to decrease lung water content in alloxan-induced pulmonary edema. Am Rev Respir Dis 120: 813–819, 1979.PubMedGoogle Scholar
  27. 27.
    Hoppin FG, Hildebrandt J: Mechanical properties of the lung. In: West JB (ed) Bioengineering aspects of the lung. New York: Marcel Dekker, 1977, pp 83 –162.Google Scholar
  28. 28.
    Horn LW: Evaluation of some alternative mechanisms for interface-related stress relaxation in lung. Respir Physiol 34: 345–357, 1978.PubMedCrossRefGoogle Scholar
  29. 29.
    Hughes JMB: Pulmonary circulation and fluid balance. In: Widdicombe JG (ed) International review of physiology: respiratory physiology II. Baltimore: University Park Press, 1977, pp 135–183.Google Scholar
  30. 30.
    King RJ: Pulmonary surface active material: basic concepts. Perinat Dev Med 14: 3–11, 1978.Google Scholar
  31. 31.
    Klingele TG, Staub NC: Alveolar shape changes with volume and isolated are filled lobes of cat lung. J Appl Physiol 28: 411, 1970.PubMedGoogle Scholar
  32. 32.
    Lloyd TC, Wright DW: Pulmonary vascular resistance and vascular transmural gradient. J Appl Physiol 15: 241–245, 1960.PubMedGoogle Scholar
  33. 33.
    Macklem PT: Respiratory mechanics. Annu Rev Physiol 40: 157–184, 1978.PubMedCrossRefGoogle Scholar
  34. 34.
    Macklin CC: Alveoli mammalian lung: anatomical study with clinical correlation. Proc Inst Med (Chicago 1878 ), 1950.Google Scholar
  35. 35.
    Mead J: Mechanical properties of lungs. Physiol Rev 41:281 –330, 1961.Google Scholar
  36. 36.
    Mead J, Takishima T, Leith D: Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol 28: 596–608, 1970.PubMedGoogle Scholar
  37. 37.
    Nakahara K, Snashall PD, Staub NC: Isogravimetric microvascular pressure in the isolated, perfused dog lung lobe: an estimate of perimicrovascular tissue pressure. J Physiol 265: 34P–35P, 1977.PubMedGoogle Scholar
  38. 38.
    Nielson D, Olsen DB: The role of alveolar recruitment and derecruitment in pressure-volume hysteresis in lungs. Respir Physiol 32: 63–77, 1978.PubMedCrossRefGoogle Scholar
  39. 39.
    Nieman GF, Clark WR Jr, Wax SD, Webb WR: The effect of smoke inhalation on pulmonary surfactant. Ann Surg 191: 45–55, 1980.CrossRefGoogle Scholar
  40. 40.
    Nieman GF, Bredenberg CE, Clark WR, West NR: Alveolar function following surfactant deactivation. J Appl Physiol 51: 895–904, 1981.PubMedGoogle Scholar
  41. 41.
    Pattle RE: Properties, function and origin of the alveolar lung layer. Proc R Soc Lond 148: 217 - 240, 1958.PubMedCrossRefGoogle Scholar
  42. 42.
    Pattle RE: The relation between surface tension and area in the alveolar lining film. J Physiol 269: 591–604, 1977.PubMedGoogle Scholar
  43. 43.
    Pontoppidan H, Laver MB, Geffin B: Acute respiratory failure in the surgical patient. Adv Surg 4: 163–254, 1970.PubMedGoogle Scholar
  44. 44.
    Pontoppidan H, Geffin B, Lowenstein E: Acute respiratory failure in the adult. N Engl J Med medical progress series. Boston: Little, Brown and Company, 1973.Google Scholar
  45. 45.
    Radford EP Jr, McLaughlin M: Dependence of lung mechanical properties on anatomical relationship with terminal air units. Fed Proc 15: 147, 1956.Google Scholar
  46. 46.
    Reifenrath R: The significance of alveolar geometry and surface tension in the respiratory mechanics of the lung. Respir Physiol 24: 115–137, 1975.PubMedCrossRefGoogle Scholar
  47. 47.
    Ryan RF, Liau DF, Loomis Bell AL, Hashim SA, Barrett CR: Correlation of lung compliance and quantities of surfactant phospholipids after acute alveolar injury from N-nitroso-N- methylurethane in the dog. Am Rev Respir Dis 123: 200–204, 1981.PubMedGoogle Scholar
  48. 48.
    Sanderson RJ, Paul GW, Vatter AE, Filley GF: Morphologic and physical basis for lung surfactant action. Respir Physiol 27: 379–392, 1976.PubMedCrossRefGoogle Scholar
  49. 49.
    Scarpelli EM: The surfactant system of the lung. Int Anesthesiol Clin 15: 19–60, 1977.PubMedCrossRefGoogle Scholar
  50. 50.
    Schurch S, Goerke A, Clements J A: Direct determination of volume- and time-dependence of alveolar surface tension in excised lungs. Proc Natl Acad Sci USA 75: 3417–3421, 1978.PubMedCrossRefGoogle Scholar
  51. 51.
    Simmons RL, Heisterkamp CA III, Collins J A, Bredenberg CE, Millis DE, Martin AM Jr: Respiratory insufficiency in combat casualties: IV. Hypoxemia during convalescence. Ann Surg 170: 53–62, 1969.PubMedCrossRefGoogle Scholar
  52. 52.
    Simmons RL, Heisterkamp CA III, Collins J A, Bredenberg CE, Martin AM: Acute pulmonary edema in battle casualties. J Trauma 9: 760–775, 1969.PubMedCrossRefGoogle Scholar
  53. 53.
    Story WF, Staub SC: Ventilation of terminal air. J Appl Physiol 17: 319, 1962.Google Scholar
  54. 54.
    Thurlbeck WM: Structure of lungs. Respiration physiology II. Int Rev Physiol 14: 1977, Baltimore, pp 1–36.Google Scholar
  55. 55.
    Weibel EP: Morphometries. In: Fenn WO, Rahn H (eds) Handbook of physiology, section 3: Respiration, vol 2. Washington DC: American Physiological Society, 1965, pp 288.Google Scholar
  56. 56.
    Wilson TA: Parenchymal mechanics at the alveolar level. Fed Proc 38: 7–10, 1979.PubMedGoogle Scholar
  57. 57.
    Wilson TA: Relations among recoil pressure, surface area, and surface tension in the lung. J Appl Physiol 5 05:921 –920, 1981.Google Scholar
  58. 58.
    Wilson TA: Effect of alveolar wall shape on alveolar water stability [letter to the editor]. J Appl Physiol 501: 222–225, 1981.Google Scholar
  59. 59.
    Woodson RD, Roab DE, Ferguson DJ: Pulmonary hemodynamics following acute atelectasis. Am J Physiol 205: 53–56, 1963.PubMedGoogle Scholar
  60. 60.
    Wyszogrodski I, Taeusch HW, Kyei-Aboagye A, Avery ME: Mechanical regulation of alveolar surfactant in adult cats: the effects of hyperventilation and end-expiratory pressure in vivo. Chest 67: 15S–16S, 1975.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media Dordrecht 1982

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  • Carl E. Bredenberg

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