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Transient Intrapulmonary Shunting in a Patient Treated With b2-Adrenergic Agonists for Status Asthmaticus
Journal article   Open access   Peer reviewed

Transient Intrapulmonary Shunting in a Patient Treated With b2-Adrenergic Agonists for Status Asthmaticus

Melissa L. Bates, Joseph E. Jacobson and Marlowe W. Eldridge
Pediatrics (Evanston), Vol.133(4), pp.E1087-E1091
04/01/2014
DOI: 10.1542/peds.2013-1171
PMCID: PMC3966497
PMID: 24639274
url
https://doi.org/10.1542/peds.2013-1171View
Published (Version of record) Open Access

Abstract

Intrapulmonary arteriovenous anastomoses (IPAVs) are large-diameter pathways that directly connect the arterial and venous networks, bypassing the pulmonary capillaries. Ubiquitously present in healthy humans, these pathways are recruited in experimental conditions by exercise, hypoxia, and catecholamines and have been previously shown to be closed by hyperoxia. Whether they play a role in pulmonary pathophysiology is unknown. Here, we describe IPAV recruitment associated with hypoxemia and right-to-left shunt in a patient with status asthmaticus, treated with agonists of the B-2-adrenergic pathway. Our observation of IPAVs in a pediatric patient, mechanically ventilated with 100% O-2, suggests that these pathways are recruited in clinically important circumstances and challenges the notion that IPAVs are always closed by alveolar hyperoxia.
Life Sciences & Biomedicine Pediatrics Science & Technology

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