title: Transient intrapulmonary shunting in a patient treated with β₂-adrenergic agonists for status asthmaticus.
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 B2-adrenergic pathway. Our observation of IPAVs in a pediatric patient, mechanically ventilated with 100% O₂, suggests that these pathways are recruited in clinically important circumstances and challenges the notion that IPAVs are always closed by alveolar hyperoxia.
authors.affiliation: Critical Care Division, Department of Pediatrics and the John Rankin Laboratory of Pulmonary Medicine, and.
authors.forename: Melissa L
authors.initials: ML
authors.lastname: Bates
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Jacobson
authors.forename: Marlowe W
authors.initials: MW
authors.lastname: Eldridge
mesh_terms: D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use*; D001163:Arteriovenous Anastomosis; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008168:Lung / Q000098:blood supply*; D013224:Status Asthmaticus / Q000188:drug therapy*
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists
keywords: asthma; gas exchange; intrapulmonary shunting; pediatrics; β2-adrenergic receptor