Bronchial vascular contribution to lung lymph flow

The lymphatic vessels of thelung provide an important route for clearance of interstitial edemafluid filtered from pulmonary blood vessels. However, the importance oflung lymphatics for the removal of airway liquid filtered from thesystemic circulation of the lung has not been demonstrated. We studiedthe contribution of the bronchial vasculature to lung lymph flow inanesthetized, ventilated sheep (n = 35). With the bronchial artery cannulated and perfused (control flow = 0.6 ml · min¹ · kg¹),lymph flow from the efferent duct of the caudal mediastinal lymph nodewas measured 1) during increasedbronchial vascular perfusion (300% of control flow);2) with a hydrated interstitium induced by a 1-h period of left atrial hypertension and subsequent recovery, both with and without bronchial perfusion; and3) during infusion (directly intothe bronchial artery) of bradykinin, an inflammatory mediator known tocause changes in bronchial vascular permeability. Increased bronchialperfusion for 90 min resulted in an average 35% increase in lung lymphflow. During left atrial hypertension, the increase in lung lymph flowwas significantly greater with bronchial perfusion (339% increase overbaseline) than without bronchial perfusion (138% increase).Furthermore, recovery after left atrial hypertension was more completeafter 90 min without bronchial perfusion (91%) than with bronchialperfusion (63%). Infusion of bradykinin into the bronchial arteryresulted in a prompt and prolonged 107% increase in lung lymph flow.This was not seen if the same dose was infused into the pulmonaryartery. Thus bronchial vascular transudate contributes significantly to lymph flow from the efferent duct of the caudal mediastinal lymph node.These results demonstrate that lymph vessels clear excess fluid fromthe airway wall and should be considered when evaluating the effect ofvascular leak in airway obstruction.