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THE RESPIRATORY SYSTEM

Lung Cancer

A 60-year-old man undergoes surgery to remove his entire right lung as treatment for lung cancer. His left

lung is normal. Assume that, after full recovery, he maintains the same cardiac output and alveolar

ventilation as before, and the same CO2 production. What is the expected change, if any, in each of the

following parameters?

1. Pulmonary artery pressure

2. Pulmonary vascular resistance

3. PaO2

4. PaCO2

5. V/Q balance

6. Exercise tolerance

[ANSWER]

1-2. Pulmonary artery pressure and pulmonary vascular resistance will increase until the remaining lung

recruits (opens up) more pulmonary capillaries, as normally occurs after a pneumonectomy.

3-5. PaO2 and PaCO2 should remain the same because the remaining lung is handling increases in both

ventilation and perfusion (i.e.,V/Q ratios should not be significantly altered).

6. For the remaining lung to accommodate twice the ventilation it normally handles, it will greatly expand its

volume, even to the point of extending over to the other hemithorax. Exercise tolerance will fall because

the remaining lung is stretched to its limit, and there is no or little reserve for increasing alveolar

ventilation.