![]() Where is the net fluid absorption or filtration from the vasculature, is a filtration coefficient that describes the permeability of the capillary to fluid and is determined in part by the capillary surface area, and are the capillary and interstitial hydrostatic pressures, and are the capillary and interstitial oncotic pressures, and is a reflection coefficient that corrects the oncotic pressure for the permeability of the capillary to large proteins. The Starling equation illustrates this as Like in other tissues, fluid flux across the lung vasculature is thought to be determined by the balance between the vascular hydrostatic and oncotic pressures relative to the interstitial space. During high intensity exercise, in the face of increased blood flow and elevated capillary pressures, the lung is faced with the challenge of keeping the respiratory membrane intact and the alveolar surface dry. The surface area for gas exchange is immense (~1 × 10 4 cm 2), and the delicate, thin-walled vasculature has the capacity to be distended and recruited in order to accept a 5-fold increase in the cardiac output during exercise. The interface between the alveolus and capillary is exquisitely thin such that the diffusion distance between the alveolus and a red blood cell is only 1 μm. A couple of key anatomical and physiological features allow this almost twentyfold increase in the transport of oxygen from the alveolar region to the capillary network. The Challenge of Lung Fluid Handling during Exerciseĭuring exercise, the transport of oxygen across the pulmonary membrane increases from ~4 mL/kg/min at rest to over 75 mL/kg/min in endurance athletes performing maximal exercise. Finally, this paper discusses how these fields can continue to advance and the areas where clinical knowledge is lacking. ![]() It also discusses the mechanisms by which pulmonary edema can develop during land exercise, swimming, and diving and the current gaps in knowledge that exist. ![]() This paper addresses the current controversies that exist in the field of exercise-induced pulmonary edema on land and with water immersion. Yet, the development of pulmonary edema during swimming and diving is well established. The question of whether pulmonary edema develops during exercise on land is controversial.
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