Collateral ventilation
Collateral ventilation is a back-up system of alveolar ventilation that can bypass the normal route of airflow when airways are restricted or obstructed. The pathways involved include those between adjacent alveoli (pores of Kohn), between bronchioles and alveoli (canals of Lambert), and those between bronchioles (channels of Martin).[1][2] Collateral ventilation also serves to modulate imbalances in ventilation and perfusion a feature of many diseases.[1] The pathways are altered in lung diseases particularly asthma, and emphysema.[3] A similar functional pattern of collateralisation is seen in the circulatory system of the heart.[4]
Interlobar collateral ventilation has also been noted and is a major unwanted factor in the consideration of
Pathways
In normal respiratory conditions, airflow is through the pathway of least resistance offered by the bronchial tree, to the alveoli and back to the bronchi and trachea.
Anatomy
The interalveolar pores of Kohn are epithelial-lined openings between adjacent alveoli, with a diameter of between three and thirteen
The bronchoalveolar canals of Lambert were described by Lambert as communications that reached from respiratory bronchioles to the alveolar ducts and sacs that they supplied. These canals have a muscular wall with possible regional airflow control. They range in size from partly closed to 30 μm.[6]
The interbronchiolar channels of Martin have a diameter of 30 μm and are found between
Interlobular channels have been described as short and tubular with a diameter of 200 μm.[1]
Clinical significance
The presence of interlobar collateral ventilation will affect the choice of
The intent of lung volume reduction is to achieve the complete collapse (
History
The pores of Kohn were described over a hundred years ago in 1893 but their functional relevance was disputed. It was only in 1931 that they were acknowledged as acting as collaterals, and the term collateral respiration was first used. In 1955 Lambert described accessory communicating channels between respiratory bronchioles and the alveoli, known as the canals of Lambert.
Other animals
Collateral ventilation is not present in horses who have a poor tolerance to airway obstruction but it is present in dogs who have a better tolerance for obstruction.[11]