VentilationandPerfusion

dr.SriLestariSulistyoRini,MSc

TERM
VENTILATION :
the rate at which blood is supplied with O2

PERFUSION :
the rate at which O2 is removed (blood
flow)

Ventilation/perfusion ratio :
Ratio of ventilation to blood flow for a single
alveolus (VA/Q), or entire lung (VA/Qt)

AnatomicalDEADSPACE
Tidalvolumeisdistributedintodead
space(VD)andalveolarvolume(VA)
Theoropharynx,tracheaand
upperairwaysinthelung,which
donotparticipateingas
exchange,compriseVD

Conducting
airways
Gasexchange
airways

Alveolicomprisethegas
exchangecompartmentor
respiratoryzone,VA

Anatomical Dead Space

Normally represents 20-30% of the
minute ventilation
Influenced by
Size
Age : neonates 3.3 ml/kg, adults 2 ml/kg
Posture : supine < standing
- tidal
volume
Head and neck position
respiratory rate
Tracheal intubation/ tracheostomy
Bronchodilating/constricting drugs
4

Totalminute
ventilation

Deadspace
ventilation
Alveolar
ventilation

V T f
V

(V

Howmuchoftotal
minuteventilationis
"wasted"?

- V D ) f

Deadspacecanbemeasuredbytwomethods:
Fowler'ssinglebreathN2washout
Bohr'smethod
5

Alveolar Dead Space

Volume of alveoli that is ventilated
but not perfused
Usually negligible, unless
Low cardiac output
Pulmonary embolism
Posture

Physiology Dead Space

Anatomic + Alveolar Dead Space
In healthy individu represents 25-35%
of the minute ventilation
Factors influencing

Age : increases with age

Sex : slightly higher in men
Body size : app 2 mL/kg
Posture : due to anat dead space
Pathology : pulmonary embolism, smoking

Anatomicandphysiologicdeadspace
areessentiallyequalinthenormallung

NormalvaluesforVD/VT=0.200.35
(or2035%)

Alveolar ventilation

Minute volume = VExp = VT x f

Alveolar ventilation rate = VA = (VT -VD) x f

10

Ventilation-perfusion ratio
(V/Q)
It is the ratio of alveolar ventilation to
pulmonary blood flow per minute. The
alveolar ventilation at rest (4.2L/min) and
is calculated as:
Alveolar ventilation = respiratory rate x (tidal
volume dead space air).
The pulmonary blood flow is equal to right
ventricular output per minute (5L/min).

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Lets assume that there is a blockage of one

alveolar region

VA
Q

<<0.8

VA
Q

~0.8
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 Normally the V/Q ratio is closer to 0.8.

If V/Q ratio is 1
capillary PO2 will reach equilibrium with alveolar
PO2
there will be no alveolar arterial PO2 difference.
If V/Q ratio is Zero :
alveolar pO2 and pCO2 = mixed venous blood
(shunt)
If V/Q ratio is Infinity :
alveolar pO2 and pCO2 = inspired gasses
(alveolar dead space)
where ventilation and perfusion have normal

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This value is an average value across the

lung.
At the apex, V/Q ratio = 3.
At the base, V/Q ratio = 0.6.
So the apex is more ventilated than perfused, and
the base is more perfused than ventilated.

During exercise, the V/Q ratio becomes more

homogenous among different parts of the
lung.

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Regional Gas Exchange

in the Lung
Even in normal healthy individuals there is a
V/Q heterogeneity.
produced by an uneven distribution of
ventilation and perfusion among regions of the
lung.
Ventilation is greater in the lower (caudal)
region of the lung than in the upper (cranial)
region
Blood flow is also greater in the caudal
compared with the cranial region of the lung

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Regionalheterogeneityinventilation
Singlebreath133Xetest
Xehasverylowwatersolubility,soremainswithintheairspace;
imagedusingexternaldetectors

RegionalVAisindeedgreateratthebaseofthelunginan
uprightindividual

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PO2=40
PCO2=45

50

PO2=100
PCO2=40

LowVA/Q
PCO2(mmHg)

Base

NormalVA/Q

PO2=150
PCO2=0

Apex
.

HighVA/Q
50

100
PO2(mmHg)

150
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perfusion
Pa

PA

Pv

PA
Pa

Pv

PA
Pa

Pv

Zone1
PA>Pa>Pv
LowFlow

Zone2
Pa>PA>Pv
Waterfall
Zone3
Pa>Pv>PA
HiFlow

Zonesofthelung
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 The lung may be

considered to
comprise 3
compartments:
Ventilated but
unperfused alveoli
Alveolar dead space

Perfused but
unventilated alveoli
Intrapulmonary shunt

Ideally perfused &

ventilated alveoli

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Characteristics of the Pulmonary Circulation

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Special Characteristics of the Pulmonary Circulation

Systemic Circ.

Pulmonary Circ.

C.O. (L/min)

6.0

5.9

Arterial B.P. (mm Hg)

100

>>

15

Venous B.P. (mm Hg)

Vascular resistance (P/flow)

100-2/6=16.3

>

15-5/5.9=1.7

Vascular compliance (V/P)

Csystemic

<<

Cpulm
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Special Characteristics of the Pulmonary Circulation: high compliance

Ability to promote a decrease in resistance as blood pressure rises

viscosity

Remember that resistance to Flow =

R=

length

8l
r4

radius

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Special characteristic of blood vessels surrounding alveoli:

hypoxic vasoconstriction
When PO2 within the alveoli decreases there is a decrease in blood
flow to that alveolus
This is called hypoxic vasoconstriction

Thought to be the result of O2-sensitive K+ channels in the smooth

muscle membrane. At low O2 the K+ channels close, the Em rises,
and the cell reaches threshold and depolarizes and contracts.
ell
c
e
scl
u
m
th
o
o
sm

This phenomenon is just the opposite of

the response to hypoxia you get with
arteriole smooth muscle in the systemic
circulation, but it is an important feature
of the pulmonary circulation that helps to
match perfusion with ventilation
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Pulmonary blood vessels are much more compliant than systemic blood vessels.
Also the system has a remarkable ability to promote a decrease in resistance as the
blood pressure rises.

Two reasons are responsible:

Recruitment: opening up of previously closed vessels
Distension: increase in caliber of vessels

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Gas exchange at alveolar and systemic capillaries

Inspired air:
PO2 = 158 mm Hg
PCO2 = 0.3 mm Hg

Expired air:
PO2 = 116 mm Hg
PCO2 = 32 mm Hg

Pu
lmo
nar
y

Right Heart

vei
n

Left Heart

ta
Aor
Arterial blood
PO2 = 95 mm Hg
PCO2 = 41 mm Hg
(physiological shunt)

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Gas exchange is optimal when

ventilation and perfusion are going to
the same places and to the extent that
they are not, gas exchange suffers.
In an extreme case, if all the blood flow
went to the right lung and all the
ventilation went to the left, the person
might have normal cardiac output and
normal alveolar ventilation and no gas
exchange.
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Ventilation/perfusion
mismatch
Main cause of hypoxemia in lung
diseases
O2 transport/perfusion inhomogeneity
probably also in other organs

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Matching respiration & blood flow:

the Ventilation-Perfusion Ratio
Ventilation
Alveolarventilation,VA
VA=(VTVD)xresp.rate
=(0.50.15)x12=4.2L/min

Perfusion
Cardiacoutput=C.O.=Q
Q=strokevol.xheartrate
=(0.086)x70=6.0L/min

VA
Q

=ventilation/perfusion~0.8

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Pathological Examples of Altered Respiratory Mechanics

Normal

Exercise

Emphysema

Capillary enlargement
(e.g., Mitral Stenosis)

Asthma

Pulm.
Circ.

Longer paths
for diffusion

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SHUNTS
the mixing of deoxygenated blood from systemic
veins with oxygenated blood coming from
pulmonary capillaries.
Shunt occurs when blood flows from the venous
system to the arterial system without being
oxygenated.
Shunts are classified as anatomic or physiologic;
(a small anatomic shunt [2-3%] is normal).
Physiologic shunts are caused by alveolar
collapse or alveoli filled with a substance other
than air.
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 Shunt (the maximal ventilation perfusion

mismatch [V/Q ratio of zero]) significantly reduces
PaO2.
Causes ;
the Thebesian circulation which perfuses the
left ventricle and empties directly into the left
ventricle without passing through the lung.
Lung tissue itself must be perfused (bronchial
circulation), and this blood empties into
pulmonary veins, mixing with pulmonary
capillary blood.
Congenital heart defects (Tetralogy of Fallot)
Pulmonary pathology (Athelectasis/PNEUMONIA)
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Forced capacity (FVC &

FEV1)
( N ) FEV 1
Normal

( N ) VC
Obstructive ( N ) FEV 1
or ( N ) VC
Restrictive

( N ) FEV 1
or ( N ) VC
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TIDAL
BREATHING

FORCED
EXPIRATION
NORMAL

FEV1

FEV1

FEV1 = 3.0L
FVC = 4.2L
FEV1/FVC = 72%

OBSTRUCTIVE
FEV1 = 0.9L
FVC = 2.3L
FEV1/FVC = 40%

RESTRICTIVE
FEV1

1 SECOND

FEV1 =1.8L
FVC = 2.3L
FEV1/FVC = 78%
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Terima kasih

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