B.

4 Pulmonary gas volumes and ventilation

a. Explain the measurement of lung volumes and capacities and indicate the
normal values.
8
The total volume of gas the lung can
contain is total lung capacity (TLC). This is
divided into the volume which can not be
exhaled which is residual volume (RV) and the
proportion which can be exhaled: vital capacity 6
(VC). IRV
The volume moved in resting

Lung vol. (l)

ventilation is known as tidal volume (TV) and
the volume remaining in the lung at the end of a VC
4
normal breath is functional residual capacity TLC
(FRC). The volumes which can be inspired or TV
exhaled in addition to TV are called inspiratory
and expiratory reserve volumes (IRV and ERV) ERV
VC, TV, IRV and ERV can easily be 2
measured by a spirometer. FRC can be FRC
measured by helium dilution and RV and TLC RV
derived from these measurements. Alternatively
FRC can be measured by nitrogen washout with 0
100% oxygen over several minutes.
FRC can also be measured in a plethysmograph using a manometer to measure
pressure change in the chamber and also in the airway during inspiration against a closed
tube. The volume change of the chest can be derived from the pressure change in the
chamber and the volume of gas in the chest determined from its volume change and
pressure change. This measures the total gas volume in the chest, including areas which
are not being ventilated, unlike the helium dilution method which measures the ventilated
volume.
The functions of FRC are as an oxygen reserve, to prevent airway closure, to
smooth alveolar gas composition and to minimize PVR, work of breathing and V/Q
mismatch.

Typical values (l)

TLC 6
VC 4.8
RV 1.2
TV 0.5
FRC 2.4
These are highly variable according to body size. The values given are for a 1.8 m male,
normal VCs range from 2.5 to 7 l.

Normal ventilation at rest consists of about 15 breaths/min of a TV of 0.5 l, giving

a ventilation of 7.5 l/min. Each breath ventilates an anatomic dead space (upper airways
not participating in gas exchange) of about 150 ml or 2.25 l/min. This leaves 5.25 l/min of
alveolar ventilation. This is roughly equal to pulmonary blood flow at rest of about 5 l/min.
These values can be measured with the spirometer except for dead space and
alveolar ventilation. Dead space can be measured using a N2 washout curve, giving
anatomic dead space. Physiological dead space can be determined from the CO2 output of
the lung if tidal volume and expired and alveolar (or arterial) CO2 are measured:
VT PECO2 = VA PACO2
VD = VT - VA
VD = VT (1 - PECO2 ÷ PACO2)
Once dead space has been measured, alveolar ventilation can be calculated.
Respiratory ventilation 1.B.4.1 James Mitchell (December 24, 2003)
b. Describe the factors influencing lung volumes and capacities.

Body size and sex are major determinants of lung volumes. VC varies
approximately linearly with height and decreases gradually with age. These relationships
are described empirically:

male VC = 5.2 h - 0.022 a - 3.6 ( ± 0.58)

female VC = 5.2 h - 0.018 a - 4.6 ( ± 0.42)

where VC is in litres, h is height in metres, and a age in years. Thus VC falls about
20 ml/year.
Any disease process which occupies space in the thorax will reduce TLC and
consequently VC. Pleural effusion is an example of a pathology which results in
compression of the lung. Disease such as bronchial cancer within the lung may cause
obstruction of ventilation to part of the lung, reducing VC. Reversible or lung volume-
dependent obstruction from asthma or emphysema will increase RV dramatically without
reducing TLC. This usually results from early airway closure on exhalation in obstructive
disease.
Restrictive lung disease such as asbestosis can reduce TLC and VC by limiting
inspiration without much change in RV.

c. Define dead space and apply the Bohr Equation and the Alveolar Gas Equation.

Dead space is the ventilated volume which does not participate in gas exchange.
Anatomical dead space is the volume of the large upper airways and is measured using a N2
washout test. Physiological or functional dead space is a similar volume in healthy
individuals and can be measured using the Bohr Equation as described above.
The alveolar gas equation relates alveolar oxygen partial pressure to inspired
oxygen partial pressure and CO2 partial pressure:
PACO2 1-R
PAO2 = PIO2 - + PACO2 • FIO2 •
R R
***

d. Explain normal ventilation-perfusion matching including the mechanisms for

these as well as the normal values.

Ventilation of the lung in the erect position is greater at the base than at the
apex because of the difference in intrapleural pressure between the top and bottom of the
lung. Similarly perfusion of the lung is less at the apex than at the base, largely due to the
hydrostatic pressure difference between arterial pressure at the top and bottom of the lung.
The difference in perfusion is greater than the difference in ventilation. Thus the ratio of
ventilation to perfusion is greatest at the apex and least at the base of the lung.
The differences in ventilation and perfusion result in differences in gas
concentrations:
Apex Base
ventilation 0.24 0.82 l/min
perfusion 0.07 1.29 l/min
V/Q 3.3 0.63
PO2 132 89 mmHg
PCO2 28 42 mmHg
pH 7.51 7.39

Matching of ventilation and perfusion is also partly due to local vascular tone.
Pulmonary vessels constrict in response to high PCO2 or low PO2, helping to match

Respiratory ventilation 1.B.4.2 James Mitchell (December 24, 2003)

perfusion to ventilation. V/Q matched alveoli are far more efficient at gas exchange; over
ventilated alveoli can not compensate for under ventilated ones because of the non-linear
nature of the O2 and CO2 dissociation curves.

e. Describe the composition of ideal alveolar and mixed expired gases.

Ideal alveolar gas is described by the alveolar gas equation. It is the gas
composition expected in alveoli if there were no ventilation-perfusion mismatch in the lung:
PACO2 = PaCO2 = 40mmHg
PACO2 1-R
PAO2 = PIO2 - + PACO2 • FIO2 •
R R
= 100 mmHg

Mixed expired gas is the gas sampled at the mouth during exhalation. It is a
mixture of gas from the dead space and from the alveolar space from alveoli with a range of
V/Q ratios. Typically:
PECO2 = 33 mmHg
PEO2 = 115 mmHg

Respiratory ventilation 1.B.4.3 James Mitchell (December 24, 2003)