AL-Azhar University- Gaza Course No.

: New plan
Faculty of Medicine
Physiology of Respiratory Lecturer: Dr. Walid Daou
System

Report 2nd semester (2019-2020)

Student name: Said Taysir Abdljawad No.20180935

Part 1 Report (20 marks)

Submit a written report on:

Ventilation / Perfusion ratio (VA/Q): definition and effects of VA/Q

ratio on alveolar gas concentration.

 Pulmonary ventilation= alveoli + dead space.

 Alveolar ventilation = alveoli.

 alveolar Ventilation Perfusion ratio (V/Q ratio) =

o Alveolar pressure / cardiac output = V/Q
 note: we are taking about alveolar pressure
here, not pulmonary pressure.

 Normal value: 0.8 = 80% = 4/5 [overall]

o In apex: 3 why? Decreased V, but Q decreased
even more, so the ratio increased.
 Why is perfusion decreased in the apex?
– gravity
 Why is ventilation decreased in the apex?
- gravity + the fact that the pleura is far away
from the apex is pulling air up there, but the air
is stagnant.
o In base: 0.6. why? Decreased V, but it decreased
more than Q, so the ration decreased.
 Mnemonic: high is high, and low is low.
 i.e apex is high, and base is low.

1
Ventilation-Perfusion Mismatch:
If there is a mismatch between the alveolar ventilation and the
alveolar blood flow, this will be seen in the V/Q ratio. In order to
maintain optimal function of the lungs, the V/Q ratio should be 1. If
the V/Q ratio drops to <1, i.e. the perfusion is higher than the
ventilation, the pO2 falls and the pCO2 in the alveolus will rise.
Hypoxic vasoconstriction can occur, diverting blood to better
ventilated parts of the lung. However, these alveoli are unlikely to
be able to take up much more O2 than they already are. As a
result, the pO2 remains low, which acts as a stimulus, causing
.hyperventilation, resulting in either normal or low CO2 levels
A mismatch in ventilation and perfusion can arise due to either
reduced ventilation of part of the lung or reduced

Clinical Relevance - Reduced Ventilation of the Lungs

Reduced ventilation can occur for a number of reasons. This
includes pneumonia, whereby the alveoli are filled with exudate,
limiting the ability to maintain ventilation. Asthma and COPD may
also result in a reduction in ventilation, as well as respiratory
distress syndrome of the newborn, whereby reduced surfactant
production results in multiple collapsed alveoli, limiting its
.ventilating capability

The effect of reduced ventilation is hypoxia. However, as the rest

of the lung can still remove CO2, hypercapnia does not occur.
.Thus, the net effect of this is type 1 respiratory failure

Clinical Relevance – Reduced Perfusion of the Lungs

Pulmonary embolism can result in reduced perfusion of the lungs.
Areas of the pulmonary circulation are obstructed, limiting blood
flow to alveoli. As a result, blood has to be redirected to other
areas of the lung. As the other areas receive an increased blood
supply, the V/Q ratio will be <1. In this case, hypoxia still occurs
.because a vast majority of the lung is still working with a V/Q of <1

2
 Decreased perfusion
Decreased ventilation
Noraml (e.g. pulmonary artery
(e.g. Obstrutive lung disease)
embolus)
V/Q
0.8 Decrease "<0.8" Increase ">0.8"
ratio
PAO2 40 mmHg (alveolar air is like the
105 (alveolar air is venous blood)
152 mmHg (alveolar air became
like the arterial Because no gas exchange
similar to atmospheric air)
blood) happened, blood came and blood
went "shunting"
PaO2 100 40 mmHg 100 mmHg
PvO2 40 mmHg 40 mmHg 40 mmHg
PACO2 40 (alveolar air is
0 (alveolar air became similar to
like the arterial 46 mmHg
atmospheric air)
blood)
PaCO2 40 40 40
PvCO2 46 46 46
In response:
In response:  hypocapnia -> alkalosis ->
vasoconstriction -> to keep
 hypoxia -> vasoconstriction
the CO2 in -> acidosis (to
-> force the blood to the well
try to compensate the
ventilated areas.
alkalosis).
 i.e. when the bronchus is
 i.e. when the vessel is
closed -> close the vessel.
closed -> close the
bronchus.