Professional Documents
Culture Documents
PERFUSION
RELATIONSHIPS
DR KAMAL BHARATHI. S
VENTILATION- PERFUSION
RELATIONSHIPS
• Oxygen Transport from Air to Tissues
• Causes of Hypoxemia
• Effect of Altering the V/Q Ratio of a Lung Unit
• Regional Gas Exchange in the Lung
• Effect of Ventilation-Perfusion Inequality on Overall Gas
Exchange
• Distributions of V/Q Ratios
OXYGEN TRANSPORT
FROM AIR TO TISSUES
• The Po2 inspired air is (20.93/100) ×(760 − 47) =149 mm Hg.
• At Alveoli Po2 has fallen to about 100 mmHg.
• Po2 of alveolar gas is determined by:
a) the removal of O2 by pulmonary capillary blood
b) continual replenishment by alveolar ventilation.
• The alveolar Po2 is largely determined by the level of alveolar
ventilation.
• When the systemic arterial blood reaches the tissue capillaries,
O2 diffuses to the mitochondria, where the Po 2 is much lower.
OXYGEN TRANSPORT
FROM AIR TO TISSUES
CAUSES OF HYPOXEMIA
Four principal potential mechanisms of failure of the O2 transport
pathway can lead to a reduced arterial PO2:
• Hypoventilation
• Diffusion Limitation
• Shunt
• The Ventilation-Perfusion inequality
HYPOVENTILATION
• The alveolar ventilation is
abnormally low
• Hypoventilation
ALVEOLAR GAS EQUATION
E. Chest wall
• Kyphoscoliosis
• Morbid Obesity
• Trauma, surgery
Pulmonary (airway) causes
A. Obstruction of central airways – OSA
(A) COPD. The blood flow to units of very low ratio would cause
arterial hypoxemia and simulate a shunt.
(B) Asthma, with a more pronounced bimodal distribution of blood
flow than the patient shown in (A).
(C) Bimodal distribution of ventilation in a 60-year-old patient with
chronic obstructive pulmonary disease, predominantly emphysema. A
similar pattern is seen after pulmonary embolism.
(D) Pronounced bimodal distribution of perfusion after a bronchodilator
was administered to the patient shown in (B).
REGIONAL GAS EXCHANGE IN
THE LUNG
• A normal lung has different V/Q
ratios in its different regions. This
may be attributed to the pull of
gravity and the heart’s location
relative to the lung.
• Airflow and blood flow increase
down the lung, but the differences
in perfusion are greater than the
differences in ventilation.
• Blood flow is proportionately
greater than ventilation at the
base- lower V/Q ratio
• Ventilation is proportionately
greater than blood flow at the
apex- higher V/Q ratio.
VENTILATION-
PERFUSION INEQUALITY
• V/Q ratio determines the gas exchange in any single lung unit.
• Regional differences of V/Q in the upright human lung cause a
pattern of regional gas exchange.
• V/Q inequality impairs the uptake or elimination of all gases by
the lung.
• Although the elimination of CO2 is impaired by V/ Q inequality,
this
can be corrected by increasing the ventilation to the alveoli.
• By contrast, the hypoxemia resulting rom V/ Q inequality cannot
be eliminated by increases in ventilation.
SUMMARY
■ The magnitudes of ventilation and perfusion, as well as their
distribution, are key factors determining pulmonary gas exchange.
■ Distribution of ventilation and perfusion is predominantly
affected by gravity in the normal lung, but intrinsic lung structure
also plays a role.
■ Distribution of ventilation-perfusion (V A/Q ) ratios is non
uniform, the V A/Q ratio being generally higher in nondependent
lung regions and lower in dependent lung regions.
■ Regional alveolar PO2 and PCO2 are determined principally by
the V A/Q ratio of each region. Secondary factors are the PO2
and PCO2 of inspired gas and mixed venous blood and also the
shape of the oxygen and carbon dioxide dissociation curves.
■ There are four causes of hypoxemia: hypoventilation, alveolar-
capillary diffusion limitation, shunt, and V A/Q inequality.
■ There are two principal causes of hypercapnia : hypoventilation
and V A/Q inequality.
■ V A/Q inequality is the most important cause of gas exchange
abnormalities in most lung diseases.
REFERENCE
West respiratory physiology
Fishman textbook of pulmonary disease and diorders
Guyton physiology
Thank You…!!!
In a German tale known as Sleep of Ondine, Ondine is a water
nymph. She was very beautiful and, like all nymphs,
immortal. However, should she fall in love with a mortal man and
bear his child, she would lose her immortality. Ondine eventually
falls in love with a handsome knight, Sir Lawrence, and they were
married. When they exchange vows, Lawrence vows to forever love
and be faithful to her. A year after their marriage, Ondine gives birth
to his child. From that moment on she begins to age. As Ondine’s
physical attractiveness diminishes, Lawrence loses interest in his
wife.
One afternoon, Ondine is walking near the stables when she hears
the familiar snoring of her husband. When she enters the stable,
she sees Lawrence lying in the arms of another woman. Ondine
points her finger at him, which he feels as if kicked, waking him up
with surprise. Ondine curses him, stating, "You swore faithfulness to
me with every waking breath, and I accepted your oath. So be it. As
long as you are awake, you shall have your breath, but should you
ever fall asleep, then that breath will be taken from you and you will
die!"