Ventilation/perfusion

ratio
&
Diffusion
of Gases Across
Pulmonary Membrane
DR. HARMINDER KAUR
 Alveolar ventilation–perfusion
ratio
• Ventilation (V) refers to the
flow of air into and out of
the alveoli

• while perfusion (Q) refers to

the flow of blood to alveolar
capillaries
 Alveolar ventilation–perfusion
ratio

• Ratio of alveolar • Normally, alveolar

ventilation/ min ventilation (VA) is • So, normal VA/Q
4.2 L/min is about 0.8
to quantity of • Pulmonary blood • At this ratio
blood flow to flow (equal to maximum
cardiac output) is oxygenation
alveoli/ min approximately occurs
5L/min
 Effect of gravity on VA/Q
• Because of effect of gravity

Basal alveoli are over-perfused and apical

alveoli are under perfused

• Almost a linear reduction in blood flow from

base to apex

• Alveolar ventilation also reduces linearly

from base to apex

• Basal alveoli are overventilated and apical

alveoli are under ventilated
 • Gravity affects perfusion much more than it affects ventilation Hence ,
apical alveoli are more under perfused than under ventilated
Because of this relationship, the VA/Q ratio is more than one at Apex

• Applied Aspect:
• Because of high VA/Q ratio
• Apical alveolar air has low pCO2 and high pO2
• Since high alveolar pO2 provides favourable environment for growth
of Mycobacterium tuberculosis
• So apices of lungs are more predisposed to Tuberculosis (TB)
 Effects of alterations in VA/Q ratio
• . Normal VA/Q ratio:

 Both normal alveolar ventilation and normal alveolar perfusion

 Exchange of gases is optimal and alveolar pO2 is about
104 mmHg and pCO2 is about 40 mm Hg

• Increased VA/Q ratio:

 Means that alveolar ventilation is more than perfusion

 As a result, whole of alveolar air is not utilized for gaseous
exchange
 Extra air in alveoli which goes waste forms so-called alveolar
dead space air
When VA/Q ratio increases to infinity,

 i.e. when alveolar perfusion

becomes zero, no exchange of
gases can occur
 Under such circumstances,
composition of alveolar air becomes
 Equal to humidified inspired air,
which has pO2 of 149 mmHg and a
pCO2 of 0 mmHg
• Decreased VA/Q ratio

• Occurs when rate of blood flow is more than rate of alveolar

ventilation

• Alveolar ventilation is not enough to provide oxygen

• A fraction of venous blood passes through pulmonary capillaries

without becoming oxygenated

• This fraction is called shunted blood

• So, alveolar air will have a pO2 of 40 mm Hg and pCO2 of 45 mmHg

 Causes of alteration in VA/Q ratio
• Factors altering the alveolar ventilation or/and pulmonary
perfusion will alter VA/Q ( ventilation/perfusion)ratio

• Causes of uneven alveolar ventilation include:

Bronchial asthma
Emphysema
Pulmonary fibrosis
Pneumothorax
Congestive heart failure
• Causes of uneven pulmonary perfusion are:

• Anatomical shunts, e.g. Fallot’s tetralogy

• Pulmonary embolism

• Regional decrease in pulmonary vascular bed

in emphysema

• Increased pulmonary resistance in conditions

like pulmonary fibrosis, pneumothorax and
congestive heart failure
 Diffusion of gases through respiratory
membrane
Respiratory Unit :
• Respiratory bronchiole
• Alveolar ducts, atria
• Alveoli
300 million alveoli in two lungs
• Diameter of about 0.2 millimeter
• Surrounded by network of
interconnecting capillaries
• Alveolar gases are in very close
proximity to blood of pulmonary
capillaries
• Gas exchange between alveolar air
and pulmonary blood occurs through
membranes of all terminal portions
of lungs
• All these membranes are collectively
known as Respiratory membrane
• Also called Pulmonary membrane
 Respiratory Membrane
Layers:
1. Layer of fluid lining of alveolus and
3.
containing surfactant
2.
2. Alveolar epithelium composed of thin 1.
epithelial cells
3. Epithelial basement membrane
4.
4. Thin interstitial space between alveolar 5.
epithelium and capillary membrane
6.
5. Capillary basement membrane
6. Capillary endothelial membrane
• Despite large number of layers, overall thickness of respiratory
membrane in some areas is as little as 0.2 micrometer, and it
averages about 0.6 micrometer
• Total surface area of respiratory membrane: 70 square meters in
normal adult human male
• Equivalent to floor area of a 25/30 feet room
• Total quantity of blood in capillaries of lungs at any given instant is 60
to 140 milliliters
• RBC’s membrane usually
touches capillary wall, so
oxygen and carbon
dioxide need not pass
through significant
amounts of plasma
• This, too, increases
rapidity of diffusion
 Factors Affecting Rate of Gas Diffusion
• Factors that determine how rapidly a gas will pass through
repiratory membrane are:
(1) Thickness of membrane
(2) Surface area of membrane
(3) Diffusion coefficient of gas through the membrane
(4) Partial pressure difference of gas across the membrane
(i)Thickness of the membrane (d):

V gas (volume of gas diffused) ∝ 1/ d

• Any factor which increases thickness of respiratory membrane

decreases gaseous exchange

• Examples are:

• Pulmonary oedema, i.e. collection of fluid in interstitial space & alveoli

• Pulmonary fibrosis occurring in certain lung diseases increases

thickness of respiratory membrane

(ii) Surface area of respiratory membrane (A):

Normally total surface area of respiratory membrane 70 m2

V gas ∝ A

• Causes of decrease in surface area are:

• Pulmonectomy, i.e. removal of one complete diseased lung reduces

surface area to half the normal

• In emphysema, many of alveoli coalesce with dissolution of alveolar

walls causes total surface to decrease by as much as five fold
(iii) Diffusion coefficient (D): amount of a particular substance that
diffuses across a unit area in 1s under the influence of a gradient of one
unit

• Rate of diffusion is directly proportional to diffusion coefficient (D) of

gas, i.e.

V gas ∝ D

• Diffusion coefficient of CO2 is about 20 times that of O2 through water

• Therefore, CO2 diffuses much more easily through respiratory

membrane
(iv) Pressure gradient across respiratory membrane:

• Rate of diffusion is directly proportional to the pressure difference

between partial pressure of a gas in alveoli (pA) and in pulmonary
capillary (pC), i.e.

V gas ∝ (pC − pA)

• From the equations (i)–(iv) it can be derived that

V gas = (pC − pA) D.A./d

Fick’s law of diffusion
 Diffusion of O2
• Normal alveolar pO2 is 104 mm Hg
• Whereas blood entering pulmonary
capillary normally has pO2 of 40 mm Hg
• Pressure gradient is 64 mm Hg in
beginning
• As O2 diffuses from alveoli to blood
• pO2 of blood becomes same as in
alveolar air (104 mm Hg) at venous end
• Gradient becomes zero and no diffusion
occurs
 Equilibration time

• Blood remains for about 0.75s

in capillary (transit time)
• Blood pO2 and alveolar pO2
equalize in one-third of transit
time, i.e. about 0.25 s
• Provides a safety margin of 0.50 s
that ensures adequate O2 uptake
During periods of stress (e.g.
exercise, exposure to high altitude)
or impaired diffusion
When normal diffusing capacity of
lung for O2 is diminished
• Equilibrium time is prolonged or
never reached
 Diffusion of CO2
• Occurs from blood to alveoli
• Because pCO2 is higher in blood than in
alveolar air
• Average pCO2 in pulmonary capillary blood is
46 mm Hg as opposed to 40 mm Hg in the
alveoli
• Pressure gradient in beginning is 6 mm Hg
• Although pressure gradient for CO2 is only
1/10th of the O2 diffusion gradient
• CO2 diffuses almost 20 times more rapidly
than O2 because of higher diffusion coefficient
 DIFFUSION CAPACITY OF LUNG FOR O2
• Is a quantitative expression of ability of respiratory membrane to exchange
a gas between the alveoli and the pulmonary blood
• It is defined as the volume of gas (V gas) that diffuses through the
respiratory membrane of lung each minute for a pressure gradient of 1 mm
Hg
• At rest, the diffusing capacity of lungs for O2 is about 20−25 mL/min/mm
Hg
• As mean oxygen pressure gradient is about 11 mm Hg
• So at rest about 250 mL of O2 diffuses through the lungs per minute
• During exercise, the diffusing capacity of lungs for O2 is increased
• It may reach up to 65 mL/min/mm Hg during strenuous exercise
DIFFUSION CAPACITY OF LUNG FOR CO2
• Never been measured because carbon dioxide diffuses across the
respiratory membrane so rapidly that the difference between the
average pCO2 of the capillary blood and pCO2 of alveolar air is
only 1 mm Hg
• From the available knowledge about diffusion coefficient of CO2,
the diffusion capacity of lungs for CO2 is estimated
• At rest, the diffusing capacity of lungs for CO2 is about 20 times that
for O2, i.e. about 400 mL−500 mL/min/mm Hg.
• During strenuous exercise, the diffusing capacity for CO2 is
increased to 1200 mL−1300 mL/min/mm Hg
Measurement of diffusion capacity of lungs
• Can be measured by Fick’s law
• According to which diffusion capacity is given by
DL = V /(pA − pC)
• Where DL = Diffusion capacity of lungs for a given gas
• V = Volume of the gas uptake in 1 min and (increase in the gas
content of blood in 1 min)
• pA − pC = Partial pressure gradient between alveolar air and
pulmonary capillary blood
• Thus, diffusion capacity for O2 (DLO2) is
DLO2 = O2 consumption/min (pAO2 − pO2)
THANK YOU