Pulmonary Circulation

Difusion of gas

Integrated Organs Systems

Medicine 2022-2023











 OBJECTIVES

• Pulmonary vs Systemic
Circulation (Functions)
• Diffusion
• Lung water balance The partial pressure of a gas

•Pulmonary Vascular • Characteristics of the

capillary alveolar membrane
Resistance
• Factors affecting diffusion
• Exercise
• Fick law
• Recruitment distension • Other factors
• Forced inspiration/expiration
• O2 uptake in the capillary
• Diffusion measurement

 1. Size
2. Pressure difference
3. Flow
4. Vessel thickness
5. Resistences

 Diferencias

1. Size
2. Pressure difference
3. Flow
mBP= sBP - dBP + dBP
4. Vessel thickness
5. Resistences 3

 1. Size
2. Pressure difference
3. Flow
4. Vessel thickness
5. Resistences

 Physiologic Shunt
1. Bronquial arteries
2. Coronary venous blood to LV through tebesian veins
3. Pulmonary arteriovenous fistula
4. Anatomical shunt
• Patent ductus arteriosus
• Atrial septum defect or VSD

 1. Size
2. Pressure difference
3. Flow
4. Vessel thickness
5. Resistence

R = Pressure gradient/ Flow

 1-2 2-8

25-0
120-0

PVR = mBP - mPAP/Flow= 13-4/5=1.8

SVR = mBP - CVP /Flow=93-2/5=18

Pulmonary circulation goals

1. Gas exchange
2. Blood reservoir (10%)
3. Angiotensin-converting enzyme
4. Filter (small thrombi)
5. Synthesis, transport, and metabolism
of substances

 Lung water balance - Starling equation

Forces that determine filtration in blood vessels

Capillary
hydrostatic p Capillary
oncotic p

Intersticial Intersticial
hydrostatic p oncotic p




Starling Equation

K = constant called the filtration coefficient

σ = oncotic reflection coefficient

Pc = capillary hydrostatic pressure

Pi = hydrostatic pressure in the interstitial fluid
πc = colloid osmotic pressure of the proteins of the blood
πi = colloid osmotic pressure of the proteins of the interstitial fluid

➢ Oncotic reflection coefficient: indicates the efficiency of the

capillary wall to prevent the passage of proteins through it.
➢ Capillary alveolus membrane 0.3 microns

Starling equation

Capillary oncotic
p: 28mmHg
Capillary
hydrostatic p:
7mmHg

Intersticial oncotic p:
14mmHg
Intersticial
hydrostatic p: ?? -8
 -28

Negative -8

-14

+7

20ml/h
Starling Equation

Capillary oncotic
p: 28mmHg
Capillary
hydrostatic
p: 7mmHg

Intersticial oncotic p:
1mmHg =20ml/h 14mmHg
Intersticial
hydrostatic p: ??
Where is the liquid that leaves the capillary going?
 PATHOLOGIES RELATED TO PRESSURE CHANGES

➢Capillary oncotic P. decrease: Hypoproteinemia

➢Increase of capillary hydrostatic P: Cardiac pathologies

➢Interstitial oncotic P increase: Pneumonia (altered

vascular permeability)

➢Surface tension: RN wet lung syndrome

➢Alteration of lymphatics: Ca lung/ca pleural/ ca in

mediastinal structures

Pulmonary Vascular Resistance - Exercise

•R = Pressure gradient/ Flow

•P = R X Flow

THERE IS RISK OF EDEMA IF PA INCREASE

Mechanisms to compensate the increase of flow

 PVR and lung volume

Alveolar vessels:
-Capillary
-Suffered alveolar
pressure

Extra-Alveolar vessels:
-Increase size
-In lung parenchyma
-Affected by lung volume

Air composition
Air composition. Partial pressure

Partial Pressure

760mmHg----------100 600mmHg
X-------------------- 78

760mmHg----------100
160mmHg
X-------------------- 21

760mmHg----------100
X-------------------- 0,03

pO2 on air = FiO2 x Barometric Pressure

(760mmHg)

pO2 = 0,21 x 760mmHg = 150mmHg

Air composition – partial pressure of O2 in air
differs compared to alveolar

➢ ALVEOLAR air is PARTIALLY replaced by atmospheric air with

each breath

➢ O2 is constantly absorbed into the blood from the pulmonary

capillary even during expiration

➢ CO2 constantly diffuses into the alveolus even during

exhalation. Alveolar air is humidified atmospheric air

PAO2= PIO2 – PACO2/R

R = respiratory coefficient 0,8

PiO2 = (Pb - PH2O) X FiO2

P H2O = water vapor pressure (47mmHg at

37C)

 PIO2 = FiO2 x (Pb – PH20)

PIO2 = 0,21 x (760 – 47) = 150 mmHg

PAO2 = PiO2 – PACO2 / R (0,8 -1)

PAO2 = PiO2 – PACO2

PAO2 = FiO2 x (Pb – PH20) – PACO2

PAO2 = 0,21 x (760 – 47) – 40 = 104





















Characteristics of the capillary-alveolar membrane
 5µm

Alveolar Surface area: 50-100m2

0,2-0,6µm
 Blood passes
around the
capillary for
0,75 sec
O2 Exchange
is done in
0,25 sec
Factors affecting diffusion

➢ Proportional to the area

(A), a difusión constant
(D), and the difference in
partial pressure (P1 - P2),
and is inversely related to
the thickness (T).

➢ D is proportional to the
gas solubility (Sol) but
inversely proportional to
the square root of its
molecular weight (MW).
 Gas solubility
Diffusion coefficient=
√MW ➢ Diffusion coefficient
for CO2 is 20-fold
Gas Diffusion coefficient compared to O2
O2 1

CO2 20,3

CO 0,81

N2 0,53
Helio 0,93

 Factors affecting diffusion

1. Area (emphysema, lobectomies)

2. Thickness membrane (fibrosis, edema, pneumonia)
Membrane factors

3. Pressure gradient
4. Coefficient Diffusion: Solubility/√MW

Other factors
1. Time of contact between capillary and alveoli membrane:
Circulatroy factors

flow
Carbon monoxide: CO
Nitrose oxide: N2O

Diffusion

Limited by
Perfusion

Limited by
Diffusion
 O2 uptake in the capillary

Normal conditions Exercise If Pb is decreased

blood flow
Equalization of pressures in 1/3 of the PA= PIO2- PaCO2/R
Time of contact is reduced by 1/3
time PIO2 = (Pb-PH2O)X FiO2
Only affected if membrane
alteration
Exercise
Difusion capacity is increased
1. Alveolar Ventilation is increased
2. Flow is improved by recruitment and
distension of vessels

Improving V/Q relationship

 1. Blood only remains in the capillary for about 0.75sec at

rest
2. At rest the PO2 of the blood reaches that of the alveolar
air in 1/3 of the total time it takes to pass through the
capillary (1/3 of 0,75 sec = 0,25 sec)
3 With exertion, the contact time decreases to 0.25sec
4. The diffusion process is altered by:
-exertion with a decrease in PAO2 or with thickening of the
capillary alveolar membrane.




















Measurement of difusion capacity

DLCO Diffusing capacity for lung carbon monoxide (DLCO is the volume of carbon
monoxide transferred in ml/mmHg alveolar partial pressure)

Thickness area and diffusion constant =

Diffusion capacity (D)
Thickness (T)

Single-breathing method
Rebreathing method

DLCO = 25 ml/min/mmHg
Increases with exercise
Decreases with diseases that produce alteration of the alveolar walls

KEY CONCEPTS

➢ The pressures within the pulmonary circulation are much

lower than in the systemic circulation. Also the capillaries
are exposed to alveolar pressure, whereas the pressures
around the extra-alveolar vessels are lower

➢ Pulmonary vascular resistance is low and falls even

more when cardiac output increases because of
recruitment and distension of the capillaries.

➢ Pulmonary vascular resistance increases at very low or

high lung volumes
KEY CONCEPTS

➢ Blood flow is unevenly distributed in the upright

lung. There is a much higher flow at the base than
the apex as a result of gravity. If capillary pressure
is less than alveolar pressure at the top of the
lung, the capillaries collapse and there is no blood
flow (zone 1)

➢ Hypoxic pulmonary vasoconstriction reduces the

blood flow to poorly ventilated regions of the lung

➢ The release of this mechanism is responsible for a

large increase in blood flow to the lung at birth
KEY CONCEPTS

➢ Fluid movement across the capillary endothelium is

governed by the Starling equilibrium

➢ Pulmonary circulation has many metabolic functions,

notably the conversion of angiotensin I to angiotensin
II by angiotensin-converting enzyme