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Learningobjectives
Ventilation V til ti perfusion f i relationships
Oxygentransportfromairtotissues Hypoventilation Diffusion Shunt Ventilationperfusionratio Regionalgasexchangeinthelung Effect ff of fventilation il i perfusion f i inequality i li onoverallgasexchange

Oxygentransportfromairtotissues

Diffusion

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Shunt
poorlyoxygenatedbloodlowersthearterialPO2
1.Anatomicshunt 1 1normal(25%ofcardiacoutput):bronchialcirculation& 1.1 thebasian circulation&pleuralcirculation 1.2abnormal atrial septal defect patentductus arteriosus ventricularseptal defect gtumor vascularlung

2. Physiologic shunt or venous admixture or wasted blood flow or capillary or true shunt (perfused but not ventilated) (V/Q = 0) : causes-atelectasis or alveolar units filled with fluid 3. Shunt-like effect (low V/Q) : causes-retained secretions, bronchospasm, partial airway obstruction, etc. Shunt usually does not result in a raised PaCO2 as chemoreceptors sense any elevation of PaCO2

Amountofshuntflow
QT x CaO2 = Qs x CvO2 + (QT Qs) x CcO2

Qs QT

= CcO2 - CaO2 C O2 - CvO Cc C O2

Qs = shunted blood QT (total blood flow) = total amount of O2 leaving the system CaO2 = O2 concentration in arterial blood CcO2 = O2 concentration in end-capillary blood CvO2 = O2 concentration in mixed venous blood

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Ventilationperfusionratio

EffectofalteringV/Q onthePO2 andPCO2 inalungunit

Model to illustrate how V/Q ratio determines PO2 in lung unit

Regionalgasexchangeinthelung

O2CO2 diagramshowingaventilationperfusionratioline normalV/Q 0.8(V 4L/min,Q 5L/min)

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Shuntlike effect(lowV/Q)

Alveolardead space(highV/Q)

Regionaldifferencesingasexchangedownthenormallung

Effectofventilationperfusion inequality onoverallgasexchange