M.A.

Lung/PHYO2202/Respiration/15-16

VENTILATION

Pulmonary Ventilation (V)
It is the amount of air moved into or out of the lungs per minute; normal value is about 6 L/min.

V = f x TV where f, frequency of breathing (breaths/min)
TV, tidal volume (L)

Alveolar Ventilation (VA)
It is the amount of air reaching the functioning alveoli (exchange surface) per minute; normal value
is about 4.2 L/min.

VA = f x VA
or f x (TV - VD) where VA, volume of air reaching the functioning alveoli, L.
VD, volume of dead space, L.

PACO2 - VA Relationship
At steady state, amount of CO2 exhaled per minute equals to amount of CO2 produced per minute.
At a constant level of CO2 production, the PACO2 varies inversely with the level of alveolar
ventilation.

PAO2 - VA Relationship
At steady state, the amount of O2 uptake per minute equals to the amount of O2 consumed per
minute. At a constant level of O2 consumption and a fixed inspired O2 concentration, there is a
direct relationship between PAO2 and the level of alveolar ventilation.

Physiological Dead Space Volume (VD)

It is the space in the lungs where gas exchange cannot take place. It oncludes:
1. Anatomical Dead Space - those parts of the respiratory tract (nose, pharynnx, trachea,
bornchi, bronchioles) which act as passageways.
2. Alveolarl Dead Space alveolar space that does not receive blood supply and/or space in
which ventilation is in excess of the need to arterialize the blood.

Learning objectives:
You should now be able to:
1. define pulmonary ventilation and state the formula relating pulmonary ventilation, tidal
volume and breathing frequency.
2. define alveolar ventilation and state the formula for calculating alveolar ventilation.
3. state the effects of alveolar ventilation on PCO2 and PO2 in the body.
4. define physiological dead space.

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 M.A. Lung/PHYO2202/Respiration/15-16

PULMONARY GAS DIFFUSION

Simultaneous processes of pulmonary ventilation, perfusion and alveolo-capillary gas transfer

accomplish the continuous exchange of O2 and CO2 between blood and atmosphere. Hence, gas
diffusion is an important step in respiratory gas exchange.

A. Factors affecting gas diffusion through respiratory membrane

Fick's Law of Diffusion:

Vg = D.A. (P1 - P2) where Vg, rate of gas transfer through a sheet
T
1. Diffusion constant (D) -
i. molecular weight of gas (O2 diffuses slightly faster than CO2).
ii. solubility coefficient of gas (CO2 diffuses much faster than O2).
Considering molecular weight and solubility coefficient together, CO2 diffuses
much faster than O2. Patient with diffusion impairment normally has problem with O2
diffusion but not with CO2 diffusion, resulting in a fall on PO2 but normal PCO2. Even
after ventilatory compensation caused by hypoxemia stimulation, the PO2 is still not
back to normal but PCO2 will fall.
2. Surface area (A) -
The total area of alveolar space in contact with capillary blood is about 50 - 100 sg.m.
3. Distance for diffusion (T) -
Thickness of the alveolo-capillary membrane varies from 0.2 - 0.5 micron.
4. Transmembrane pressure gradient (P1 -P2)

Learning objectives:
You should now be able to:
1. state the factors affecting gas diffusion across the alveolocapillary membrane.
2. explain why CO2 diffuses faster than O2 across alveolocpaillary membrane.
3. state the effects of diffusion impairment on PO2 and PCO2 in the body.

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 M.A. Lung/PHYO2202/Respiration/15-16

VENTILATION AND PERFUSION MISMATCHING

Matching of ventilation and blood flow within various regions of the lung is critical for
adequate gas exchange. If ventilation and blood flow are mismatched in various regions of the lung,
impairment of gas transfer results.
They key to understanding
how this happens is the alveolar
ventilation/perfusion
ratio (V A/Q ). The normal value of VA/Q for the lung as a whole is 0.8 (VA, 4
L/min; Q, 5 L/min).

Effect of altering VA/Q of the lung

Suppose that VA/Q of a lung unit is gradually reduced by obstructing its ventilation, leaving
its blood flow unchanged.
It is clear that PO2 will fall and PCO2 will rise. When ventilation is
completely abolished (VA/Q = zero), the PO2 of the alveolar gas and end-capillary blood must be
same as those of the mixed venous blood.

Suppose instead when VA/Q is increased by gradually obstructing blood flow, the PO2 rises
and PCO2 alls,eventually reaching the composition of the inspired gas when blood flow is
abolished (VA/Q = infinity).

Effect of VA/Q mismatching on overall gas exchange
1. Depression ofPaO 2 - (i) because the major share of blood leaving the lung comes from the
zones where VA/Q ratio is low, i.e. blood with low PO2 and (ii) because of the
non-linear
shape of the O2 dissociation curve resulting in the fact that alveoli with high VA/Q ratio add
relatively
little O2 to the blood compared with the decrement caused by alveoli with low
VA/Q ratio.
2. CO2 retention - PaCO2 will be elevated as the major share of the blood leaving the lung
comes from the zones where VA/Q ratio is low, i.e. blood with high PCO2.

In practice, patients with undoubted VA/Q mismatching often have a normal PaCO2. Whenever,
the chemoreceptors sense a rising PCO2, there is an increase in ventilatory drive which is effective
in returning the PCO2 back to normal but is much less effective in raising the PaO2. The difference
in behavior of the two gases lies in the shape of their dissociation curves.

Learning objectives:

You should now be able to:

1. understand how an unusual VA/Q ratio will affect the gas composition of the pulmonary
capillary blood.
2. state the consequences of ventilation-perfusion mismatching on the overall gas exchange in
the lungs.

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Theme:

Gas Exchange in Lungs

1. Alveolar Ventilation
2. Perfusion (blood flow)
3. Gas Diffusion
(across alveolocapillary membrane)
4. Matching of alveolar ventilation and
perfusion

1
Pulmonary ventilation (V)
amount of air moved into or out or the lungs per
minute or minute volume
= breathing frequency (f) x tidal volume (TV)
size of each breath
(6 L/min at rest)
Alveolar ventilation (VA)
minute volume for gas exchange
= f x VA (4.2 L/min at rest)

Physiological dead space ventilation (VD)

minute volume NOT for gas exchange
= f x VD (VD is the volume of respiratory
tract plus alveolar space without
blood supply or excess ventilation)
2
3
Effects of changes in Alveolar Ventilation on PACO2

At a constant level of CO2 production (or

metabolic activity)
PACO2 1 / VA

Hypoventilation - inadequate ventilation to meet

metabolic demand
PCO2
Hyperventilation - ventilation in excess to
metabolic demand
PCO2
4
5
Effects of changes in Alveolar Ventilation on PAO2

At a constant level of O2 consumption (or metabolic

activity) and a fixed inspired O2 concentration
PAO2 VA

Hypoventilation
PO2

Hyperventilation
on partial pressure of blood gas:
PO2

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Learning objectives:

You should now be able to:

1. define pulmonary ventilation and state the

formula relating pulmonary ventilation, tidal
volume and breathing frequency.

2. define alveolar ventilation and state the formula

for calculating alveolar ventilation.

3. state the effects of alveolar ventilation on PCO2

and PO2 in the body.

4. define physiological dead space.

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Gas diffusion across alveolocapillary membrane

A effective surface area

T - thickness

gas pressure
difference

(gas)

D diffusion constant
Sol solubility coefficient
MW molecular weight
Impaired Diffusion
PO2
normal n PCO2

After ventilatory
compensation
PO2
PCO2
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Surface Area
Total area of alveoli in contact with capillary blood
(50 100 sq m)
surface area (e.g. alveolar damage - emphysema,
blockade of lung capillaries embolism)
gas diffusion

Distance
Thickness of the alveolo-capillary membrane
(0.2 0.5 )

distance (e.g. thickened alveolar or capillary wall -

lung fibrosis)
gas diffusion

Impaired Diffusion PO2 & n PCO2

After ventilatory compensation PO2 & PCO2 10
Pressure gradient for gas diffusion

Ventilation or
blood flow

pressure
gradient for
gas diffusion

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Learning objectives:

You should now be able to:

1. state the factors affecting gas diffusion across

the alveolocapillary membrane.

2. explain why CO2 diffuses faster than O2 across

alveolocapillary membrane.

3. state the effects of diffusion impairment on PO2

and PCO2 in the body.

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 Matching of alveolar ventilation to perfusion
Conc. of O2:
1. Alveolar ventilation
2. Blood perfusion
oxygen
Va:high blood flow trying to remove CO2
Q:high blood flow trying to add CO2

diffusion

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air: 760 mmHg v: systemic venous blood
O2: 20% in air a: systemic artery
i = inspired air

no air supply no blood flow

PO2 PIO2 PO2 PvO2
PCO2 PICO2 PCO2 PvCO2

ratio PO2 ratio PO2

PCO2 PCO2
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O2 dissociation curve (Sigmoid curve)
Causes of hypoxemia

1. CO2 by alveoli of ratio >

CO2 by alveoli of ratio

related to sigmoid shape

of O2 dissociation
curve
2. most of the blood comes
from alveoli of ratio
0.5 vol %

4.9 vol % blood with PO2

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 Causes of CO2
retention
1. CCO2 by alveoli of ratio =
CCO2 by alveoli of ratio

CO2 retention is
unrelated to the
shape of CO2
dissociation
curve

2. Most of the blood comes

CCO2 = CCO2 from alveoli with ratio
low ratio = high CO2 content
linear CO2 dissociation curve
blood with PCO2

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 Consequences of V/Q mismatching
CO2 is a potent
PO2, PCO2 ventilatory stimulus

After ventilatory compensation,

lesser PO
due to the sigmoid shape of 2 , normal PCO2
O2 dissociation curve
If lungs with severe V/Q mismatching and
unable to have ventilatory compensation,
severe hypoxemia and hypercapnia
Low PO2, High PCO2
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Learning objectives:

You should now be able to:

1. understand how an unusual VA/Q ratio will affect

the gas composition of the pulmonary capillary
blood.

2. state the consequences of ventilation-perfusion

mismatching on the overall gas exchange in the
lungs.

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References

1. Human Physiology
The Mechanisms of Body Function
ed. Vander, Sherman & Luciano
(McGraw Hill)

2. Pathophysiology
Concepts of Altered Health States
ed. C.M. Porth
(Lippincott)

3. Pulmonary Physiology - the essentials

ed. J.B. West
(Williams & Wilkins)
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