- -2

Ventilation and perfusion :

.

: - "
, "
.

VT

' : ' .
(Kelvin: (K = 273 + C
: , '

1
P

V .

:
.
- .

[ gas ]dissolved = x Pgas

-Alveoli
- .
" : ".
" " .
:Pulmonary Circulation
. cardiac output -

terminal -

.bronchioles

Sheet flow

, ,

. " .
) (

Angiotensin converting enzyme Converts angiotensin I to angiotensin

.II

26

Bronchial circulation separate, supplies nutrition to larger airways

.((<3% cardiac output
:
Pulmonary circulation - ,

.
Systemic circulation - ,
.
:

, ,
.

- .
.

.
:
3 .
, ,
.
- ,15- ) (Zone 1
" .
.
:
) (Q
.

) . (.

26

 "" .
- - ) (
- ) ( ,
.
-
Alveolar vessels

Pulmonary Capillaries

Surrounded by alveolar pressure (measured relative to pleural

.(pressure
Extra-alveolar vessels

(Arteries and Veins (large vessels

.Surrounded by intra-pleural pressure

-Hypoxic Vasoconstriction
.x-


- .
.
) ( pH- .
- .
) ( "
- ) (.
,
.

PAO2=70

PAO2=150

O2=70
PA PAO2=150

)
-
PaO2=80
80mmHg.(95mmHg -

PaO2=95

26

 Vasoconstriction -
- "
"

,
.
.
-
Vasoconstriction -
) ,( Vasodilatation

.
-Vasodilatation -

-Vasoconstriction -

(Prostacyclin (PGI2

Nitric Oxide
Acetylcholine
Bradykinin

Endothelins
PGE2
Thromboxane A2
Catecholamines
Angiotensin II
Serotonin

Ventilation-Perfusion
Relationships
-
Alveolar ventilation (VA) = 4.0 L/min

Perfusion (Q) = 5.0 L/min

:
) (PO2= 160mmHg -
=PCO2
0.03mmHg

) ( .
"
, . -
.
)=( , = .
:
,
.

26

- .

-VENTILATION PERFUSION MATCHING

-A , .
"

-B , .
.
.

- ) ,(shunt

-C , .
) .(1Zone
- ,
No Alveolar Ventilation (low V/Q) -non-anatomical shunt
) ,(B . , ) '(
. Shunt .

, .
-No Capillary Flow (high V/Q) -physiological dead space
) ,(C-
, .
, ' .

PAO2 = Pc 'O2 PvO2 = 22m m H g

PAC O2 = Pc 'CO2 PvCO2 = 44mm H g
PAO2 = Pc 'O 2 PI O2 = 222mmHg
PACO2 = Pc 'CO2 PI CO2 = 2mmHg

-Decreasing V/Q of an alveolus

".
.(PAO2 and PcO2 fall toward mixed venous (100
40 mmHg
45 mmHg

(PACO2 and PcCO2 rise toward mixed venous (40

-Increasing V/Q of an Alveolus

".
.(PAO2 and PcO2 rise toward inspired (100
149 mmHg

26

0 mmHg

(PACO2 and PcCO2 fall toward inspired air (40

 - :

(venous admixture (low V/Q units

(physiological dead space (high V/Q units

-
(PAO2 - PaO2 (A-a
O2 100%
PaCO2 ,
-SHUNT
-Anatomical Shunt ,
.
.2%- .
Capillary Shunt (non anatomical shunt)- Shunt -
" '
-
.

2' - 1 ,((VA=0ml 2 .((VA=80ml

O2 100% Shunt - )
( 2- O2 80% " 100%
O2 - mmHg53- .mmHg65- , 80%-
)( .100%-

-
V/Q Mismatching !
Non-uniform V/Q ratios
(arterial hypoxemia (Low PaO2

26

 .total alveolar ventilation is uniform - total capillary blood flow is

.uniform
-Compare PAlveolus O2 to ParterioleO2
.PAO2 = PaO2
:
(PAO2 - PaO2) difference
PaO2 / PAO2 ratio
normal anatomical shunt :
.Ventilation/Perfusion mismatching
)(pulmonary disease
V/Q , / )
/ (.
-

-
V/Q Ratio

Ventilation Perfusion
Ratio

.
- =
) (
= .
) (

26

 1
.



90

V\Q
-
V\Q -

,
VQ.-
" -42
,
100 90- V.Q-

V\Q - , . "
" ,
,
.
".

:
-1 -.
-2 " .
-3 ) (- .
-4 .

- -

26

 - , ,O2- .
- , , ,O2- .
- - O2.
- , O2.

26

- -3

-




.100%




.

,
' . 0.25
.
.

)
( -
~ ml 500

26

 ~ ml 850
) (
-
- )) ~2%
.
- )~.(98%
-
) O2 Partial Pressure ( - ,mmHg :

, ' , .
) O2 Content( ,(%ml O2 / dl blood (synonym Vol :

) =Hb). (dl- = 100"(.

) O2 Saturation( - ,% :

PO2- .

60-70-" ,
' .
- The plateau
) ( .
' ,Hb 100%-
.
-
.
.
x- .
- .
-
2 2 2- ) 2 heme( , 4'

g of hemoglobin can bind 1.36 ml O2 1

Normal [Hb]blood = 15 g/dl
-
:100%-

26

 ) ,(ml/dl0.3 O2 100%
.ml O2 /dl blood 1.8
-
-

(100 mmHg ) (0.003ml / dl / mmHg ) = 0.3ml / dl

" -

98%
= 20 ml / dl
100%

)= 1.36 (15

% S aO2
100%

]CaO = 1.36 [ Hb
2

-
-

(40 mmHg ) (0.003ml / dl / mmHg ) = 0.12 ml / dl

" -

75%
= 15ml / dl
100%

)= 1.36 (15

% S vO2
100%

]CvO = 1.36 [ Hb
2

) (S= 75%
) 40- (.
-' ,Hb - ,
.

) ml/dl/mmHg 0.003(.
, : ) ( , ,
) (.
Hb P50- .20mmHg
.
Mb P50- 2.7mmHg ) 10 -
(Hb .

26

.1 :
-

.2 .

 - ,

) (
) (

) .
(DPG-
-CO
,
210 ,

.
P50 .

.1
.2
.3

.4

CO2.
pH ) (Bohr
'.
2,3DPG.

- pH- 7.4 ,7.2-

. pH- ,
. , pH- ,
. .CO2
-CO2 " Hb-
.
" - , Hb
"" .
" .
-Bohr
: CO2 pH
CO2 : , Hb-
'

Hb NH 2 + CO2 Hb NH COO + H +
') -' - (
'- ' - .
.

26

 - DPG 2,3 2,3BPG

,
, DPG .
2,3DPG -
,
: , : ,,
, )). right to left shunt
- , )
( ".

CO2
" 3- .1 - .2 , -- .
.
" 7% - 70% , 23% ,-.
- , ' ,

"

carbonic
-

se
anhydra
" .
, -
/ . buffered" )
.(HbH
CO2 -.ml/dl/mmHg. [CO2] = 3.4 ml/dl at 45 mmHg 0.075 :.
CO2 - ' .

R N H2 + C O2 R N H C O O + H +

26

 CO2-
".

" .
,
"
" , .

CO2 -

" ,
" ,

"
HB.

"

"
-CO2

26

 "

" - ,
" " ) "
(30-50

' HB.
",
,

) (.

Low PO2

. CO2 dissociation curve shifts downward

Hb-CO2 affinity

. CO2 dissociation curve shifts upward

PO2 ) CO2(

PO2 ) CO2(

26

High PO2

Hb-CO2 affinity

t1/2 ( CO2) in plasma = 10 sec vs. t1/2 in red cells = 50 msec

-Q/V
mmHg125 -
125 . =
" " .mmHg80 -
,
.
-
)4l -
) ( 8l -(
"
,
- 100-
.120


.
regions with high VA/Q do
NOT, canNOT, will NOT
compensate for regions of
low VA/Q
Transient Time: The exchange unit of the lung consists of individual alveoli and
each is supplied by capillaries. As a result, it takes a small amount of time for the
.blood to move through this unit. At rest, the blood transit time is about 0.75 seconds
.When exercising, the transit time can fall to about 0.25 seconds
.However, the efficiency of the system is very good
The PO2 of the blood rapidly rises as it crosses the alveolus, such that the blood is
.fully saturated with O2 by the time it has crossed only 1/3 of the alveolus
So even with heavy exercise, when the flow rate is increased, the blood can still be
fully saturated. Thus, the lung has a considerable reserve capacity for O2
.exchange
:depends on The exact shape of the curve
The carrying capacity of the blood for the gas
And the perfusion rate
If the blood can hold a lot of gas, without changing the Pgas the process is diffusion
limited e.g. CO

26

If the blood can carry little gas, i.e. the Pgas quickly rises, the process is perfusion
limited
Much the same hold for PCO2 although the curve is slightly different because C02 is
.carried in the blood differently to O2, is more soluble and has a lower gradient
Supply to tissues: Diffusion is also the process that gets the O2 to the tissues
.However, there are greater distances between the cells and the blood vessels
At the proximal end of the vessel, the PO2 is highest and there is a good gradient of
PO2 surrounding the vessel. This zone will eventually overlap with the diffusion zone
.of another vessel. Therefore the gradient does not go to zero
Approaching the distal end, the PO2 has fallen and while the gradient into the tissue
.remains, the tissue PO2 can be much lower
Critical if the blood PO2 is reduced, all of these gradients are reduced. So while the
.blood PO2 may be 20 , some tissue PO2s are going to be 0

- 4 -

-
: 2
Central Chemoreceptors

Responsive to increased arterial PCO2

Peripheral Chemoreceptors

Responsive to decreased arterial PO2

Responsive to increased arterial PCO2

Responsive to increased H+ ion

concentration

-
y-
carotid- .
" )
(

26

 ) mmHg 70 -(
.carotid-
) ( .carotid-
- - ' .
- .
" .
- . BBB- "
) ( ." .
) "( , " .
CSF poorly buffered " pH -.CSF-
80%- ' , 20%
.
"
.
" .

:Factors which affect slope of relationship

gender, ethnic origin

(sleep (slow wave sleep B

respiratory depressants ) B (:

low PO2: hypoxia

26

))unconsciousness

alcohol, barbiturate, anaesthetics, narcotics

- -5

-
.
CO2-

.
...

) sea level: 760 mmHg ; PO2 = 105mmHg : (

Vail :550 mmHg ; PO2 = 74mmHg

Everest Base camp: 400mmHg PO2 = 52 mmHg

- ) (
, .
-water 47mmHg at 37 degrees; alveolar O2 fraction 14.75% :

) sea level : (PO2 = (760-47) x 0.1475 = 105mmHg :

Everest:Base camp (5,400m) : PO2 = (400-47) x 0.1475 = 52mmHg

Summit (8,848m): PO2 = (253-47) x 0.1475 = 30mmHg
-
8000- -
.

3000
m
5000
m
8000
m

.
, " .
4000- )
80 ( -
.

.

26

)) BP.

- .

=Acute Mountain Sickness -

-3,500m 50%- .

-5,000m .

: , , , ,

2-3 .

3300' 1000' , 1500 - 1000
'
) +(

-

Decreased PaO2 detected by carotid body hyperventilation and cardiac

output
] [ O2 delivery.
] [ Hyperventilation PaCO2 and alkalosis results.
Higher pH is detected by pH receptors in carotid and aortic
body and CSF.
] [ These hypoventilation O2 delivery.

Lower PaO2 vasoconstriction of pulmonary capillaries high pulmonary

blood pressure and pulmonary
] [ edema
:
- . " -
.1
. "
,-pH- .

26

 ,
.2
,
. .
- - . .PaCO2 -
.
- - . .PaCO -
2 .2
DPG-2,3 O2 Hb -
DPG-2,3
.
DPG-2,3 .
BPG 2,3 :
.
. " pH
.
-Acetazolamide or :
Diamox ) ( , pH-,
. pH- ) , (
.
.
- 3

) Hb
(:

26

e.g. normal HB levels 15.6 g/dl; increase to 21.1 g/dl

15.6*1.36 @98% saturation = 20.5 ml/dl

21.1*1.36 @ 81% saturation = 22.9 ml/dl

-
-
"

.
-
,
90% .
.
-

) (.

-
-
,
.

.
-
1cubic foot air= 0.083lbs :
1cu.ft. sea water= 64lbs :

26

 :-

. - . :
....

SCUBA DIVER

breath-hold
diver

-breath -hold vs. Scuba

.vol

.mol

.vol

.mol

Depth
(.(ft

10

10

sea level

20

10

33

30

10

66

40

10

99

" ' ) (mol

) (V : 8-
4- 3- .2- 100 ) 30-'( ,
) .4 -
(
) ,(Scuba diving
' ' 10-
40- .

) ,(Scuba diving
,:

-Risk of barotraumas
) Ambient pressure - "
(.
.
Free -
.diving

26

66
.33%" -
2


.

)
( -
.
- .

26

 -
.

mm Hg 159.6 592.8

33 ) (

66 - , .

On descent
.1
.2 ,.
On ascent -
.1
.2 .

. ,
.
- ,
- Bent
) ( . - .
-Oxygen toxicity
:
- Muscular twitching

- Nausea

- Abnormal Vision

- Uncoordination

- Convulsions

:
) , 10 - 297
(. .
.

26

 :
- Return to the surface

- Fresh Air

-.Nitrogen narcosis and decompression sickness

.
PN2

- Nitrogen narcosis .

Decompression sickness
.
-Nitrogen narcosis

" - Rupture of the deep - .

PN2
intoxication
80 130 - :
.

CNS- .

- Decompression sickness
.
.
:
.
.
:- . . .
: 2 ) ( . .

-Marine mammals .
-Diving mammals -

) ( .

, .
.
, ,
.
-

26

.1 " 2
.
.2 :
,
.
- .
/ "
-
.

,
) (1,2,3" " .

.

-
bradycardia ,
,8 160-20-

) (CO -
- , .

.
CO- .
"- "
"
)
(.
"
)(.

26

Organ

93%

Brain

17%

Heart

58%

Lungs

5%

Diaphragm

-

.
)
( ,
. " ,
.
-
:

7 - .

Residual volume - 15%

. vital capacity - .85%
) (RV CV- )
.75%-
100 - .-

.

, .

, , decompression sickness -
.

:
.

.
.

26

 -
: , )
(.
: , ,
.
: , ) ,
(.
: ,
:shunting .

.

..
.

26