RESPIRATORY DEAD SPACE

8. Respiratory dead
space
Questions on respiratory dead space are particularly common in the primary FRCA examination. Examiners will
expect clear definitions of what constitutes the different types of dead space and how they can be measured.

Define dead space as applied to
the respiratory system.
Respiratory dead space is the volume of inspired gas that does not take part
in gas exchange. It is divided into anatomical and alveolar dead space.
> Anatomical dead space:
• Constitutes the conducting airways (Weibel classification – airway
generations 1–16: trachea, bronchi, bronchioles and terminal
bronchioles)
• Includes the mouth, nose and pharynx
• Equates to 2 mL/kg

Table 8.1  Factors affecting anatomical dead space

Anatomical dead space increased by: Anatomical dead space decreased by:
Sitting up General anaesthesia
Neck extension and Jaw protrusion Hypoventilation
Increasing age Intubation
Increasing lung volume Tracheostomy

> Alveolar dead space:

• Constitutes alveoli that are ventilated but not perfused and, therefore,
no gas exchange occurs
• Can be significantly affected by physiological and pathological
processes
> Physiological dead space:
• Represents the combination of anatomical and alveolar dead space

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 01 PHYSIOLOGY
How is anatomical dead space Fowler’s method is used to measure anatomical dead space. It is a
measured? technique that uses single-breath nitrogen washout utilising a rapid nitrogen
gas analyser.
> A nose clip is placed on the subject, and the subject breathes air in and
out through their mouth via a mouthpiece.
> From the end of a normal expiratory breath (i.e. FRC) the subject takes a
maximal breath of 100% O2 to vital capacity.
> Subject then exhales maximally at a slow and constant rate to residual
volume.
> During exhalation the expired gas passes through the rapid nitrogen
analyser and so nitrogen concentration is measured against volume.
> Four distinct phases are seen in expired nitrogen concentration.

Expired N2 concentration (%) I II III IV

40 A

B
0
TLC Lung Volume (L) CC RV
Anatomical dead space

Fig. 8.2  Nitrogen concentration versus lung volume

> Phase I: Initial expired gas from the conducting airways containing 100%
O2 and no N2.
> Phase II: Nitrogen concentration increases as alveolar gas begins to mix
with anatomical dead space gas.
> Phase III: Alveolar plateau phase – exhalation of alveolar gas containing
N2 from the alveoli. Oscillations can be seen in phase 3, which are
caused by interference from the heartbeat.
> Phase IV: Represents closing capacity. During expiration airways at the
lung bases close as the lung approaches residual volume, so phase 4
expired gas comes mainly from the upper lung regions. During normal
inspiration the lung bases are preferentially ventilated and therefore the
lung apices receive less of the 100% O2 breath. At closing volume N2
from the lung apices is expired causing the phase 4 rise in expired N2
concentration.
> Anatomical dead space is found by dividing phase 2 so that areas
A and B are equal and measuring from the start of exhalation.

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 RESPIRATORY DEAD SPACE
How is physiological dead space The Bohr equation is used to derive physiological dead space
measured? (anatomical + alveolar).

VD.PHYS PaCO 2 – PECO 2

=
VT PaCO 2

Where:
VD.PHYS Physiological dead space
VT Tidal volume – measured with a spirometer
PaCO2 Arterial partial pressure of CO2 – measured from an arterial
blood gas
PECO2 Mixed expired partial pressure of CO2 – measured from
end-tidal CO2.
Any of the situations previously mentioned that increase anatomical dead
space will consequently increase physiological dead space.
Alveolar dead space is increased by most lung diseases (especially
pulmonary embolus), general anaesthesia, positive pressure ventilation and
positive end expiratory pressure. Under such circumstances VD.PHYS / VT may
approach 70% (normally 35%), which has obvious implications for CO2
removal.

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