Ventilation: Breathing Quantified

VENTILATION
• Process by which fresh gas moves in and out
of the lungs.
• Alveolar ventilation: process by which gas
moves between the alveoli and external
environment.
• Minute ventilation: volume of air that enters
or leaves the lung per minute.MV=f x Vt
 VENTILATION(cont.)
• Each minute at rest on an average 300ml of
O2 is taken up and 250ml of CO2 is removed
by alveolar ventilation.
• Thus the partial pressure of O2 and CO2 in the
alveolar air are determined by alveolar
ventilation, by O2 consumption and by CO2
production.
 VENTILATION(cont.)
• RESPIRATORY QUOTIENT : Ratio of
CO2 excreted(Vco2) to the O2 taken up(Vo2)
by the lungs.
• It varies between 0.7 and 1.0 and considered
to be 0.8 under usual circumstances.
 DISTRIBUTION OF VENTILATION
• Ventilation is not evenly distributed in the
lung.
• Regional differences in ventilation due to
effects of gravity.
• In upright position,ventilation per unit of
volume is greatest in lower regions of the lung
compared with the upper lung regions.
 DISTRIBUTION OF VENTILATION(cont.)

• In upright position the intrapleural pressure is

less negative in the lower gravity dependent
regions.
• Pleural pressure increases by +0.2cm of water
for every cm of vertical displacement from top
to the most dependent part of the lung.
• This pressure gradient is due to effect of
gravity and weight of lung.
 DISTRIBUTION OF VENTILATION(cont.)

• In upright position alveoli near the apex are

more expanded than alveoli at the base.
• This is because transpulmonary pressure is
more in the apical regions than in the base.
• As inspiration begins, alveoli at the apex and
at the base of lung have different volumes and
are therefore at different locations on the
pressure volume curve.
Intrapleural Pressure Gradient
Intrapleural Pressure Gradient
Regional Distribution of Alveolar Ventilation
from FRC
Regional Distribution of Alveolar Ventilation
from RV
 DISTRIBUTION OF VENTILATION(cont.)
• Single breath nitrogen test: used to examine the
distribution of ventilation in patients.
• Exhales to RESIDUAL VOLUME and then inspires
100% O2 maximally.
• During the subsequent exhalation N2 conc. Of
exhaled air is measured.
• Initially there is no nitrogen in the exhaled air.
• As alveolar emptying occurs the N2 conc. In the
expired air begins to rise reaching a plateau.
SINGLE BREATH NITROGEN TEST
 Pulmonary blood flow
• Lung is the only organ in the body that receives
blood from two separate sources.
• Pulmonary blood flow and bronchial blood flow.
• Pulmonary circulation arises from right ventricle
and receives 100% of blood flow.
• Bronchial circulation arises from aorta and
receives only 2% of left ventricular output.
•
Pulmonary Circulation
 Functional Anatomy of the
Pulmonary Circulation
• •Thin
Thinwalled
walledvessels
vesselsatatallalllevels.
levels.
• Pulmonary arteries have far less smooth
• muscle
Pulmonary arteries
in the havesystemic
wall than far less smooth
arteries.
•muscle in the wall
Consequences of than systemic arteries.
this anatomy- the
vessels are:
• •Consequences
Distensible. of this anatomy- the vessels
•are:Compressible.
– Distensible.
– Compressible.
 PULMONARY BLOOD FLOW
• Pulmonary capillary bed has the largest surface
area of any vascular bed in the body.
• Many of these capillaries are closed at rest and
open periodically during periods of increased
flow.
• At rest it takes 4 to 5 seconds for a red cell to
travel through the pulmonary circulation with
0.75 secs of this time spent in pulmonary
capillaries.
 PULMONARY BLOOD FLOW
• Pulmonary capillaries have diameter of about 6
micrometer slightly smaller than the diameter of a
red cell.
• During exercise CO and thus pulmonary blood
flow can increase to as much as 25lts/min/m2 and
the pulmonary capillary volume increases with
little or no increase in the vascular resistance.
• This increase in volume occurs through two
processes: 1)recruitment 2)distension
RECRUITMENT AND DISTENSION
 PULMONARY BLOOD FLOW
• Pulmonary veins are situated within loose
interlobular connective tissue septae and
receive blood from many lung units.
• They return the blood to left atrium and due to
large numbers and thin walls provide a large
reservoir of blood.
• Larger pulm. vessels contain smooth muscle
and have a motor supply through the
sympathetic nervous system.
 BRONCHIAL BLOOD FLOW
• Perfuses the respiratory tract to the level of
terminal bronchioles.
• Distal to it lung is directly oxygenated by diffusion
from alveolar air and receive nutrients from the
blood in pulmonary circulation.
• Usually 3 in number arise either from aorta or
from intercostal arteries.
• Pressure is equal to that in the systemic
circulation.
 BRONCHIAL BLOOD FLOW(cont.)
• The return of bronchial blood to the heart is through
either of the following: 1) true bronchial veins 2)
bronchopulmonary veins
• True bronchial veins drain into azygous,hemiazygous
or intercostal veins and finally into right atrium.
• Bronchopulmonary veins are formed by anastomosis
of both pulmonary and bronchial vessels which with
an admixture of blood from both vessels returns to
left atrium through pulm. veins.
 BRONCHIAL BLOOD FLOW(CONT.)
• Lung transplant studies have shown that adult
lungs can function normally in absence of
bronchial circulation .
• However they are important in neonates and
young children in bringing nutrients to the
developing lungs .
• Another importance is in diseased states in which
reciprocal change in flow in the two circulations
provides a steady supply of nutrients.
 EFFECTS OF GRAVITY ON PULM. FLOW
• Because the pulm. Circulation is low pressure,
low resistance system it is effected by gravity
much more dramatically than the systemic
circulation.
• Leads to an uneven distribution of blood flow in
the lung.
• In upright position there is a linear increase in
blood flow from the apex to the base of the
lung.
EFFECTS OF GRAVITY ON PULM. FLOW(cont.)

• Under conditions of stress the difference in blood

flow between apical and basal regions becomes
less due mainly to the increase in blood flow.
• Upon leaving the pulmonary artery blood must
travel up to the apex against gravity in upright
position.
• For every increase of 1cm in height above the
heart there is a corresponding decrease in
hydrostatic pressure in vessels.
 ZONES OF LUNG
• When referring to blood flow lung has been
classically divided into three zones: a)
zone 1 represents the apex where it is
possible to have no blood flow. Under normal
conditions this zone does not exist. b)
zone 2 represents upper 1/3rd of the lung.
C) zone 3 comprises of
basal areas of lung.
ZONES IN THE LUNG
 EFFECT OF PRESSURE CHANGES ON
EXTRA ALVEOLAR AND ALVEOLAR VESSELS
• Changes in alveolar and intrapleural pressure can
also influence pulmonary blood flow.
• These effects are different depending on the
location of the vessels.
• The EA vessels are larger vessels and are generally
not affected by alveolar pressure changes.
• They are affected by pleural and interstitial
pressure changes.
 EFFECT OF PRESSURE CHANGES ON
EXTRA ALVEOLAR AND ALVEOLAR VESSELS
• As the transpulmonary pressure increases the
caliber of extra alveolar vessels increases and
vice-versa.
• As the alveolar pressure increases the alveolar
vessels get constricted and caliber decreases.
• Thus high lung volumes have opposite effect
on alveolar and extra alveolar vessels and
their resistance.
 PULMONARY VASCULAR RESISTANCE

• The resistance of alveolar and extra alveolar

vessels are additive to each other at any lung
volume because the alveolar and extra
alveolar vessels are in series to each other.
• This results in U shaped curve of total
pulmonary resistance.
• PVR is lowest near FRC and increases at both
low and high volumes
PULMONARY VASCULAR RESISTANCE
 Pulmonary Vascular Resistance

• With positive pressure mechanical ventilation

there is both an increase in alveolar pressure
and a decrease in transmural pressure
gradient.
• this results in compression of both alveolar
and extra alveolar capillaries and can block
blood flow to the area.
• Thus it can create zone 1 blood flow.
 HYPOXIC VASOCONSTRICTION IN PULM.
VESSELS
• This occurs in small arterial vessels in response
to decreased arterial po2.
• Response is local and is believed to be a
protective response as it shifts the blood flow
from the hypoxic areas to normal areas in an
effort to enhance gas exchange.
 VVentilation perfusion relationships

• V/Q ratio is the ratio of ventilation to blood

flow (perfusion).
• It can be defined for a single alveolus, a group
of alveoli, or for the entire lung.
• The relationship between ventilation
perfusion that is V/Q ratio is the major
determinant of normal gas exchange.
 V/Q relationships (cont.)
• At rest in normal individuals alveolar
ventilation is 4 lts per minute.
• Pulmonary blood flow is 5 lts per minute.
• Overall V/Q ratio is 0.8.
• If ventilation and perfusion are mismatched
impairment of both O₂ and CO₂ transfer occurs
.
 V/Q relationships (contd…)
• Ventilation-perfusion mismatching occurs with
increasing age and with various lung diseases.
• When ventilation exceeds perfusion, the V/Q
ratio > 1.
• When perfusion exceeds ventilation, the V/Q
ratio < 1
 REGIONAL DIFFERENCES IN VENT. AND
PERFUSION
• Because of the regional differences in
ventilation and perfusion, even in the normal
lung the V/Q in different areas of the lung is
greater or less than the normal value of 0.8.
• In upright position in a lung from top to bottom
ventilation increases more slowly than
perfusion does.
• As a result V/Q at the top is high while as at the
bottom it is abnormally low.
VENTILATION, PERFUSION AND V/P RATIO
ALVEOLAR O2 AND CO2 LEVELS IN RELATION
TO V/P RATIO
O2 CO2 DIAGRAM SHOWING A VENTILATION-
PERFUSION RATIO LINE
Effects of ventilation-perfusion inequality on
overall gas exchange
• Lung with ventilation perfusion
inequality is not able to transfer as
much O2 and CO2 as a lung that is
uniformly ventilated and perfused,
other things being equal.
•Thank you
• O2 = 150
• CO2 = 0.3