OBJECTIVES

 To define and classify ventilation and perfusion

in lungs

 To describe zone of perfusion in lungs

 To describe ventilation-perfusion ratio in lungs

 INTRODUCTION

 VENTILATION

The cyclic process by which there is mass movement

of air in and out of the lungs through nasal passages
or mouth
Ventilation is divided into two

1.Pulmonary ventilation

2.Alveolar ventilation
 Pulmonary ventilation is the  Alveolar ventilation is the volume of
fresh air entering the respiratory
amount of air that is taken in or
zone in one minute
given out during quiet normal
 Represents the amount of fresh air
respiration for one minute.
available for gas exchange

Alveolar ventilation , VA
Pulmonary ventilation
= (Tidal volume-RDS)
= Tidal volume x Respiratory x Respiratory rate

rate =(500-150 )x 12

=500 x 12 =6 L/minute =4.2 L/minute

REGIONAL VARIATION IN
VENTILATION
Intra pleural
pressure changes
 Apex  - 10 mmHg

 Base  -2.5 mmHg

 At the apex
↓
Intrapleural pressure more –ve
↓
Greater expansion of apical
alveoli
↓
Larger resting volume
↓
Less compliance
↓
During inspiration,less expansion
of apical alveoliless ventilation
 At the base
↓
Intrapleural pressure less –ve
↓
Alveoli small size initially
↓
Lower resting volume
↓
More compliance
↓
Expands more readily during
inspiration  more ventilation
PERFUSION

The process by which deoxygenated

blood passes through the lungs and
becomes reoxygenated.
REGIONAL VARIATION IN
PERFUSION
 Continuous blood
No blood flow Intermittent blood flow
PA>Pa>Pv flow
Pa>Pv>PA
systole flow+ Alveolar capillary
Alveolar capillary Diastole flow- pressure > alveolar
air pressure during
pressure never rises Pa>PA>Pv
entire cardiac cycle
higher than alveolar
air pressure.
10cm above midlevel 10cm above midlevel
of heart to top of of heart to bottom
Abnormal lungs of lungs
1. Gravity – affects perfusion much more than it affects
ventilation

So the apical alveoli are more underperfused than

underventilated.

2. Hypoxic pulmonary vasoconstriction

3. Chemical and humoral substances

vasoconstrictors- α agonists,TXA2,NE,histamine,endothelin
vasodilators- βagonists,bradykinin,PGI2,NO
Concept of ventilation-perfusion
ratio?
VENTILATION-PERFUSION RATIO

 It
is the ratio between alveolar ventilation in one
minute and pulmonary perfusion in one minute.

 It is designated as VA/Q
Where VA is the alveolar ventilation and Q the blood
flow
 NORMAL VA/Q
 Resting alveolar ventilation = 4.2L/minute
 Pulmonary blood flow (equal to CO) = 5L/minute

VA/Q = 4.2 L/mt

5L/mt
=0.84 (at the middle of the lung)
When VA/Q equals zero or infinity

VA/Q=0 VA/Q=∞
Effects of alterations in VA/Q
NORMAL VA/Q ↓↓VA/Q ↑↑ VA/Q

Optimal exchange physiologic shunt physiologic dead space

Alveolar Po2-104 Alveolar Po2-40 Alveolar Po2-149
Alveolar Pco2-40 Alveolar Pco2-45 Alveolar Pco2-0
Clinical importance of VA/Q

 Pulmonary tuberculosis affects apex of the lung

first.
Reasons??

 One lung non-functional

 Determining gas concentration in alveoli

 Determining the effectiveness of gas exchange

through the alveolo-capillary membrane

 Helps to assess whether there is imbalance between

alveolar ventilation and alveolar blood flow
 Measurement of dead space
 Continuous monitoring of CO2 content of expired
air
 Radioisotope method Xe-133
Measurement of ventilation

 Subject inhales a breath of radioactive xenon gas(Xe 133).

 Enters lung  penetrates chest wall

 Measured by placing scintillation counters over appropriate

areas of thorax.

 Inference??

 Effect on changing posture??

Measurement of blood flow distribution

 Radioactive xenon gas dissolved in saline  injected into

SVC/Peripheral vein  reaches pulmonary capillaries 
measured by a radiation camera mounted behind the
chest.

 Inference??
ABNORMALITES IN VA/Q
 Abnormal VA/Q in the upper and lower normal lung

 In COPD

 VENTILATION WITH OUT PERFUSIONPULMONARY EMBOLISM

PULMONARY HTN

 PERFUSION WITH OUT VENTILATION CONSOLIDATION,

COLLAPSE,FIBROSIS
PULMONARY EDEMA
 Ganongs review of medical physiology

 Guyton and Hall textbook of medical

physiology

 Textbook of medical physiology ,N Geetha

 Indukhurana textbook of physiology