Ventilation Dec 17, 2023

1 PHYSIOLOGY

• ALVEOLAR / PULMONARY
VENTILATION
• DR DANIEL
 Ventilation Dec 17, 2023

PULMONARY VENTILATION

Tidal volume 500 ml Total ventilation

7500 ml/min
Anatomical dead
space 150 ml Frequency = 15
per min

Alveolar gas Alveolar

3000 ml ventilation
5250 ml/min

Pulmonary
Pulmonary blood flow
capillary blood 70 5000 ml/min
ml

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 Ventilation Dec 17, 2023

3 PULMONARY VENTILATION

• Minute ventilation (VE)

• Volume of air inspired or expired per minute
• Depends on the frequency (f)
• Depth of breathing (tidal volume, VT)
• VE = ( VT * f)
 Ventilation Dec 17, 2023

4 PULMONARY VENTILATION

• At rest
• VT = 500 ml , f = 12 to 15 breath per
minute
• VE = (500 * 12) = 6000 ml/min
• VE = (500 * 15) = 7500 ml/min
 Ventilation Dec 17, 2023

ALVEOLAR
5
VENTILATION

Portion of tidal
volume air that
• Alveolar ventilation
Tidal vol =

remain in dead
(VA)
500 ml

space (150 ml)

• VA = (VT – VD) * f
Portion of tidal
air that gets into
Alveolar
air
alveoli (350 ml) • VA = (500 – 150) * 12
• VA = 4200 ml/min

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 Ventilation Dec 17, 2023

ALVEOLAR – CAPILLARY GAS

6 EXCHANGE

alveoli

Pulmonary
Pulmonary blood flow
capillary blood 70 5000 ml/min
ml
 ALVEOLAR/CAPILLARY EXCHANGE

CO2 • Composition of
O2
alveolar gas mixture
• Contain respiratory
Alveolar gases
space
CO2
• Oxygen, carbon
O2
dioxide
• Together with
CO2 O2 • Nitrogen, water
vapour

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 ALVEOLAR/CAPILLARY EXCHANGE

CO2
O2 • The conc of O2 in the
alveoli (FAO2) depends
Alveolar
on
space • Rate of diffusion of
CO2 O2 oxygen in blood (VO2)
• Oxygen uptake
• Rate of entry of O2 into
CO2 O2
the lung
• (FIo2) * (VA)

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 ALVEOLAR/CAPILLARY EXCHANGE

CO2
O2
• Where
• (FIO2) is the conc of O2
Alveolar
space
in inspired air
CO2 O2 • (VA) is alveolar
ventilation
CO2 O2

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 ALVEOLAR/CAPILLARY EXCHANGE

CO2
O2 • The alveolar CO2 conc
(FACO2) depends on
• Rate of excretion of
Alveolar
space CO2 from blood into
CO2 O2
alveolar
• Rate of CO2 removal
from the alveoli
CO2 O2 • (FACO2) * (VA)

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 ALVEOLAR/CAPILLARY
EXCHANGE

CO2
O2
• Where
• (FACO2) is the alveolar
Alveolar
space
CO2 conc
CO2 O2 • (VA) is alveolar
ventilation
CO2 O2

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 Ventilation Dec 17, 2023

12 ALVEOLAR PARTIAL PRESSURES

• In a mixture of gases
• Each gas exerts its own partial pressure (tension)
• According to Dalton’s law
• Partial pressure equal
• Fraction of gas present (concentration) times the total
pressure
• Partial pressure of gas in a mixture is a measure of
the concentration of the gas in the mixture
 Ventilation Dec 17, 2023

13 PARTIAL PRESSURE

• % Composition of dry air at sea level contain

• O2 = 20.93%
• Co2 = 0.03%
• N2 = 79.04%
• Partial pressure
• Total pressure * % conc
• For O2
• Po2 = 760 * 0.2093 = 159 mm hg
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PARTIAL PRESSURE

• For CO2
• PCO2 = 760 * 0.0003 = 0.2 mm Hg
• For N2
• PN2 = 760 * 0.7904 = 600 mm Hg
PARTIAL PRESSURES & CONC OF O2, CO2 IN
ALVEOLI

• Oxygen
• Conc of O2 in alveoli (FAO2)
Alveoli & PAO2
FAO2
PACO2
PAO2 • Depend on
CO2 O2
• Rate of diffusion into blood (V O2)
CO2 O2
• Rate of entry of O2 in lungs

Pulmonary capillary • (FIO2) * (VA)

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 PARTIAL PRESSURES & CONC OF O2,
CO2 IN ALVEOLI
• Hence
• If you increase O2
Alveoli consumption (VO2)
FAO2
PACO2
PAO2 • You need to increase
CO2 O2
alveolar ventilation (VA)
CO2 O2

• To maintain PAO2 at 100

Pulmonary capillary
mmHg
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 PARTIAL PRESSURES & CONC OF O2,
CO2 IN ALVEOLI
VO2 = 250 ml/min
• When the oxygen
150
uptake (VO2) is 250
ml/min
PAO2 & PACO2 mm Hg

100 PAO2 = 100

mm Hg • You require alveolar
VO2 = 1000 ml/min
vent of about 5 liters
40
PACO2 = 40 mm /min to maintain PAO2 =
Hg
100mm Hg
5 10 15 20 30
Alveolar ventilation (L/min)

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 PARTIAL PRESSURES & CONC OF O2,
CO2 IN ALVEOLI
VO2 = 250 ml/min
• When the oxygen
150
uptake (VO2) is 1000
ml/min
PAO2 & PACO2 mm Hg

100 PAO2 = 100

mm Hg • You require alveolar
VO2 = 1000 ml/min
vent of about 20
40
PACO2 = 40 mm liters /min to maintain
Hg
PAO2 = 100mm Hg
5 10 15 20 30
Alveolar ventilation (L/min)

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 PARTIAL PRESSURES & CONC OF O2,
CO2 IN ALVEOLI
• For CO2

• The alveolar CO2 conc

Alveoli (FACO2) and the PACO2

FAO2
PACO2
PAO2
depend on rate of
CO2 O2 • Excretion of CO2 from
CO2 O2 blood into the alveoli
• CO2 removal from
Pulmonary capillary alveoli (VA * FACO2)

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 PARTIAL PRESSURE OF
RESPIRATORY GASES (MM HG)
Gas Atmospheric air Alveolar gas Expired air

O2 159.0 (20.84%) 104.0 120.0

(13.6%) (15.7%)
CO2 0.3 (0.04%) 40.0 (5.3%) 26.0 (3.6%)

N2 597.0 (78.62%) 569.0 566.0 (74.5)

(74.9%)
H2O 3.7 (0.5%) 47.0 (6.2%) 47.0 (6.2%)

Total 760 (100%) 760 (100%) 760 (100%)

From Guyton

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 PARTIAL PRESSURES & CONC OF O2,
CO2 IN ALVEOLI
• The partial pressure of the
respiratory gases in the
alveoli
Alveoli • PAO2 = 100 mmHg
PACO2 = 40 • PACO2 = 40 mm hg
PAO2 = 100
CO2 O2 • In the capillary at arterial
CO2 O2 end
PaCO2 = 46 mm Hg
• Pao2 = 40 mmHg
PvCO2 = 40 mm Hg
PaO2 = 40 mm Hg PvO2 = 100 mm Hg • Paco2 = 46 mm hg

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 PARTIAL PRESSURES & CONC OF O2,
CO2 IN ALVEOLI
• In the capillary at venous
end
• PvO2 = 100 mmHg
Alveoli • PvCO2 = 40 mm Hg
PACO2 = 40 PAO2 = 100
• Thus there is
CO2 O2
• Partial pressure difference
CO2 O2
which form the driving
PaCO2 = 46 mm Hg PvCO2 = 40 mm Hg force for diffusion of O2 and
PaO2 = 40 mm Hg PvO2 = 100 mm Hg CO2

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ALVEOLAR CAPILLARY MEMBRANE

• Alveolar capillary
membrane
• Made up of
• Capillary endothelium
• Single layer
endothelial cells
• Basement membrane
• Elastic collagenous
tissue
• Alveolar epithelium
• Single layer
epithelial cells
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 DIFFUSION CAPACITY OF THE LUNG

• Ability of respiratory
membrane (RM )
• To exchange gas between
alveoli & pulmonary blood
Alveoli • Diffusion capacity
• Volume of gas that will
CO2 O2 diffuse through the
RM/min/mm Hg
Pulmonary capillary

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 EQUILIBRATION FOR O2

• Diffusion of O2 occurs
from alveolar gas to
pulmonary capillary blood
PO2 = 60 • Normal Alveolar O2 tension
PO2 = 0
Alveoli (PAO2) = 100 mm Hg
• Oxygen tension of blood
PAO2 = 100 PAO2 = 100
entering the capillary (PaO2)
= 40 mm Hg
PaO2 = 40 PvO2 = 100

Pulmonary capillary

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 EQUILIBRATION FOR O2

• Diffusion of O2 occurs
from alveolar gas to
pulmonary capillary blood
PO2 = 60 • Normal Alveolar O2 tension
PO2 = 0
Alveoli (PAO2) = 100 mm Hg
• Oxygen tension of blood
PAO2 = 100 PAO2 = 100
entering the capillary (PaO2)
O2
= 40 mm Hg
PaO2 = 40 O2 PvO2 = 100

Hb Hb O2 Hb

Pulmonary capillary
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 EQUILIBRATION FOR O2

• After crossing the

alveolar/capillary
membrane
PO2 = 60
PO2 = 0 • O2 diffuse in plasma
Alveoli
• Raising plasma O2
PAO2 = 100 PAO2 = 100
tension
O2
• Cause O2 to diffuse into
PvO2 = 40 O2 PaO2 = 100 RBC
Hb Hb O2 Hb

Pulmonary capillary
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 EQUILIBRATION FOR O2

• Equilibration time
• Enough O2 diffuse
PO2 = 60
PO2 = 0 across the alveolar/
Alveoli capillary membrane
PAO2 = 100 PAO2 = 100
O2 • Blood O2 tension and
PvO2 = 40 O2 PaO2 = 100 alveolar O2 tension
Hb Hb O2 Hb • Equalize in about 0.25
seconds
Pulmonary capillary
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 EQUILIBRATION FOR CO2

• Diffusion of CO2 occurs

from pulmonary capillary
blood to alveolar gas
PCO2 = 6 • Normal Alveolar CO2
PCO2 = 0
Alveoli tension (PACO2) = 40 mm Hg
• CO2 tension of blood
PACO2 = 40 PACO2 = 40
entering the capillary (PaCO2)
= 46 mm Hg
PaCO2 = 46 PvCO2 = 40

Pulmonary capillary

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 EQUILIBRATION FOR CO2

• CO2 diffuse
• From capillary blood into
alveoli
PCO2 = 6 • It is estimated that the time
PCO2 = 0
Alveoli required for
PACO2 = 40 PACO2 = 40 • The blood CO2 tension and
CO2 the alveolar CO2 tension to
equalize
PaCO2 = 46 CO2 PvCO2 = 40 • Is approximately 0.25
sec
Hb Hb CO2 Hb

Pulmonary capillary
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 EQUILIBRATION

Alveolus
• Blood transit time during
CO2, O2
its passage through the
RBC
capillaries
100 mm Hg • At rest transit time is 0.75
sec
Oxygen
• By 0.25 sec blood and
alveolar air have equalized
for O2 and CO2 tensions
46
Carbon dioxide
40

0 0.25 0.50 0.75 seconds

Transit time
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 FACTORS AFFECTING GAS EXCHANGE

• Amount of gas
exchanged across the
respiratory membrane
Alveoli
may be dependent on
• Perfusion or
• Diffusion properties
Pulmonary capillary

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 PERFUSION LIMITED GAS EXCHANGE

Alveolus

• As soon as the O2
RBC CO2, O2
equilibrates
100 mm Hg
Oxygen
• Net transfer of O2
ceases
• No additional uptake of
46
40
Carbon dioxide O2 occurs until
• Capillary blood is
0 seconds replaced by new blood
0.25 0.50 0.75
Transit time
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 PERFUSION LIMITED GAS EXCHANGE

Alveolus

• Increase in gas exchange

RBC CO2, O2 can only
100 mm Hg • Be achieved by increase in
Oxygen blood flow

• Average RBC
• Spends 0.75 sec in
46
Carbon dioxide pulmonary capillary
40
• O2 equilibration occurs in
seconds
0.25 sec
0 0.25 0.50 0.75
Transit time
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 DIFFUSION LIMITED GAS EXCHANGE

Alveolus
• Occurs whenever
CO2, O2
• Equilibration does not occur
RBC
• Many pulmonary diseases
100 mm Hg
• Reduce the rate of O2
Oxygen transfer
• By altering with RM
• Reduce alveolar O2 tension
46 • Reduces diffusion rate
Carbon dioxide
40

0 0.25 0.50 0.75 seconds

Transit time
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 DIFFUSION LIMITED GAS EXCHANGE

Alveolus  PAO2

• The diffusion rate can be

RBC CO2, O2 increased by
• Raising the alveolar O2 tension
100 mm Hg (PAO2)
Oxygen

46
Carbon dioxide
40

0 0.25 0.50 0.75 seconds

Transit time
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 PULMONARY BLOOD FLOW

• The entire blood flow

from the right ventricle
• Distributed to the
pulmonary vessels
Alveoli • Pulmonary blood flow
is essentially equal to
cardiac output (5 l/min)

Q
Pulmonary capillary

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 Ventilation Dec 17, 2023

38 BLOOD VOLUME

• Blood volume of the lungs

• Is about 450 ml
• 9% of total blood volume
• About 70 ml of this is in the capillaries
• The remaining is divided equally
between arteries and veins
 VENTILATION – PERFUSION RATIO

• The alveolar O2 (PAO2)

tension and CO2(PACO2)
tension
Alveoli • Determined by the rate of

VA • Alveolar ventilation
(VA) and

Q • Transfer of O2 & CO2

through the respiratory
Pulmonary capillary membrane

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 VENTILATION – PERFUSION RATIO

• In the lung with normal

ventilation & blood flow
some areas are well
• Ventilated but poorly
perfused
Alveoli
• Perfused but poorly
ventilated
VA
• In either of these situation
• Gas exchange at the
Q respiratory membrane
would be impaired
Pulmonary capillary

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 VENTILATION – PERFUSION RATIO

• Ventilation – perfusion
ration
• Expressed as VA/Q
• Where
Alveoli
• VA = alveolar
VA ventilation for a given
alveolus
• Q = capillary blood
Q flow for the same
alveolus
Pulmonary capillary

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 VENTILATION – PERFUSION RATIO

• For the entire lung

• VA = 4.2 liters / min
• Q = 5 liters/ min
Alveoli
VA (4.2) • Thus the VA/Q = 4.2/5
= 0.84
Q (5) • This is the normal ratio
Pulmonary capillary

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 EFFECT OF VENTILATION-PERFUSION
RATIOS
• If an alveolus is well
ventilated & well perfused
PAO2 = 104
• The VA/Q = 0.84
PACO2 = 40
VA • In this case there will be
PaO2 = 40
Q normal gas exchange
PaCO2 = 46 PvO2 = 98
• The alveolar gas equilibrates
PvCO2 = 40 with the capillary blood
VA / Q = 0.84 partial pressures of O2 &
CO2

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 EFFECT OF VENTILATION-PERFUSION
RATIOS

• If an alveolus is not
PAO2 = 40 ventilated but is well
PACO2 = 46 perfused
PaO2 = 40
VA
Q • The VA/Q = 0
PaCO2 = 46
PvO2 = 40
PvO2 = 46 • In this case there will be no
VA / Q = 0 gas exchange
• Pulmonary capillary blood
not oxygenated (Shunt)

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 EFFECT OF VENTILATION-PERFUSION
RATIOS

• The alveolar gas

PAO2 = 149 equilibrates with the
PACO2 = 0 venous blood partial
PaO2 = 40 VA
PaCO2 = 46
Q pressures of O2 & CO2

• If an alveolus is well
VA / Q = ∞
ventilated but not
perfused
• The VA/Q = ∞

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 EFFECT OF VENTILATION-PERFUSION
RATIOS

• In this case there will be no

PAO2 = 149 gas exchange
PACO2 = 0 • Pulmonary capillary blood
PVO2 = 40 VA not oxygenated
PVCO2 = 46
Q
• The alveolar gas equilibrates
with the atmospheric air
VA / Q = ∞ partial pressures of O2 &
CO2
• Dead space

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 PHYSIOLOGIC SHUNT

• In a poorly ventilated
alveolus
PVO2 = 40
VA • VA is low while Q is
Q
PVCO2 = 46 normal
• The VA/Q < 0.8
VA / Q < 0.8

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 PHYSIOLOGIC SHUNT

• Certain portion of
venous blood does not
PVO2 = 40
VA become oxygenated
Q
PVCO2 = 46 • Poorly aerated blood
leaves pulmonary
VA / Q < 0.8 capillary (shunted
blood)

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 PHYSIOLOGIC SHUNT

• Physiologic shunt
• There is a fall in PvO2

PaO2 = 40
VA • Only slight elevation of
Q
PaCO2 = 46 PvCO2
• CO2 is eliminated in
VA / Q < 0.8 ventilated alveoli

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 VENTILATION – PERFUSION RATIOS IN
LUNG
Zone 1 • In the lung of upright
VA/Q > 0.8 individual
• Upper part is less well
ventilated than the lower
Zone 2 Level of
part, but
VA/Q = 0.8 RA
• It is also poorly perfused
Zone 3 • VA/Q > 0.8
VA/Q < 0.8 • This amounts to Dead
space

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 VENTILATION – PERFUSION RATIOS IN
LUNG
Zone 1 • In the lung of upright
VA/Q > 0.8
individual
• Lower part is well
Zone 2 Level of ventilated, but
VA/Q = 0.8 RA
• It is also very well
Zone 3 perfused
VA/Q < 0.8
• VA/Q < 0.8
• This amounts to
physiologic shunt
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