Ventilation-perfusion Ratio

Ventilation/perfusion Ratio or V/Q

 This relationship between ventilation and
PERFUSION is called the ventilation-perfusion
ratio (V/Q ratio).
 On average,alveolar ventilation is about 4 l/min
and pulmonary capillary blood flow, ( cardiac
output) is about 5 l/min, making the overall ratio
of ventilation to perfusion 4:5, or 0.8.
 The V/Q ratio varies throughout the lung.
 How the V/Q Ratio affects Alveolar Gas
 Ventilation and Perfusion (V/Q) has a profound
effect on the partial pressures of O2 and CO2 in
the alveolus.
 Pa02 and PaCO2 levels average about 100 mmHg
and 40 mmHg respectively.
 Only in a small portion of the lungs are those
numbers true. They are actually an average
Ventilation -------4 l/min.
Perfusion ---------5 l/min.
Normal V/Q = 4.5 =0.8
( all over the lung)
When V (alveolar ventilation) is normal for a
given alveolus and Q (blood flow) is also
normal for the same alveolus, the ventilation-
perfusion ratio (V/Q ) is normal.
When the ventilation (V) is zero, but there is
still perfusion (Q ) of the alveolus, the V /Q
is zero.

When there is adequate ventilation (V) but

zero perfusion (Q), the ratio V/Q is infinity.
When V/Q is equal to zero—that is, without
any alveolar air and because the blood that
perfuse the capillaries is venous blood
returning to the lungs from the systemic
circulation the Po2 is of 40 mm Hg and a
Pco2 of 45 mm Hg in alveoli that have
blood flow but no ventilation.
When VA/Q Equals Infinity The air that is inspired
loses no oxygen to the blood and gains no carbon
dioxide from the blood. And because normal
inspired and humidified air has a Po 2 of 149 mm
Hg and a Pco2 of 0 mm Hg, these will be the
partial pressures of these two gases in the alveoli.
At a ratio of either zero or infinity, there is no
exchange of gases through the respiratory
membrane of the affected alveoli.
When there is both normal alveolar ventilation
and normal alveolar capillary blood flow
(normal alveolar perfusion), exchange of
oxygen and carbon dioxide through the
respiratory membrane is nearly optimal, and
alveolar Po2 is normally at a level of 104 mm
Hg, which lies between that of the inspired air
(149 mm Hg) and that of venous blood (40
mm Hg).
“Physiologic Shunt”
Whenever V/Q is below normal, there is
inadequate ventilation to provide the oxygen
needed to fully oxygenate the blood flowing
through the alveolar capillaries.
Therefore, a certain fraction of the venous blood
passing through the pulmonary capillaries does
not become oxygenated. This fraction is called
shunted blood.
Some additional blood flows through bronchial
vessels rather than through alveolar
capillaries, normally about 2 % of the cardiac
output; (unoxygenated, shunted blood).
 The total quantitative amount of shunted blood per
minute is called the physiologic shunt.

The greater the physiologic shunt, the greater the

amount of blood that fails to be oxygenated as it
passes through the lungs.
When V /Q is greater than normal

When ventilation of some of the alveoli is great

but alveolar blood flow is low, (more oxygen
in the alveoli be wasted), anatomical dead
space areas of the respiratory passageways is
also wasted.
The sum of these two types of wasted ventilation
is called the physiologic dead space.

This is measured in the clinical pulmonary

function laboratory by making appropriate
blood and expiratory gas measurements
Abnormal V/Q in the upper and lower normal
lung
In a normal person in the upright position, both
pulmonary capillary blood flow and alveolar
ventilation are considerably less in the upper
part of the lung than in the lower part; (blood
flow is decreased more than ventilation is.
At the top of the lung, V /Q is as much as 2.5
times as great as the ideal value, which causes a
moderate degree of physiologic dead space in
this area of the lung
 In the bottom of the lung, there is slightly
too little ventilation in relation to blood
flow, with V /Q as low as 0.6 times the ideal
value.
In this area, a small fraction of the blood fails
to become normally oxygenated, and this
represents a physiologic shunt.
During exercise, blood flow to the upper part
of the lung increases and less physiologic
dead space occurs.
-Emphysema causes many of the alveolar
walls to be destroyed.
-In smokers two abnormalities occur to cause
abnormal V/Q

First, because many of the small bronchioles

are obstructed, the alveoli beyond the
obstructions are unventilated, causing a V/Q
that approaches zero.
 Second, in those areas of the lung where the
alveolar walls have been mainly destroyed but
there is still alveolar ventilation, most of the
ventilation is wasted because of inadequate
blood flow to transport the blood gases.
In chronic obstructive lung disease, some
areas of the lung exhibit serious physiologic
shunt, and other areas exhibit serious
physiologic dead space.
Both these conditions decrease the
effectiveness of the lungs as gas exchange
organs, &this is the most prevalent cause of
pulmonary disability .
Effect of the ventilation-perfusion ratio on
alveolar gas concentration
Two factors determine the Po2 and the Pco2 in
the alveoli:
(1) the rate of alveolar ventilation and
(2) the rate of transfer of oxygen and carbon
dioxide through the respiratory membrane.
 How the V/Q Ratio affects Alveolar Gas
 Pa02 is determined by the amount of 02 entering
the alveoli and its removal by capillary blood flow.
 If capillary blood flow is low Pa02 will remain
high.
 This occurs in the apices; Ventilation with very
little perfusion results in a high Pa02
 How the V/Q Ratio affects Alveolar Gas
 PaC02 is determined by:
 the amount of capillary blood perfusing an alveolus,
allowing the CO2 to diffuse out of the capillary bed and
into the alveolus and the amount of ventilation that
alveolus receives.
 Areas of high perfusion and low ventilation have higher
PaC02’s. ie: The bases.
 Affects of Increased V/Q
 When the V/Q ratio increases, the PaO2 rises and
the PaCO2 falls.
 The PaCO2 decreases because it washes out of the
alveoli faster than it is replaced by venous blood.
 The PaO2 increases because it does not diffuse
into the blood as fast as it enters the alveolus.
 This V/Q relationship is present in the upper
segments of the upright lung. (zone I)
 Affects of Decreased V/Q
 When the V/Q ratio decreases, the PaO2 falls and the
PaCO2 rises.
 The PaO2 decreases because oxygen moves out of the
alveolus and into pulmonary blood faster than it is
replenished by ventilation.
 The PaCO2 increases because it moves out of the blood
and into the alveolus faster than it is washed out.
 This is seen in the lower lung segments.(zone III)
 Respiratory Quotient
 Gas exchange between the systemic capillaries and
the cells is called internal respiration.
 About 250 ml of O2 are consumed by the tissues
during 1 minute.
 The cells produce about 200 ml of CO2.
 The ratio between the volume of O2 consumed and
the volume of CO2 produced is called the
respiratory quotient.
 Respiratory Exchange Ratio
 Gas exchange between the pulmonary capillaries
and the alveoli is called external respiration.
 The quantity of O2 and CO2 exchanged during a
period of 1 minute is called the respiratory
exchange ratio (RR).
 Under normal condition,s the RR equals the RQ.