Post on 25-Feb-2018
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Ventilation and Perfusion
dr. Sri Lestari Sulistyo Rini, MSc
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Anatomical DEAD SPACE
Tidal volume is distributed into deadspace (VD) and alveolar volume (VA)
Conducting
airways
Gas exchange
airways
The oropharynx, trachea and
upper airways in the lung, whichdo not participate in gas
exchange, comprise VD
Alveoli comprise the gas
exchange compartment or
respiratory zone, VA
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A&ato!ical ,ead pace
Nor!all- represe&ts 2./0.1 o( the!i&ute "e&tilatio&
I&$ue&ced b-
ie A)e : &eo&ates 030 !l'4)+ adults 2 !l'4)
Posture : supi&e 5 sta&di&) / tidal"olu!e
6ead a&d &ec4 positio& /respirator- rate
Tracheal i&tubatio&' tracheosto!-
7ro&chodilati&)'co&stricti&) dru)s
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Ph-siolo)- ,ead pace
A&ato!ic 8 Al"eolar ,ead pace I& health- i&di"idu represe&ts 29/091
o( the !i&ute "e&tilatio&
Factors i&$ue&ci&) A)e : i&creases with a)e e : sli)htl- hi)her i& !e& 7od- sie : app 2 !L'4)
Posture : due to a&at dead space Patholo)- : pul!o&ar- e!bolis!+ s!o4i&)
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VA
Q
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Nor!all- the V/Qratio is closer to .3?3
I( V'* ratio is @ capillar- PO2will reach e>uilibriu! with al"eolar
PO2
there will be &o al"eolar arterial PO2
diere&ce3 I( V'* ratio isBero :
al"eolar pO2 a&d pCO2 < !ied "e&ous blood
#shu&t%
I( V'* ratio is I&D&it- :
al"eolar pO2 a&d pCO2 < i&spired )asses
#al"eolar dead space%
where "e&tilatio& a&d per(usio& ha"e &or!al 14
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This "alue is a& a"era)e "alue across the lu&)3At the ape+ V'* ratio < 03
At the base+ V'* ratio < .33
So the apex is more ventilated than perfused,
and the base is more perfused thanventilated.
,uri&) eercise+ the V'* ratio beco!es !oreho!o)e&ous a!o&) diere&t parts o( thelu&)3
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Regional Gas Exchangein the Lung
E"e& i& &or!al health- i&di"iduals there is a V/Qhetero)e&eit-3
produced b- a& u&e"e& distributio& o(
"e&tilatio& a&d per(usio& a!o&) re)io&s o( thelu&)3
Ve&tilatio& is )reater i& the lower #caudal% re)io&o( the lu&) tha& i& the upper #cra&ial% re)io&
Blood ow is also greater in the caudal
compared with the cranial region of thelung
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Single-breath 133Xe test
Xe has very low water solubility, so remains within the airspace;imaged using external detectors
Regional VA is indeed greater at the base of the lung in an
upright individual
Regional heterogeneity in ventilation
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PO2= 40
PCO2 = 45
Low VA/Q.
Normal VA/Q
.
PO2= 100
PCO2 = 40
High VA/Q.
PO2= 150
PCO2 = 0
PO2(mm Hg)
PCO2
(mmH
g)
50 100 150
50
Base
Apex
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PAPa Pv
Zone 1
PA>Pa>PvLow Flow
PAPa Pv
PA
Pa Pv
Zone 2
Pa>PA>PvWaterfall
Zone 3
Pa>Pv>PAHi Flow
perfusion
Zones of the lung
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The lu&) !a- beco&sidered to
co!prise 0co!part!e&ts:
Ve&tilated butu&per(used al"eoli
Al"eolar dead space
Per(used butu&"e&tilated al"eoli
I&trapul!o&ar- shu&t
Ideall- per(used "e&tilated al"eoli
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"haracteristics of the #ulmonar$ "irculation
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%&pecial' "haracteristics of the #ulmonar$ "irculation
&$stemic "irc #ulmonar$ "irc
" (L*min) +, ./
Arterial 0# (mm 1!) 2,, 33 2.
Venous 0# (mm 1!) 4 %' .
Vascular resistance (5#*flo6) 2,,-4*+=2+7 3 2.-.*./=28
Vascular compliance (5V*5#) "s$stemic 99 "pulm
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Ability to promote a decrease in resistance as blood pressure rises
Special Characteristics of the Pulmonary Circulation: high compliance
: =; l
r
hypoxic vasoconstriction
?hen #46ithin the alveoli ecreases there is a ecrease in bloo
flo6 to that alveolus
This is calle h$poxic vasoconstriction
Thou!ht to be the result of 4-sensitive @
channels in the smoothmuscle membrane At lo6 4the @
channels closeB the EmrisesB
an the cell reaches threshol an epolariCes an contracts
smooth
mus
clece
ll This phenomenon is ust the opposite of
the response to h$poxia $ou !et 6itharteriole smooth muscle in the s$stemic
circulationB but it is an important feature
of the pulmonar$ circulation that helps to
match perfusion 6ith ventilation
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#ulmonar$ bloo vessels are much more compliant than s$stemic bloo vessels
Also the s$stem has a remarable abilit$ to promote a ecrease in resistance as the
bloo pressure rises
T6o reasons are responsible>
Recruitment: opening up of preiously closed essels
!istension: increase in caliber of essels
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nspire air>
#4= 2.; mm 1!
#"4= ,7 mm 1!
Expire air>
#4= 22+ mm 1!
#"4= 74 mm 1!
#ulmonar$vein
Aort
a
Arterial bloo
#4= /. mm 1!
#"4=
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Gas echa&)e is opti!al whe&"e&tilatio& a&d per(usio& are )oi&) tothe sa!e places a&d to the ete&t thatthe- are &ot+ )as echa&)e suers3
I& a& etre!e case+ i( all the blood $owwe&t to the ri)ht lu&) a&d all the"e&tilatio& we&t to the le(t+ the perso&
!i)ht ha"e &or!al cardiac output a&d&or!al al"eolar "e&tilatio& a&d &o )asecha&)e3
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Ve&tilatio&'per(usio&
!is!atch Mai& cause o( h-poe!ia i& lu&)
diseases
O2tra&sport'per(usio& i&ho!o)e&eit-probabl- also i& other or)a&s
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Matchin! respiration G bloo flo6>
the Ventilation-#erfusion:atio
Alveolar ventilation, VA
VA= (VT- VD) x resp. rate
= (0.5 - 0.15) x 12 = 4.2 L/min
Cardiac output = C.O. = Q
Q = stroke vol. x heart rate
= (0.086) x 70 = 6.0 L/min
= ventilation/perfusion ~ 0.8VA
Q
Ventilation
#erfusion
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Hormal Emph$sema Asthma#ulm
"irc
Exercise "apillar$ enlar!ement(e!B Mitral &tenosis)
Lon!er paths
for iffusion
Pathological Examples of Altered Respiratory Mechanics
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hu&t #the !ai!al "e&tilatio& per(usio&!is!atch V'* ratio o( eroJ% si)&iDca&tl- reducesPaO23
Causes H
theThebesia& circulatio& which per(uses the
le(t "e&tricle a&d e!pties directl- i&to the le(t
"e&tricle without passi&) throu)h the lu&)3 Lu&) tissue itsel( !ust be per(used #bro&chial
circulatio&%+ a&d this blood e!pties i&to
pul!o&ar- "ei&s+ !ii&) with pul!o&ar-
capillar- blood3
Co&)e&ital heart de(ects #Tetralo)- o( Fallot%
Pul!o&ar- patholo)- #Athelectasis'PNEUMONIA%
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F d i #FVC
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Forced capacit- #FVC FEV@%
Nor!al
Obstructi"e
Restricti"e
VCNor
FEVN
)(
1)(
VCN
FEVN
)(1)(
VCNor
FEVN
)(
1)(
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I:"EDI:"ED
EJ#:ATHEJ#:ATH
H:MALH:MAL
IEVIEV22= 7,L= 7,L
IV" =
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Teri!a 4asih