Ventilasi Perfusi Baca Ulang

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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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