LECTURE 35 ALI HUSSEIN

VENTILATION is defined as the breathing in of air into the lungs.

PERFUSION is defined as the flow of blood through the Pulmonary Circulation.

In healthy lungs, ventilation (~5L/min) is approximately equal to perfusion (~5L/min), giving a VA/Q ratio
of 1. If VA/Q is significantly different from 1, then reduction of oxygenation blood occurs.

Regions under-perfused in relation to ventilation result in a high VA/Q, and just behave like Dead
Space.
Regions under-ventilated in relation to perfusion result in a low VA/Q, and behave as Right to Left
Shunts. It should be noted that high VA/Q areas do not compensate for the low VA/Q areas, and high
VA/Q area do not have a high O2 content, since the blood is at maximum O2 saturation.

A pure right to left shunt involves a VA/Q of value 0, so the O2 enriched air will not reach the shunted
blood and the content will therefore remain unchanged. If VA/Q is low, the enriched O2 air will help raise
the local O2 in poor ventilations and improve O2 content of blood from these areas. This is effective in
asthmatics when receiving O2 enriched air.

There are three methods of measuring VA/Q:

• The PalveolarO2-ParterialO2 gradient provides an estimate of VA/Q, with a gradient of 0.6-1kPa
normal, and a gradient greater than 2 kPa being a VA/Q mismatch.
• Measurement of Alveolar Dead Space
• Isotope ventilation and perfusion scans of the lungs to proved a visualisation of the airways and
pulmonary circulation.

Pulmonary circulation is in series with system

circulation, and is a far less pressure system. The right
ventricle only needs to generate 15 mmHg pressure to drive
cardiac output, since the resistance to blood flow in
pulmonary vessels is very low. The resistance to these
vessels can be regulated, but only weakly by
parasympathetic and sympathetic innervation. The major
influence of this regulation is hypoxia, where blood from
areas of hypoxia is diverted to area of good oxygen supply.
Sometimes, part of the de-oxygenated systemic blood
serving the bronchial airways feeds into the oxygenated
blood of the pulmonary vein without being oxygenated again. In addition, part of the de-oxygenated
coronary venous blood drains directly into the left ventricle. This addition of right-sided deoxygenated
blood to left-sided oxygenated blood is referred to as a RIGHT TO LEFT SHUNT.
Abnormal right to left shunts occur in diseases such as:
COLLAPSED LUNG, when obstruction in bronchi results in no gas exchange in the area, causing
wasted perfusion.
PNEUMONIA, when infection leads to the accumulation of inflammatory cells and the prevention of gas
exchange in the affected area.
FALLOTS TETRAOLOGY (Hole in the Heart Condition), when a SEPTAL DEFECT between the
ventricles is directly below the aorta, meaning the Aorta receives blood from the right ventricle instead.
This leads to CYANOSIS. The right ventricle wall thickens due to the stenosis of the pulmonary artery,
which receives little blood supply.
Other cases if HYPOXAEMIA (low arterial PO2) include low inspired PO2, due to altitude, and
Hypoventilation, caused by trauma or head injury.