Meds I Respiratory Physiology Pulmonary Circulation...

Pulmonary Circulation

Lecture Outline Objectives

1. Pressure 1. List the causes of increased pulmonary

(a) normal values artery pressure.
(b) causes of increased pressure
2. Describe how pulmonary vascular resistance
2. Resistance is calculated
(a) calculation
(b) recruitment 3. Describe the distribution of blood flow in the
(c) distension lung of an upright person.

3. Flow 4. List the relationship between PA, Pa, and Pv

(i) Measurement - FICK principle
(ii) Distribution - apex to base gradient
(iii) West Zones - important to understand!
4. Hypoxic Vasoconstriction
in the three West lung zones.
5. Discuss the variables determining fluid
exchange in the lung.

5. Pulmonary Edema

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1. Pressure

- normally the pressure in the pulmonary - two important effects of increased PAP
circulation is low (PAP = 15) (i) pulmonary edema
- reason for the relatively low pressure is the (ii) right ventricular strain
relatively low height of lung

Figure 1

- pressure may rise due to

1. elevation of pressure beyond pulmonary

circulation
2. increased resistance to flow in pulmonary
circulation
3. increased blood flow
4. any combination of the above

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2. Resistance

Resistance = Driving Pressure - normal PVR is about 1/10 of SVR

Blood Flow
- despite increased pressure, resistance may
not increase because of:

= Mean PAP - Mean LAP (a) recruitment

Cardiac Output (b) distension

Figure 2

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3. Flow

. .
(i) Measurement
V O2 =Q x (CaO2 - Cv- O2)
- cardiac output of right side of heart must O2 consumption |
equal cardiac output of left side of heart O2 content of
blood entering
- can be measured by the FICK principle the lungs
which states that O2 consumption equals O2
O2 content of
uptake
systemic arterial
blood

Blood flow through lungs

per minute
or
. .
Q = V O2 / (CaO2 - Cv- O2)

ii) Distribution of Flow

- can measure with radioactive xenon injected into peripheral vein

Figure 3

- distribution depends on posture. When supine there is little apex-base gradient of flow but
anterior parts of lung are less perfused.
- consider pulmonary arterial system as a continuous volume of blood so pressure difference apex-
base is 30 cm H2O

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iii) West Zones

Figure 4

Zone 1
- PA > Pa > Pv
- no flow in capillaries
- does not happen in normal lung but can Zone 3
happen if Pa falls eg. hypotension secondary to - Pa > Pv > PA
hemorrhage - flow is determined by the usual Pa - Pv
- ventilated but not perfused lung = difference
DEADSPACE

Zone 2
- Pa > PA > Pv where:
- Pa has increased due to hydrostatic forces PA = alveolar pressure
- venous pressure has no effect on flow Pa = pulmonary arterial pressure
which is determined by difference of Pa and Pv = pulmonary venous pressure
PA

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Figure 5
West Zones

4) Hypoxic Vasoconstriction

The main purpose of the pulmonary circulation

is to carry blood to areas of the lung which are
rich in oxygen. Therefore, if an area of lung is
diseased and not well ventilated, it makes
sense that there is a mechanism to diminish
blood flow to this area; to better match alveolar
ventilation to alveolar perfusion.

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5. Pulmonary edema

- it is crucial to keep the alveoli free of fluid in order to keep gas transfer in the lung maximal
- fluid exchange is governed by Starling’s law
- The force pushing fluid out of the capillary is the capillary hydrostatic pressure minus the
hydrostatic pressure in the interstitial fluid. The force tending to pull fluid into the capillary is the
osmotic pressure of the proteins of the blood minus that of the proteins of the interstitial fluid

Starling Equation:

Qf = Kf [(Pmv - Pi) - f (mv - i)]

Qf = fluid filtration rate

Kf = filtration coefficient
Pmv = microvascular hydrostatic pressure
Pi = interstitial space hydrostatic pressure
f = osmotic reflection coefficient
mv = microvascular oncotic pressure
i = interstitial space oncotic pressure

alveolus
lymphatics
Pi

Pmv i
capillary

mv

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- when the fluid leaks out of the capillary it
first leaks into the interstitial space (1) and
ultimately into the alveolus (2)
- the pulmonary lymphatic system, located
within the subpleural and peribronchial
connective tissue spaces, moves fluid from the
interstitium to the medistinal lymphatic
channels and eventually to the thoracic duct

alveolar space

alveolar wall
2
capillary
1 interstitium
perivascular space
bronchus
alveolar space art ery

ly m phat ics

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