ALVEOLI VENTILATION AND

PERFUSION
 Ventilation: It is the movement of air in and out of the lungs. It is the rate at
which air enters or leaves the lungs.

• The amount of oxygen reaching the lungs is dependent upon the partial
pressure of oxygen in the inspired gas. Ventilation in respiratory physiology is
of two types:

1. Pulmonary ventilation

2. Alveolar ventilation
• Pulmonary ventilation is defined as the volume of air moving in and out of respiratory tract in a
given unit of time during quiet breathing. It is also called minute ventilation or respiratory minute
volume (RMV).

• It is a cyclic process, by which fresh air enters the lungs and an equal volume of air leaves the lungs.

• Normal value of pulmonary ventilation is 6,000 mL (6 L)/minute. It is the product of tidal volume
(TV) and the rate of respiration (RR). It is calculated by the formula:

• Pulmonary ventilation = Tidal volume × Respiratory rate (PV = TV x RR)

• = 500 mL × 12/minute

• = 6,000 mL/minute.
• Alveolar ventilation: The amount of the inspired air, which reaches the alveoli so that it is available
for gas exchange, is called the alveolar ventilation.
• It is the amount of air utilized for gaseous exchange every minute.
• Alveolar ventilation is different from pulmonary ventilation.
• In pulmonary ventilation, 6 L of air moves in and out of respiratory tract every minute. But the
whole volume of air is not utilized for exchange of gases.
• Volume of air subjected for exchange of gases is the alveolar ventilation.
• Air trapped in the respiratory passage (dead space) does not take part in gaseous exchange.
• Normal value of alveolar ventilation is 4,200 mL (4.2 L)/minute. It is calculated by the formula:
Alveolar ventilation = (Tidal volume – Dead space) x Respiratory rate
= (500 – 150) mL × 12/minute
= 4,200 mL (4.2 L)/minute.
• Tidal volume: The tidal volume (TV) is the amount air that moves in and out of
the lungs per breath during normal quiet breathing. It is measures around 500mL in
an average healthy adult.

• Residual Volume: Residual volume is the amount of air remaining in the lungs
after maximum forceful expiration, i.e, it is the volume of air that cannot be
expelled from the lungs, thus causing the lungs to remain open at all times.

• Dead space: It is the part of the respiratory tract, where gaseous exchange does not
take place. Air present in the dead space is called dead space air.

• Dead space is of two types; Anatomical dead space and Physiological dead space.
• Anatomical Dead Space : Anatomical dead space extends from nose up to terminal
bronchiole. It includes nose, pharynx, trachea, bronchi and branches of bronchi up to
terminal bronchioles. These structures serve only as the passage for air movement. Gaseous
exchange does not take place in these structures.

• Physiological Dead Space

• Physiological dead space includes anatomical dead space plus two additional volumes.
• Additional volumes included in physiological dead space are:
1. Air in the alveoli, which are non-functioning. In some respiratory diseases, alveoli do not
function because of dysfunction or destruction of alveolar membrane.
2. Air in the alveoli, which do not receive adequate blood flow. Gaseous exchange does not
take place during inadequate blood supply. These two additional volumes are generally
considered as wasted ventilation.
• Wasted ventilation and wasted air: Wasted ventilation is the volume of air that
ventilates physiological dead space. Wasted air refers to air that is not utilized for
gaseous exchange. Dead space air is generally considered as wasted air.

• Volume of normal dead space is 150 mL. Under normal conditions, physiological
dead space is equal to anatomical dead space. It is because, all the alveoli are
functioning and all the alveoli receive adequate blood flow in normal conditions.

• Physiological dead space increases during respiratory diseases, which affect the
pulmonary blood flow or the alveoli.
• Perfusion: Perfusion is the blood flow at the capillary level in tissue.
• Perfusion specifies the amount of blood reaching the tissue of interest and is measured in
units of ml/100g/min.
• Perfusion is the means by which blood provides nutrients and removes cellular waste.
Adequate tissue perfusion-when supply meets demand-is necessary to maintain healthy vital
tissue.
• Insufficient perfusion (ischemia)-when demand exceeds supply-induces an oxygen debt and
causes a buildup of toxic cellular waste, stressing the vitality of the tissue. Untreated
ischemia leads to cellular dysfunction, loss of organ function, and even cellular death i.e.,
tissue infarction.
• Excessive perfusion (hyperemia) -when supply exceeds demand-is frequently associated
with formation of edema in the associated tissue.
• Consequently, maintaining adequate perfusion (via managing perfusion pressure and
vascular patency) is vital to maintaining healthy tissue.
 VENTILATION-PERFUSION RATIO
• It is the ratio of alveolar ventilation to the amount of blood that perfused the
alveoli.
• It is expressed as VA/Q. VA is alveolar ventilation and Q is the blood flow
(perfusion).
• Mathematically, V/Q = 0.84
Where V = Alveolar ventilation
Q = Pulmonary perfusion
Zone 1: No blood flow
Reason: -More negative intrapleural pressure
- Increased alveoli size
- Low arterial pressure due to gravity
- Decreased diameter of the vessels
- V >>>Q hence, V/Q = 3.4 (High)
Zone 2: Intermittent blood flow
Reason: - Arterial pressure is greater than alveolar
and venous pressure, whereas venous pressure is less
than alveolar pressure.
- Venules are collapsed
- Intermittent size of alveoli
- Decreased diameter of the vessels
- V = Q hence, V/Q = 0.8 (Average)
Zone 3: Continuous blood flow
Reason: - Due to gravity
- High pressure
- Vasodilation
- More blood flow
- Decreased size of alveoli
- Q >>>V hence, V/Q = 0.63 (Low)
The ventilation/perfusion (V/Q) ratio is an indication of how well alveolar ventilation
matches pulmonary capillary perfusion.

•Ventilation without perfusion = dead space

•Perfusion without ventilation = shunt

• Physiological Variation

• Ratio increases, if ventilation increases without any change in blood flow

• Ratio decreases, if blood flow increases without any change in ventilation

• In sitting position, there is reduction in blood flow in the upper part of the
lungs (zone 1) than in the lower part (zone 3). Therefore, in zone 1 of lungs
ventilation-perfusion ratio increases three times. At the same time, in zone 3
of the lungs, because of increased blood flow ventilation-perfusion ratio
decreases.
 Alveolar Capillary gas Exchange
• Oxygen is essential for the cells. Carbon dioxide, which is produced as waste product in the cells
must be expelled from the cells and body. Lungs serve to exchange these two gases with blood

• In the lungs, exchange of respiratory gases takes place between the alveoli of lungs and the
blood. Oxygen enters the blood from alveoli and carbon dioxide is expelled out of blood into
alveoli. Exchange occurs through bulk flow diffusion.
• Exchange of gases between blood and alveoli takes place through respiratory membrane.
• Respiratory membrane: Respiratory membrane is a membranous structure through which
exchange of respiratory gases takes place.
• It is formed by epithelium of respiratory unit and endothelium of pulmonary capillary.
Alveolar Capillary gas Exchange
• Epithelium of respiratory unit is a very thin
layer since, the capillaries are in close
contact with this membrane, alveolar air is in
close proximity to capillary blood. This
facilitates gaseous exchange between air and
blood.
• Respiratory membrane is formed by
different layers of structures belonging to the
alveoli and capillaries.
•
• Layers of Respiratory Membrane • Diffusion Capacity (DC): Diffusing capacity
• Different layers of respiratory membrane is defined as the volume of gas that diffuses
from within outside are given in is very through the respiratory membrane each minute
for a pressure gradient of 1 mm Hg.
thin with an average thickness of 0.5 μ.
Total surface area of the respiratory
membrane in both the lungs is about 70 Factors Affecting Diffusing Capacity
square meter.
DC = Pg × S × A
• Average diameter of pulmonary capillary
is only 8 μ, which means that the RBCs Mw × D
with a diameter of 7.4 μ actually squeeze DC = Diffusing capacity
through the capillaries.
Pg = Pressure gradient
• Therefore, the membrane of RBCs is in
close contact with capillary wall. This S = Solubility of gas
facilitates quick exchange of oxygen and A = Surface area of respiratory
carbon. membrane
Mw = Molecular weight
D = Thickness of respiratory
membrane
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TRANSPORT OF RESPIRATORY GASES,

HYPOXIA AND REGULATION BREATHING