Ventilation is the movement of air in and out of the lungs.

Inhalation or inspiration- movement of air into the lungs Exhalation or expiration- movement of air out of the lungs

Perfusion is the exchange of oxygen and carbon dioxide at the alveolar- capillary level. Normal ventilation- perfusion (V/Q) ratio is 4:5 Normal Ventilation and Perfusion: When ventilation and perfusion is matched, unoxygenated blood from the venous system returns to the right side of the heart through the pulmonary arteries to the lungs, carrying carbon dioxide. The arteries branch into the alveolar capillaries where gas exchange takes place. Ventilation- Perfusion Dysfunction Two Types of Ventilation- Perfusion Mismatch: 1. Shunting- there is decreased ventilation related to perfusion This is the portion of the cardiac output that does not exchange with alveolar air. The PaO2 falls because less oxygen is delivered and the PaCO2 increases because less CO2 is expired. Clinical examples: Vascular lung tumors Congenital heart disease Intrapulmonary fistulas Pneumothorax Hemothorax Pleural effusion Obstruction of the bronchi or bronchioles

2. Dead Space- decreased perfusion related to ventilation also called wasted ventilation Anatomic dead space is that portion of ventilation that is within the upper airways, not in contact with a capillary. Alveolar dead space is the volume that is within the alveoli; theres no blood flow adjacent to it. PaCO2 falls because less CO2 is delivered and the PaO2 increases, because less oxygen enters the blood Clinical example: Pulmonary embolus

Hypoxemia versus Hypoxia Hypoxemia is a decreased level of oxygen in the arterial blood as measured by the PaO2.

Early signs: Late signs: Arrhythmias Hypotension Cyanosis Coma Restlessness Anxiety Disorientation, confusion, lassitude and listlessness Headaches

Hypoxia refers to the state of decreased perfusion of oxygen to the tissues and is measured by pulse oxymetry.

Signs: Change in mental status (earliest sign) Change in vital signs Headache Hypercapnia versus Hypocapnia Hypercapnia is defined as a PaCO2 above 45. Indicates that ventilation is inadequate.

Signs: flushed skin, full pulse, tachypnea, dyspnoea, extrasystoles, muscle twitches, hand flaps, reduced neural activity, and possibly a raised blood pressure

Hypocapnia is defined as a PaCO2 below 35. Indicates that there is too much ventilation

Signs: dizziness, visual disturbances anxiety muscle cramps

Oxygen Transport Two Ways: 1. Dissolved in the plasma Clinical measure of the dissolved oxygen is the PaO2 3% of O2 2. Attached to hemoglobin (oxyhemoglobin) 97% of O2 Clinical measure of this oxygen attached to hemoglobin is oxygen saturation (SaO2, SpO2 ) Fully saturated= SpO2 >92% Desaturated= SpO2 < 98% Oxygen- Hemoglobin Dissociation Curve Illustrates relationship between the PaO2 and the SaO2 Illustrates condition that change the affinity of oxygen for hemoglobin Factors that cause decreased affinity of oxygen for hemoglobin will shift the oxyhemoglobin dissociation curve to the RIGHT which causes Acidemia. Factors that cause increased affinity of oxygen for hemoglobin will shift the oxyhemoglobin dissociation curve to the LEFT which causes Alkalemia.

Left shift (high affinity for O2)

Right shift (low affinity for O2)

Temperature

hypothermia

hyperthermia

2,3-diphospoglycerate

increase

PaCO2

decrease

increase

pH

Increased arterial pH >7.45 (alkalosis)

Decreased arterial pH <7.35 (acidosis)