True or False: O2 is highly soluble in blood.
False. O2 is poorly soluble in blood.
Arterial O2 content is the sum of what two things?
Hb-bound O2 and freely-dissolved O2
What are the typical values for the following components:
1. Arterial O2 content
2. Hb-bound O2
3. Freely-dissolved O2
1. Arterial O2 content = 20.7 ml O2/100 ml blood
2. Hb-bound O2 = 20.4 ml O2/100 ml blood
3. Freely-dissolved O2 = 0.3 ml O2/100 ml blood
This demonstrates that O2 is poorly solube in blood. Most of arterial O2 content is from Hb-bound O2.
Does oxygen or carbon dioxide dissolve more easily in blood?
CO2. By about 23 times.
True or False: In normal conditions, O2 binding sites on hemoglobin are mostly vacant.
False. They are mostly saturated.
The diagram below demonstrates how at a normal PaO2 of 100 torr, saturation of hemoglobin binding sites is about 98%
How does PaO2 (partial pressure of arterial oxygen) relate to CaO2 (total arterial oxygen content)?
PaO2, the partial pressure of arterial oxygen, only measures the freely-dissolved O2. Remember, out of the total arterial oxygen content of 20.7 mlO2/100mlblood, only 0.3 of it is freely-dissolved O2 in the blood.
If freely-dissolved O2 only makes up a small part of the total arterial oxygen content, why is PaO2 so important? Because, PaO2 dictates the binding of oxygen to hemoglobin (the part which makes up the majority of the arterial oxygen content). The relationship between PaO2 and saturation of hemoglobin is demonstrates by the oxyhemoglobin dissociation curve.
In other words, the partial pressure of arterial oxygen is directly related to the freely-dissolved O2 but also affects the hemoglobin-bound O2.
What 3 factors affect the rate of gas diffusion and how do they effect gas diffusion?
1. Pressure gradient (the greater the pressure gradient, the greater the diffusion)
2. Cross-sectional Area (the greater the area, the greater the diffusion)
3. Thickness (the greater the thickness between the alveoli and capillaries, the less the diffusion)
How is the O2 pressure gradient between alveoli and blood maintained?
When O2 enters the capillaries, they are quickly bound by Hb. This preserves the alveolar-blood O2 pressure gradient because it is only the free O2 level that affects the gradient.
Our lungs are set up to facilitate diffusion very well. About how far does deoxygenated blood arriving from the right ventricle have to go (% capillary bed passed) to become fully oxygenated?
About one third (33%).
The diagram shows how blood arriving from the right ventricle is has a partial pressure of oxygen of about 40 torr and it is increased to a partial pressure of 100 torr by the time it passes through about a third of the pulmonary capillary beds.
Explain how you might get some of these abnormal curves shown on the diagram
In a normal patient, demonstrated by the black line, the mixed venous blood only has to travel through about a third of the pulmonary capillary beds until it is fully oxygenated.
The pink line shows what the curve may look like in a patient with moderate disease or a patient during exercise. In moderate disease, the diffusion rate may be slowed down but the patient could still oxygenate the blood to 100 torr. During exercise, the diffusion rate is also decreased because the blood is moving faster and has less time to oxygenate.
The red line shows what the curve may look like in a patient with severe disease. These patients have a high deficiency in their diffusion which results in arterial blood that has insufficient partial pressure of oxygen. This could also happen in patients with moderate disease during exercise.
Name two diffusion disorders and explain how they decrease diffusion
1. Interstitial disease. This decreases diffusion by increasing the distance between alveoli and the capillaries (thickness).
2. Emphysema. This decreases diffusion by decreasing the surface area participating in diffusion. In emphysema, there is a destruction in the integrity of elastin which ends up destroying many of the alveoli and bronchioles. This is why there is reduced surface area.
True or False: CO2 diffusion is affected much less by disease. Even in the presence of severe disease, the PCO2 is able to drop to the desired level of 40 torr throughout the course of the capillary beds.
CO2 is about 23 times more soluble than O2 so it moves readily and is less susceptible to negative diffusion effects of diseases.
What is perfusion?
In physiology, perfusion is the process of a body delivering blood to a capillary bed in its biological tissue
What is minute perfusion (Q)?
The amount of blood flow in the lung in one minute
What is an average minute perfusion for an adult?
5L (same as typical cardiac output)
What factors affect perfusion?
1. O2 tension (hypoxic pulmonary vasoconstriction)
2. Capillary recruitment
What is hypoxic pulmonary vasoconstriction and how is it advantageous?
Hypoxic pulmonary vasoconstrictoin is when blood vessels in areas of the lung with less O2 are narrower because of vasoconstriction. This is advantageous because when vessels in areas with less O2 constrict, blood is diverted to areas in the lungs that have more O2.
What is capillary recruitment?
Normally, there are many collapsed capillaries throughout the lung that are not in use. During exercise, cardiac output rises which causes more blood to go through the lungs and the increase in blood causes an increase in pressure which pulls the collapsed capillaries open.
How does gravity affect perfusion?
When a person is standing upright, blood pools towards the bottom of the lung due to gravity. The higher volume of blood at the bottom of the lungs increases pressure which opens more vessels.
Perfusion at the bottom of the lungs is about 6 times greater than the top of the lungs.
What is V/Q mismatch?
This is a mismatch between ventilation (air flow) and perfusion (blood flow) in specific parts of the lungs. This can cause problems in oxyygenation even if the total ventilation and perfusion are normal.
What can cause V/Q mismatch? (name 2 main things)
1. Resistance/Compliance Problems
There can be a low V/Q mismatch ratio if there is an occlusion in an airway to an alveolus. There can be a high V/Q mismatch ratio if there is an occlusion in a capillary associated to an alveolus. Check out this diagram:
How can areas of the lung with low V/Q ratios cause other areas to have high V/Q ratios?
The body is very interested in maintaining a near-normal PaCO2 in order to maintain normal pH. If you remember the alveolar ventilation equation, PaCO2 is inversely related to VA (alveolar ventilation). In areas with a low V/Q ratio, there is less alveolar ventilation which results in an increase in PaCO2 that the body doesn't want. In order to counteract this, the body is able to increase the ventilation to other areas of the lung, resulting in a high V/Q ratio at those sites. This helps the body to maintain PaCO2 levels.
What is a typical CVO2 value?
15.7 ml O2/100 ml blood
True or False: Areas of the lung with low V/Q are compensated well by areas of the lung that have high V/Q.
False. Areas of the lung with high V/Q ratio try to compensate for areas of the lung with low V/Q ratio but it ultimately doesn't work no matter how high the ventilation because the hemoglobin that flows through is getting fully saturated and cannot bind more oxygen.
Look at the attached diagram, you can see that while the V/Q ratio of the top unit is 10 times that of a normal V/Q ratio, the oxygen content resulting from that is not substantially higher.
True or False: V/Q mismatch affects both arterial O2 and arterial CO2 levels.
False. V/Q mismatch affects arterial O2 levels but generally not arterial CO2 levels.
True or False: V/Q mismatch only happens in moderate-severe disease conditions.
False. V/Q mismatch can happen in mild, moderate, and severe disease conditions.
This is different from situations like hypoventilation when total ventilation goes down.
Is ventilation greater in areas at the bottom or top of the lung? How about perfusion? How a bout V/Q ratio?
Ventilation and perfusion are both greater at the bottom of the lung than the top of the lung due to gravity. V/Q ratio is greater on the top of the lung than the bottom of the lung. This is because gravity increases the Q at the bottom of the lungs by a factor of 6 while only increasing V by a factor of 2.5. So, for the V/Q ratio, Q is increased more by gravity than V at the bottom of the lung, so the bottom of the lungs have a smaller V/Q ratio compared to the top.
Vbottom/Vtop = 2.5
Qbottom/Qtop = 6
Why is there a difference between PAO2 (normally 100 torr) and PaO2 (normally 90-100 torr)?
V/Q mismatch resulting from gravity is the main contributor to the 5-10 torr difference between PAO2 and PaO2.