testing for v/q mismatch nonuniform gas distribution – alveolar plateau of closing volume test –...
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Testing for V/Q MismatchTesting for V/Q Mismatch
• Nonuniform gas distribution
– Alveolar plateau of closing volume test
– Nitrogen washout
– Trapped gas
– Single breath of 133Xe
– 99mTc-labeled DTPA (diethylene triamine pentaacetic acid)
• Nonuniform gas distribution
– Alveolar plateau of closing volume test
– Nitrogen washout
– Trapped gas
– Single breath of 133Xe
– 99mTc-labeled DTPA (diethylene triamine pentaacetic acid)
Testing for V/Q MismatchTesting for V/Q Mismatch
• Nonuniform pulmonary blood flow
– Pulmonary angiogram
– Lung scans:
•131I-labeled MAA
•99mTc-labeled MAA
•133Xe
• Nonuniform pulmonary blood flow
– Pulmonary angiogram
– Lung scans:
•131I-labeled MAA
•99mTc-labeled MAA
•133Xe
• Mismatched V/Q– Physiologic shunts : shunt equation
•Anatomic
• Intrapulmonary– Absolute
– Shuntlike states (low V/Q)
– Physiologic dead space : Bohr equation•Anatomic
•Alveolar : (a-A)Dco2
– (A-a)Do2
– Lung scans after inhaled and infused markers
– Multiple inert gas technique
• Mismatched V/Q– Physiologic shunts : shunt equation
•Anatomic
• Intrapulmonary– Absolute
– Shuntlike states (low V/Q)
– Physiologic dead space : Bohr equation•Anatomic
•Alveolar : (a-A)Dco2
– (A-a)Do2
– Lung scans after inhaled and infused markers
– Multiple inert gas technique
Testing for V/Q MismatchTesting for V/Q Mismatch
....
Physiologic ShuntPhysiologic Shunt
Physiologic = Anatomic + IntrapulmonaryShunt Shunt Shunt
Absolute Shunt
Shuntlike States
Shunt EquationShunt Equation
QS
Qt
.
.QS
Qt
QS
Qt
QS
Qt
CC´ – CaO2 O2
CC´ – CvO2 O2
=
PHYSIOLOGIC DEAD SPACEPHYSIOLOGIC DEAD SPACE
PhysiologicDead space
Anatomic Dead space
Alveolar Dead space
= +
Bohr EquationBohr Equation
VD
VT
Pa - PECO2 CO2 CO2
Pa CO2
=
Causes of Increased Alveolar-Arterial Oxygen Partial Pressure Gradient
Causes of Increased Alveolar-Arterial Oxygen Partial Pressure Gradient
•Increased right - to left shunt–Anatomic
– Intrapulmonary
•Increased ventilation-perfusion mismatch
•Impaired diffusion
•Increased inspired partial pressure of oxygen
•Decreased mixed venous partial pressure of oxygen
•Shift of oxyhemoglobin dissociation curve
•Increased right - to left shunt–Anatomic
– Intrapulmonary
•Increased ventilation-perfusion mismatch
•Impaired diffusion
•Increased inspired partial pressure of oxygen
•Decreased mixed venous partial pressure of oxygen
•Shift of oxyhemoglobin dissociation curve
vol VA Q VA / Q Po2 Pco2 PN2 O2 CO2 pH O2 CO2
. . . .
(%) (liters/min) (mmHg) content (ml/100ml
)
in out (ml/min)
7 .24 .07 3.3 132 28 553 20.0 42 7.51
4 8
13 .82 1.29
0.63 89 42 582 19.2 49 7.39
60 39