OXYGEN CASCADE

The purpose of the cardio-respiratory system is to extract oxygen from the atmosphere
and deliver it to cell mitochondria. As a gas, oxygen exerts a partial pressure
1
(PO2). We
can determine the PO2 by multiplying its composition in air (21%) by the total
atmospheric pressure (760 mmHg), the result of which is ~160 mmHg. However, the
PO2 in the alveoli is lower than the PO2 in the atmosphere because as humans inspire,
their upper airways humidify the air with water vapor. Since water vapors partial
pressure is now contributing to the total inspired air pressure (inspired air pressure is
equalized with atmospheric air), it reduces the amount of oxygen needed: (760 mmHg
47 mmHg) x 21% ~ 150 mmHg (PIO2). At the alveoli, gases are exchanged with O2
moving into the capillaries and CO2 moving out. After exchange, the alveolar CO2 level
(PACO2) is usually the same as the PaCO2. The PAO2 can be calculated from the
following equation: PAO2 = PIO2 PaCO2/R
2
.

Oxygen moves from the alveolus to the artery via a gradient caused by small ventilation
perfusion abnormalities, the diffusion gradient, and anatomic shunts
3
. Four factors
influence transmission of oxygen from the alveoli to the capillaries:
1. Ventilation-perfusion mismatch
2. Right-to-left shunt
3. Diffusion defects
4. Cardiac output

Interference to delivered oxygen at any point in the cascade can cause significant injury
downstream.

Intrapulmonary Shunt includes:
1. True Shunts with flow past unventilated or collapsed alveoli or arterial-venous
anastomoses
2. Low VA/Q regions where blood is not completely oxygenated



1
Partial pressure: The hypothetical pressure of a gas if it alone occupied the volume of
the mixture at the same temperature. Partial pressure is [ideally] solely determined by the
thermodynamic activity of a gass molecules because the gas molecules are too far apart
to interact with each other. NOTE: Do not think of volume occupied as an actual
volume, but the amount of the gas compared to the total amount of gases.
2
R is the respiratory quotient, representing the amount of carbon dioxide excreted for the
amount of oxygen utilized (CO2 eliminated/O2 consumed). This is dependent on the
carbon source (carbohydrates high, fat low).
3
An anatomic shunt occurs when blood bypasses alveoli through a channel, such as from
the right to left heart via an atrial or ventricular septal defect or from a branch of the
pulmonary artery connecting directly to the pulmonary vein. An anatomic shunt is often
called a right-to-left shunt. The bronchial circulation also constitutes shunted blood
because bronchial venous blood (deoxygenated blood) drains directly into the pulmonary
veins, which are carrying oxygenated blood.