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Polmone O2
1 Scambi gassosi
CO2
tra aria e sangue
Sistema circolatorio
2 Trasporto di
gas tramite il
sistema
circolatorio
Cellula
Nei polmoni gli scambi gassosi tra aria e sangue avvengono a
livello degli alveoli polmonari costituiti da un sottile strato di
cellule epiteliali.
La presenza nei polmoni delle numerosissime cavità alveolari
porta la superficie di scambio tra aria e sangue a circa 70 m 2
Sangue
ricco Sangue povero
di ossigeno di ossigeno
Bronchiolo
Alveoli
Capillari
sanguigni
Principles of Gas Exchange
• Gas movement between alveolar air and blood is a passive
process (pulmonary gas exchange) determined by the
concentration gradient for the particular gas.
Perfect Lung
Effect of hypoventilation
Alveolar gas equation for hypoventilation
PACO2
PAO2 PIO2 - F
R
80
PAO2 150 -
0.8
PAO2 50
Diffusion of Gases
– Random molecular motion of
molecules with energy provided by
kinetic motion of the molecules
– All molecules are continually
undergoing motion except in
absolute zero temperature
– Net diffusion
• Product of diffusion from high to low
concentration
Gas Pressures
• Partial Pressure
– Pressure is directly proportional to the concentration
of gas molecules
– In respiration, there’s mixture of gases: O2, N2, CO2
– Rate of diffusion of each gas is directly proportional to
the pressure caused by each gas alone.
• AIR = total Pressure 760 mmHg
79% N2, 21% O2 = PPN2 = 600mmHg ,
PPO2 =160mmHg
Gas Pressure in Fluid
• Determined by its concentration and by
solubility coefficient
membrane is very
large being beneficial
to gas exchange
RBC
Thickness of
respiratory
membrane is
close related to
diseases Structural Diagram of Respiratory
membrane
Legge di Fick
Descrive la diffusione di un gas
attraverso i tessuti:
Vgas = A/T x ΔP x D
A: superficie tissutale;
D: costante di diffusione del gas
ΔP (P1-P2): differenza di pressione
parziale del gas tra i due lati.
T: spessore del tessuto.
O2 O2+ Hb HbO2
CO CO+Hb HbCO
ΔP
(driving pressure)
O2 O2+ Hb HbO2
CO CO+Hb HbCO
ΔP
(driving pressure)
DL: overall diffusion capacity;
DM: diffusion from alveolar gas up to the red cell (“membrane
component”);
Θ . VC: diffusion for the red cell membrane to Hb molecules (“red cell
component”);
Why CO is preferred over O2 ?
1. Respiro tranquillo
2. Espirazione non forzata fino a RV, per
non più di 6 sec
3. Rapida (<4 sec) inspirazione a TLC
(volume inspirato >85% VC)
4. Tempo di apnea di 10 ± 2 sec (evitare
manovre di Valsalva o Mueller)
5. Espirazione in < 4 sec
Perfusion ( Q )
L/min
Ventilation
( VA )
0
Apex of Lung Base of Lung
Because of the effect of gravity, lung perfusion (Q), and
ventilation (VA) increase from the top (apex) to the
bottom (base) of the lung.
Effect of hydrostatic P on
regional pulmonary blood flow
• From apex to base capillary P (gravity)
– Zone 1: no flow
• alveolar P > capillary P
• normally does not exist
– Zone 2: intermittent flow (toward the apex)
• during systole; capillary P > alveolar P
• during diastole; alveolar P > capillary P
– Zone 3: continuous flow (toward the base)
• capillary P > alveolar P
– During exercise entire lung zone 3
Balancing ventilation and perfusion
• Regional differences in ventilation and blood flow cause the top
of the lung to be overventilated and the bottom of the lung
to be overperfused under normal conditions.
CO2 = 45 . . .
Low VA/Q Normal VA/Q High VA/Q
Increase in Increase of
physiologic shunt physiologic dead
blood: blood that is space: area where
not oxygenated as it oxygenation is not
passes the lung taking place
PO2 = 40
PCO2 = 45
PO2 = 100
50 PCO2 = 40
.
Low VA/Q
Base
PCO2 (mm Hg)
.
Normal VA/Q
PO2 = 150
PCO2 = 0
Apex
.
High VA/Q
50 100 150
PO2 (mm Hg)