Skip to main content

Problems Associated with Clinical Determination of Pulmonary Shunting

  • Conference paper
Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.
  • 140 Accesses

Abstract

A disturbance of pulmonary gas exchange results in hypoxaemia and hypercarbia. Given a stable cardiac output and a known FiO2, it is possible to explain changes in arterial PO2 and PCO2 by mismatch of alveolar ventilation to pulmonary perfusion or disturbance of the distribution of the alveolar ventilation to perfusion ratio (VA/Q). The normal healthy lung consists of more than 300 million alveoli which all receive the same inspiratory gas and mixed venous blood. Nevertheless the composition of intraalveolar and endcapillary partial pressures of O2, CO2 and N2 differ between various areas of the lung because the partial pressures in the alveoli (PA) depend upon the VA/Q.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Similar content being viewed by others

References

  1. Dantzker DR, Brook CJ, Dehart P et al (1979) Ventilation-perfusion distributions in the adult respiratory distress syndrome. Am Rev Respir Dis 120:1039–1052

    PubMed  CAS  Google Scholar 

  2. West JB, Wagner PD (1998) Pulmonary gas exchange. Am J Respir Crit Care Med 157: S82–S87

    PubMed  CAS  Google Scholar 

  3. Riley RL, Cournand A (1949) “Ideal” alveolar air and the analysis of ventilation-perfusion relationships in the lung. J Appl Physiol 1:825

    PubMed  CAS  Google Scholar 

  4. Berggren S (1942) The oxygen deficit of arterial blood caused by non-ventilating parts of the lung. Acta Physiol Scand [Suppl II]: 1

    Google Scholar 

  5. Martin L (1986) Abbreviating the alveolar gas equation: an argument for simplicity. Resp Care 31:40

    Google Scholar 

  6. Cane RD, Shapiro BA, Harrison RA et al (1980) Minimizing errors in intrapulmonary shunt calculations. Crit Care Med 8:294–297

    Article  PubMed  CAS  Google Scholar 

  7. Carlon GC, Howland WS, Turnbull AD et al (1980) Pulmonary venous admixture during mechanical ventilation with varying FIO2 and PEEP. Crit Care Med 8:616–619

    Article  PubMed  CAS  Google Scholar 

  8. Dantzker DR, Wagner PD, West JB (1974) Proceedings: Instability of poorly ventilated lung units during oxygen breathing. J Physiol Lond 242:72P

    PubMed  CAS  Google Scholar 

  9. Quan SF, Kronberg GM, Schlobohm RM et al (1980) Changes in venous admixture with alterations of inspired oxygen concentration. Anesthesiology 52:477–482

    Article  PubMed  CAS  Google Scholar 

  10. Shapiro AR, Virgilio RW, Peters RM (1977) Interpretation of alveolar-arterial oxygen tension difference. Surg Gynecol Obstet 144:547–552

    PubMed  CAS  Google Scholar 

  11. Shapiro BA, Cane RD, Harrison RA et al (1980) Changes in intrapulmonary shunting with administration of 100 percent oxygen. Chest 77:138–141

    Article  PubMed  CAS  Google Scholar 

  12. Suter PM, Fairley HB, Schlobohm RM (1975) Shunt, lung volume and perfusion during short periods of ventilation with oxygen. Anesthesiology 43:617–627

    Article  PubMed  CAS  Google Scholar 

  13. Wagner PD, Laravuso RB, Uhl RR et al (1974) Distributions of ventilation-perfusion ratios in acute respiratory failure. Chest 65[Suppl]:32S–35S

    Article  PubMed  Google Scholar 

  14. Lampron N, Lemaire F, Teisseire B et al (1985) Mechanical ventilation with 100% oxygen does not increase intrapulmonary shunt in patients with severe bacterial pneumonia. Am Rev Respir Dis 131:409–413

    PubMed  CAS  Google Scholar 

  15. Pesenti A, Latini R, Riboni A et al (1982) Simple estimate of the true right to left shunt (Qs/Qt) at maintenance FIO2 by sulphur hexafluoride retention. Intensive Care Med 8: 283–286

    Article  PubMed  CAS  Google Scholar 

  16. Fahri LE (1967) Elimination of inert gases by the lung. Respir Physiol 3:1

    Article  Google Scholar 

  17. Fahri LE, Yokoyama T (1967) Effects of ventilation perfusion inequality on elimination of inert gases. Respir Physiol 3:12

    Article  Google Scholar 

  18. Wagner PD, Saltzman HA, West JB (1974) Measurement of continuous distributions of ventilation-perfusion ratios: theory. J Appl Physiol 36:588–599

    PubMed  CAS  Google Scholar 

  19. Evans JW, Wagner PD, West JB (1974) Conditions for reduction of pulmonary gas transfer by ventilation-perfusion inequality. J Appl Physiol 36:533–537

    PubMed  CAS  Google Scholar 

  20. Wagner PD, Naumann PF, Laravuso RB (1974) Simultaneous measurement of eight foreign gases in blood by gas chromatography. J Appl Physiol 36:600–605

    PubMed  CAS  Google Scholar 

  21. Radermacher P, Cinotti L, Falke KJ (1988) Grundlagen der methodischen Erfassung von Ventilations-Perfusions-Verteilungsstörungen. Anaesthesist 37:36–42

    PubMed  CAS  Google Scholar 

  22. Enghoff H (1937) Volumen inefficax. Bemerkungen zur Frage des schädlichen Raumes. Up-sala Laekareforen Foerh 44:191

    Google Scholar 

  23. Bohr C (1891) Über die Lungenatmung. Scand Arch Physiol 2:236

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer-Verlag Italia

About this paper

Cite this paper

Lohbrunner, H.M., Falke, K.J. (1999). Problems Associated with Clinical Determination of Pulmonary Shunting. In: Gullo, A. (eds) Anaesthesia, Pain, Intensive Care and Emergency Medicine — A.P.I.C.E.. Springer, Milano. https://doi.org/10.1007/978-88-470-2145-7_67

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2145-7_67

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0051-3

  • Online ISBN: 978-88-470-2145-7

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics