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Basics of Ventilation/Perfusion Abnormalities in Critically Ill Ventilated Patients

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Abstract

The effective and efficient transfer of oxygen and carbon dioxide between the lung and bloodstream depends on close matching of ventilation and perfusion. In this chapter, we introduce the theoretical basis of gas exchange in the lung, including quantification of ventilation-perfusion \( \left({\dot{V}}_{\mathrm{A}}/\dot{Q}\right) \) matching, shunt, and dead space. The multiple inert gas exchange technique (MIGET) is introduced as the fundamental method for measuring \( {\dot{V}}_{\mathrm{A}}/\dot{Q} \) relationships within the lung, along with clinically accessible measures of gas exchange. We then discuss measurements confirming that ventilation and perfusion are tightly matched in the normal lung, along with the importance of gravitational/positional and nongravitational (i.e., structural) factors affecting ventilation and perfusion. Aging, obesity, and lung disease also affect \( {\dot{V}}_{\mathrm{A}}/\dot{Q} \) relationships in important ways. Finally, we discuss the importance of ventilation-perfusion matching in the acute respiratory distress syndrome (ARDS) as well as the impact of prone positioning, positive airway pressure, and mechanical ventilation.

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Authors and Affiliations

  1. Department of Medicine, Division of Pulmonary Critical Care and Sleep Medicine, University of California, La Jolla, CA, USA

    Jeremy E. Orr & Susan R. Hopkins

  2. Department of Medicine and Radiology, University of California, San Diego, La Jolla, CA, USA

    Susan R. Hopkins

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  1. Jeremy E. Orr
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Correspondence to Jeremy E. Orr .

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Editors and Affiliations

  1. Royal Victoria Hospital (McGill University Health Centre), Departments of Critical Care and Physiology McGill University, Montreal, QC, Canada

    Sheldon Magder

  2. UC San Diego, Department of Medicine, La Jolla, CA, USA

    Atul Malhotra

  3. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA

    Kathryn A. Hibbert

  4. Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital, Boston, MA, USA

    Charles Corey Hardin

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Orr, J.E., Hopkins, S.R. (2021). Basics of Ventilation/Perfusion Abnormalities in Critically Ill Ventilated Patients. In: Magder, S., Malhotra, A., Hibbert, K.A., Hardin, C.C. (eds) Cardiopulmonary Monitoring. Springer, Cham. https://doi.org/10.1007/978-3-030-73387-2_14

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