## Figure 3910

Diffusing capacities for carbon monoxide, oxygen, and carbon dioxide in the normal lungs under resting conditions and during exercise.

capacity by such a direct procedure, except on an experimental basis.

To obviate the difficulties encountered in measuring oxygen diffusing capacity directly, physiologists usually measure carbon monoxide diffusing capacity instead and then calculate the oxygen diffusing capacity from this. The principle of the carbon monoxide method is the following: A small amount of carbon monoxide is breathed into the alveoli, and the partial pressure of the carbon monoxide in the alveoli is measured from appropriate alveolar air samples. The carbon monoxide pressure in the blood is essentially zero, because hemoglobin combines with this gas so rapidly that its pressure never has time to build up. Therefore, the pressure difference of carbon monoxide across the respiratory membrane is equal to its partial pressure in the alveolar air sample. Then, by measuring the volume of carbon monoxide absorbed in a short period and dividing this by the alveolar carbon monoxide partial pressure, one can determine accurately the carbon monoxide diffusing capacity.

To convert carbon monoxide diffusing capacity to oxygen diffusing capacity, the value is multiplied by a factor of 1.23 because the diffusion coefficient for oxygen is 1.23 times that for carbon monoxide. Thus, the average diffusing capacity for carbon monoxide in young men at rest is 17 ml/min/mm Hg, and the diffusing capacity for oxygen is 1.23 times this, or 21 ml/min/mm Hg.

Effect of the VentilationPerfusion Ratio on Alveolar Gas Concentration

In the early part of this chapter, we learned that two factors determine the Po2 and the Pco2 in the alveoli: (1) the rate of alveolar ventilation and (2) the rate of transfer of oxygen and carbon dioxide through the respiratory membrane. These earlier discussions made the assumption that all the alveoli are ventilated equally and that blood flow through the alveolar capillaries is the same for each alveolus. However, even normally to some extent, and especially in many lung diseases, some areas of the lungs are well ventilated but have almost no blood flow, whereas other areas may have excellent blood flow but little or no ventilation. In either of these conditions, gas exchange through the respiratory membrane is seriously impaired, and the person may suffer severe respiratory distress despite both normal total ventilation and normal total pulmonary blood flow, but with the ventilation and blood flow going to different parts of the lungs. Therefore, a highly quantitative concept has been developed to help us understand respiratory exchange when there is imbalance between alveolar ventilation and alveolar blood flow. This concept is called the ventilation-perfusion ratio.

In quantitative. te.rms, the v. entilation-perfusion ratio is expressed as Va/Q. When VA (alveolar ventilation) is normal for a given alveolus and Q (blood flow) is also normal. for. the same alveolus, the ventilation-perfusion ratio (Va/Q) is also said to be normal. When the ventilation (Va) is zero, yet there is still perfusion (Q) of the alveolus, the Va/Q is zero. Or, at the other extreme, when there is adequate ventilation (VA) but zero perfusion (Q), the ratio Va/Q is infinity. At a ratio of either zero or infinity, there is no exchange of gases through the respiratory membrane of the affected alveoli, which