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Any deviation from this value is considered a V/Q mismatch. Maintenance of the V/Q ratio is crucial for preservation of effective pulmonary gas exchange and maintenance of oxygenation levels. A mismatch can contribute to hypoxemia and often signifies the presence or worsening of an underlying pulmonary condition. [3]
Hypoxemia is caused by five categories of etiologies: hypoventilation, ventilation/perfusion mismatch, right-to-left shunt, diffusion impairment, and low PO 2. Low PO 2 and hypoventilation are associated with a normal alveolar–arterial gradient (A-a gradient) whereas the other categories are associated with an increased A-a gradient. [11]: 229
When the ratio gets above or below 0.8, it is considered abnormal ventilation-perfusion coupling, also known as a ventilation–perfusion mismatch. [3] Lung diseases, cardiac shunts, and smoking can cause a ventilation–perfusion mismatch that results in significant symptoms and diseases; treatments include bronchodilators and oxygen therapy.
This matching may be assessed in the lung as a whole, or in individual or in sub-groups of gas-exchanging units in the lung. On the other side Ventilation-perfusion mismatch is the term used when the ventilation and the perfusion of a gas exchanging unit are not matched. The actual values in the lung vary depending on the position within the lung.
A pulmonary shunt is the passage of deoxygenated blood from the right side of the heart to the left without participation in gas exchange in the pulmonary capillaries. It is a pathological condition that results when the alveoli of parts of the lungs are perfused with blood as normal, but ventilation (the supply of air) fails to supply the perfused region.
An abnormally increased A–a gradient suggests a defect in diffusion, V/Q mismatch, or right-to-left shunt. [5] The A-a gradient has clinical utility in patients with hypoxemia of undetermined etiology. The A-a gradient can be broken down categorically as either elevated or normal. Causes of hypoxemia will fall into either category.
Hypoxic pulmonary vasoconstriction (HPV), also known as the Euler–Liljestrand mechanism, is a physiological phenomenon in which small pulmonary arteries constrict in the presence of alveolar hypoxia (low oxygen levels).
Pulmonary hypoxia is hypoxia from hypoxemia due to abnormal pulmonary function, and occurs when the lungs receive adequately oxygenated gas which does not oxygenate the blood sufficiently. It may be caused by: [7] Ventilation perfusion mismatch (V/Q mismatch), which can be either low or high. [8]