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Through ventilation and perfusion scans, the abnormal area of lung may be localized. A provisional diagnosis of COPD, asthma or pulmonary embolisms may be made. Treatment of these underlying conditions may address ventilation perfusion mismatch. [citation needed] Management of the condition may vary.
Ventilation-perfusion mismatch (parts of the lung receive oxygen but not enough blood to absorb it, e.g. pulmonary embolism, Acute respiratory distress syndrome, Chronic obstructive pulmonary disease, Congestive heart failure. [1]
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.
These terms can also be used to describe areas or effects where blood flow and ventilation are not properly matched, though both may be present to varying degrees. Some references refer to “shunt-effect” or “dead space-effect” to designate the ventilation/perfusion mismatch states that are less extreme than absolute shunt or dead space.
As the mismatch between ventilation and perfusion grows, blood oxygen saturation is reduced. [41] Pulmonary hypoxic vasoconstriction, in which blood vessels near the hypoxic alveoli constrict (narrow their diameter) in response to the lowered oxygen levels, can occur in pulmonary contusion. [ 27 ]
By redirecting blood flow from poorly-ventilated lung regions to well-ventilated lung regions, HPV is thought to be the primary mechanism underlying ventilation/perfusion matching. [1] [2] The process might initially seem counterintuitive, as low oxygen levels might theoretically stimulate increased blood flow to the lungs to increase gas exchange.
[48] [49] A large animal model of ALI is the ovine model of body surface burn + heated smoke inhalation. [50] [51] It has been established that combined burn and smoke inhalation injury impairs hypoxic pulmonary vasoconstriction (HPV), the vasoconstrictive response to hypoxia, thereby mismatching ventilation with perfusion. Gas exchange is ...