Alveolar gas equation: Difference between revisions

Content deleted Content added

Inline

Latest revision as of 18:00, 23 August 2024

The alveolar gas equation is the method for calculating partial pressure of alveolar oxygen (p_AO₂). The equation is used in assessing if the lungs are properly transferring oxygen into the blood. The alveolar air equation is not widely used in clinical medicine, probably because of the complicated appearance of its classic forms. The partial pressure of oxygen (pO₂) in the pulmonary alveoli is required to calculate both the alveolar-arterial gradient of oxygen and the amount of right-to-left cardiac shunt, which are both clinically useful quantities. However, it is not practical to take a sample of gas from the alveoli in order to directly measure the partial pressure of oxygen. The alveolar gas equation allows the calculation of the alveolar partial pressure of oxygen from data that is practically measurable. It was first characterized in 1946.^[1]

Assumptions

The equation relies on the following assumptions:

Inspired gas contains no carbon dioxide (CO₂)
Nitrogen (and any other gases except oxygen) in the inspired gas are in equilibrium with their dissolved states in the blood
Inspired and alveolar gases obey the ideal gas law
Carbon dioxide (CO₂) in the alveolar gas is in equilibrium with the arterial blood i.e. that the alveolar and arterial partial pressures are equal
The alveolar gas is saturated with water

Equation

$p_{A}{\ce {O2}}=F_{I}{\ce {O2}}(P_{{\ce {ATM}}}-p{\ce {H2O}})-{\frac {p_{a}{\ce {CO2}}(1-F_{I}{\ce {O2}}(1-{\ce {RER}}))}{{\ce {RER}}}}$

If F_iO₂ is small, or more specifically if $F_{I}{\ce {O2}}(1-{\ce {RER}})\ll 1$ then the equation can be simplified to:

$p_{A}{\ce {O2}}\approx F_{I}{\ce {O2}}(P_{{\ce {ATM}}}-p{\ce {H2O}})-{\frac {p_{a}{\ce {CO2}}}{{\ce {RER}}}}$

where:

Quantity	Description	Sample value
$p_{A}{\ce {O2}}$	The alveolar partial pressure of oxygen ( $p{\ce {O2}}$ )	107 mmHg (14.2 kPa)
$F_{I}{\ce {O2}}$	The fraction of inspired gas that is oxygen (expressed as a decimal).	0.21
$P_{ATM}$	The prevailing atmospheric pressure	760 mmHg (101 kPa)
$p{\ce {H2O}}$	The saturated vapour pressure of water at body temperature and the prevailing atmospheric pressure	47 mmHg (6.25 kPa)
$p_{a}{\ce {CO2}}$	The arterial partial pressure of carbon dioxide ( $p{\ce {CO2}}$ )	40 mmHg (5.33 kPa)
${\text{RER}}$	The respiratory exchange ratio	0.8

Sample Values given for air at sea level at 37 °C.

Doubling F_iO₂ will double p_iO₂.

Other possible equations exist to calculate the alveolar air.^[2]^[3]^[4]^[5]^[6]^[7]^[8]

${\begin{aligned}p_{A}{\ce {O2}}&=F_{I}{\ce {O2}}\left(PB-p{\ce {H2O}}\right)-p_{A}{\ce {CO2}}\left(F_{I}{\ce {O2}}+{\frac {1-F_{I}{\ce {O2}}}{R}}\right)\\[4pt]&=p_{I}{\ce {O2}}-p_{A}{\ce {CO2}}\left(F_{I}{\ce {O2}}+{\frac {1-F_{I}{\ce {O2}}}{R}}\right)\\[4pt]&=p_{I}{\ce {O2}}-{\frac {V_{T}}{V_{T}-V_{D}}}\left(p_{I}{\ce {O2}}-p_{E}{\ce {O2}}\right)\\[4pt]&={\frac {p_{E}{\ce {O2}}-p_{I}{\ce {O2}}\left({\frac {V_{D}}{V_{T}}}\right)}{1-{\frac {V_{D}}{V_{T}}}}}\end{aligned}}$

Abbreviated alveolar air equation

$p_{A}{\ce {O2}}={\frac {p_{E}{\ce {O2}}-p_{i}{\ce {O2}}{\frac {V_{D}}{V_{T}}}}{1-{\frac {V_{D}}{V_{T}}}}}$ p_AO₂, p_EO₂, and p_iO₂ are the partial pressures of oxygen in alveolar, expired, and inspired gas, respectively, and VD/VT is the ratio of physiologic dead space over tidal volume.^[9]

Respiratory quotient (R)

$R={\frac {p_{E}{\ce {CO2}}(1-F_{I}{\ce {O2}})}{p_{i}{\ce {O2}}-p_{E}{\ce {O2}}-(p_{E}{\ce {CO2}}*F_{i}{\ce {O2}})}}$

Physiologic dead space over tidal volume (VD/VT)

${\frac {V_{D}}{V_{T}}}={\frac {p_{A}{\ce {CO2}}-p_{E}{\ce {CO2}}}{p_{A}{\ce {CO2}}}}$

References

^ Curran-Everett D (June 2006). "A classic learning opportunity from Fenn, Rahn, and Otis (1946): the alveolar gas equation". Adv Physiol Educ. 30 (2): 58–62. doi:10.1152/advan.00076.2005. PMID 16709734. S2CID 42010762.
^ Raymond L, Dolan W, Dutton R, et al: Pulmonary function and gas exchange during altitude hypoxia (abstract). Clin Res 19:147, 1971
^ Spaur WH, Raymond LW, Knott MM, et al: Dyspnea in divers at 49.5 ATA: Mechanical not chemical in origin. Undersea Biomed Res 4:183-198, 1977
^ Rossier P-H, Blickenstorfer E: Espace mort et hyperventilation. Helv Med Acta 13:328-332, 1946
^ Riley RL, Lilienthal JL Jr, Proemmel DD, et al: On the determination of the physiologically effective pressures of oxygen and carbon dioxide in alveolar air. Am J Physiol 147:191-198, 1946
^ McNicol MW, Campbell EJM: Severity of respiratory failure: arterial blood gases in untreated patients. Lancet 1:336-338, 1965
^ Begin R, Renzetti AD Jr: Alveolar-arterial oxygen pressure gradient: I. Comparison between an assumed and actual respiratory quotient in stable chronic pulmonary disease; Relationship to aging and closing volume in normal subjects. Respir Care 22:491-500, 1977
^ Suwa K, Geffin B, Pontoppidan H, et al: A nomogram for deadspace requirement during prolonged artificial ventilation. Anesthesiology 29:1206-1210, 1968
^ Fenn WO, Rahn H, Otis AB: A theoretical study of the composition of alveolar air at altitude. Am J Physiol 146:637-653, 1946

External links

[pmid16709734-1] Curran-Everett D (June 2006). "A classic learning opportunity from Fenn, Rahn, and Otis (1946): the alveolar gas equation". Adv Physiol Educ. 30 (2): 58–62. doi:10.1152/advan.00076.2005. PMID 16709734. S2CID 42010762.

[2] Raymond L, Dolan W, Dutton R, et al: Pulmonary function and gas exchange during altitude hypoxia (abstract). Clin Res 19:147, 1971

[3] Spaur WH, Raymond LW, Knott MM, et al: Dyspnea in divers at 49.5 ATA: Mechanical not chemical in origin. Undersea Biomed Res 4:183-198, 1977

[4] Rossier P-H, Blickenstorfer E: Espace mort et hyperventilation. Helv Med Acta 13:328-332, 1946

[5] Riley RL, Lilienthal JL Jr, Proemmel DD, et al: On the determination of the physiologically effective pressures of oxygen and carbon dioxide in alveolar air. Am J Physiol 147:191-198, 1946

[6] McNicol MW, Campbell EJM: Severity of respiratory failure: arterial blood gases in untreated patients. Lancet 1:336-338, 1965

[7] Begin R, Renzetti AD Jr: Alveolar-arterial oxygen pressure gradient: I. Comparison between an assumed and actual respiratory quotient in stable chronic pulmonary disease; Relationship to aging and closing volume in normal subjects. Respir Care 22:491-500, 1977

[8] Suwa K, Geffin B, Pontoppidan H, et al: A nomogram for deadspace requirement during prolonged artificial ventilation. Anesthesiology 29:1206-1210, 1968

[9] Fenn WO, Rahn H, Otis AB: A theoretical study of the composition of alveolar air at altitude. Am J Physiol 146:637-653, 1946

[1]

[2]

[3]

[4]

[5]

[6]

[7]

[8]

[9]

@@ Line 1: / Line 1: @@
+{{short description|Formula for the partial pressure of alveolar oxygen}}
-The [[partial pressure]] of oxygen (pO<sub>2</sub>) in the [[pulmonary alveoli]] is required to calculate both the [[alveolar-arterial gradient]] of oxygen and the amount of right-to-left [[cardiac shunt]], which are both clinically useful quantities. However it is not practical to take a sample of gas from the alveoli in order to directly measure the partial pressure of oxygen. The '''alveolar gas equation''' allows the calculation of the alveolar partial pressure of oxygen from data that is practically measurable. It was first characterized in 1946.<ref name="pmid16709734">{{cite journal |author=Curran-Everett D |title=A classic learning opportunity from Fenn, Rahn, and Otis (1946): the alveolar gas equation |journal=Adv Physiol Educ |volume=30 |issue=2 |pages=58–62 |date=June 2006 |pmid=16709734 |doi=10.1152/advan.00076.2005 |url=http://advan.physiology.org/cgi/content/full/30/2/58?ck=nck}}</ref>
+The '''alveolar gas equation''' is the method for calculating [[partial pressure]] of [[pulmonary alveolus|alveolar]] oxygen ({{chem2|''p_{A}''O2}}). The equation is used in assessing if the [[lungs]] are properly transferring [[oxygen]] into the [[blood]].  The alveolar air equation is not widely used in clinical medicine, probably because of the complicated appearance of its classic forms.
+The partial pressure of oxygen ({{chem2|''p''O2}}) in the [[pulmonary alveoli]] is required to calculate both the [[alveolar-arterial gradient]] of oxygen and the amount of right-to-left [[cardiac shunt]], which are both clinically useful quantities. However, it is not practical to take a sample of gas from the alveoli in order to directly measure the partial pressure of oxygen. The alveolar gas equation allows the calculation of the alveolar partial pressure of oxygen from data that is practically measurable. It was first characterized in 1946.<ref name="pmid16709734">{{cite journal |author=Curran-Everett D |title=A classic learning opportunity from Fenn, Rahn, and Otis (1946): the alveolar gas equation |journal=Adv Physiol Educ |volume=30 |issue=2 |pages=58–62 |date=June 2006 |pmid=16709734 |doi=10.1152/advan.00076.2005 |s2cid=42010762 }}</ref>
 ==Assumptions==
 The equation relies on the following assumptions:
-* Inspired gas contains no carbon dioxide (CO<sub>2</sub>) or water
+* Inspired gas contains no carbon dioxide ({{chem2|CO2}})
 * Nitrogen (and any other gases except oxygen) in the inspired gas are in equilibrium with their dissolved states in the blood
 * Inspired and alveolar gases obey the [[ideal gas law]]
-* Carbon dioxide (CO<sub>2</sub>) in the alveolar gas is in equilibrium with the arterial blood i.e. that the alveolar and arterial partial pressures are equal
+* Carbon dioxide ({{chem2|CO2}}) in the alveolar gas is in equilibrium with the arterial blood i.e. that the alveolar and arterial partial pressures are equal
 * The alveolar gas is saturated with water
 ==Equation==
+<math chem display=block>
-<math>p_AO_2=F_IO_2(P_{ATM}-pH_2O)-\frac{p_aCO_2(1-F_IO_2[1-RER])}{RER}</math>
+  p_A\ce{O2} = F_I\ce{O2}(P_\ce{ATM} - p\ce{H2O}) - \frac{p_a\ce{CO2}(1 - F_I\ce{O2}(1 - \ce{RER}))} \ce{RER}
+</math>
+If {{chem2|''F_{i}''O2}} is small, or more specifically if <math chem>F_I\ce{O2}(1-\ce{RER}) \ll 1</math> then the equation can be simplified to:
+<math chem display=block>
+  p_A\ce{O2} \approx F_I\ce{O2}(P_\ce{ATM} - p\ce{H2O}) - \frac{p_a\ce{CO2}} \ce{RER}
+</math>
-If F<sub>I</sub>O<sub>2</sub> is small, or more specifically if<br /><math>F_IO_2[1-RER] \ll 1</math><br />then the equation can be simplified to:<br /><math>p_AO_2 \approx F_IO_2(P_{ATM}-pH_2O)-\frac{p_aCO_2}{RER}</math>
 where:
@@ Line 21: / Line 31: @@
 ! Sample value
 |-
+| <math chem>p_A\ce{O2}</math>
-| p<sub>A</sub>O<sub>2</sub>
-| The alveolar partial pressure of oxygen (pO<sub>2</sub>)
+| The alveolar partial pressure of oxygen (<math chem>p\ce{O2}</math>)
 | 107 mmHg (14.2 kPa)
 |-
+| <math chem>F_I\ce{O2}</math>
-| F<sub>I</sub>O<sub>2</sub>
 | The fraction of inspired gas that is oxygen (expressed as a decimal).
 | 0.21
 |-
-| P<sub>ATM</sub>
+| <math>P_{ATM}</math>
 | The prevailing atmospheric pressure
 | 760 mmHg (101 kPa)
 |-
-| pH<sub>2</sub>O
+| <math chem>p\ce{H2O}</math>
 | The saturated vapour pressure of water at body temperature and the prevailing atmospheric pressure
 | 47 mmHg (6.25 kPa)
 |-
+| <math chem>p_a\ce{CO2}</math>
-| p<sub>a</sub>CO<sub>2</sub>
-| The arterial partial pressure of carbon dioxide (pCO<sub>2</sub>)
+| The arterial partial pressure of carbon dioxide (<math chem>p\ce{CO2}</math> )
-| 40 mmHg (4.79 kPa)
+| 40 mmHg (5.33 kPa)
 |-
+| <math>\text{RER}</math>
-| RER
 | The [[respiratory exchange ratio]]
 | 0.8
 |}
-Sample Values given for air at sea level at 37°C.
+Sample Values given for air at sea level at 37&nbsp;°C.
+Doubling {{chem2|''F_{i}''O2}} will double {{chem2|''p_{i}''O2}}.
+Other possible equations exist to calculate the alveolar air.<ref>Raymond L, Dolan W, Dutton R, et al: Pulmonary function and gas exchange during altitude hypoxia (abstract).
+Clin Res 19:147, 1971</ref><ref>Spaur WH, Raymond LW, Knott MM, et al: Dyspnea in divers at 49.5 ATA: Mechanical not chemical in origin. [[Undersea Biomed Res]] 4:183-198, 1977</ref><ref>Rossier P-H, Blickenstorfer E: Espace mort et hyperventilation. [[Helv Med Acta]] 13:328-332, 1946</ref><ref>Riley RL, Lilienthal JL Jr, Proemmel DD, et al: On the
+determination of the physiologically effective pressures of oxygen and carbon dioxide in alveolar air. [[Am J Physiol]] 147:191-198, 1946</ref><ref>McNicol MW, Campbell EJM: Severity of respiratory failure: arterial blood gases in untreated patients. [[The Lancet|Lancet]] 1:336-338, 1965</ref><ref>Begin R, Renzetti AD Jr: Alveolar-arterial oxygen pressure gradient: I. Comparison between an assumed and actual respiratory quotient in stable chronic pulmonary disease; Relationship to aging and closing volume in normal subjects. [[Respir Care]] 22:491-500, 1977</ref><ref>Suwa K, Geffin B, Pontoppidan H, et al: A nomogram for
+deadspace requirement during prolonged artificial ventilation.
+[[Anesthesiology]] 29:1206-1210, 1968</ref>
+<math chem display=block>\begin{align}
+  p_A \ce{O2} & =  F_I \ce{O2} \left(PB - p\ce{H2O}\right) - p_A \ce{CO2} \left(F_I \ce{O2} + \frac{1 - F_I \ce{O2}}{R}\right) \\[4pt]
+  & = p_I \ce{O2} - p_A \ce{CO2} \left(F_I \ce{O2} + \frac{1 - F_I \ce{O2}}{R}\right) \\[4pt]
+  & = p_I \ce{O2} - \frac{V_T}{V_T - V_D}\left(p_I \ce{O2} - p_E \ce{O2}\right) \\[4pt]
+  & = \frac{p_E \ce{O2} - p_I \ce{O2} \left(\frac{V_D}{V_T}\right)}{1 - \frac{V_D}{V_T}}
+\end{align}</math>
+=== Abbreviated alveolar air equation ===
+<math chem display=block>
+  p_A \ce{O2} = \frac{p_E \ce{O2} - p_i \ce{O2} \frac{V_D}{V_T}}{1- \frac{V_D}{V_T}}
+</math>
+{{chem2|''p_{A}''O2}}, {{chem2|''p_{E}''O2}}, and {{chem2|''p_{i}''O2}} are the partial pressures of oxygen in alveolar, expired, and inspired gas, respectively, and VD/VT is the ratio of physiologic dead space over tidal volume.<ref>Fenn WO, Rahn H, Otis AB: A theoretical study of the composition of alveolar air at altitude. [[Am J Physiol]] 146:637-653, 1946</ref>
+=== Respiratory quotient (R) ===
+<math chem display=block>
+  R = \frac{p_E \ce{CO2} (1 - F_I \ce{O2})}{p_i \ce{O2} - p_E \ce{O2} - (p_E \ce{CO2} * F_i \ce{O2})}
+</math>
+=== Physiologic dead space over tidal volume (VD/VT) ===
+<math chem display=block>
+  \frac{V_D}{V_T} = \frac{p_A \ce{CO2} - p_E \ce{CO2} }{p_A\ce{CO2} }
+</math>
 ==See also==
@@ Line 52: / Line 93: @@
 ==References==
-{{Research help|Med}}
 {{reflist}}
 ==External links==
 * [http://vam.anest.ufl.edu/simulations/alveolargasequation.php Free interactive model of the simplified and complete versions of the alveolar gas equation (AGE)]
-* [http://www.surgery.ucsf.edu/eastbaytrauma/Protocols/Formulas%20pages/formulasaalvgasequation.htm Formula at ucsf.edu]
+* [https://web.archive.org/web/20070418215127/http://www.surgery.ucsf.edu/eastbaytrauma/Protocols/Formulas%20pages/formulasaalvgasequation.htm Formula at ucsf.edu]
-* [http://ceaccp.oxfordjournals.org/content/4/1/24.full Derivation and explanation from Continuing Care in Anaesthesia, Critical Care, and Pain]
+* [https://academic.oup.com/bjaed/article-pdf/4/1/24/1021798/mkh008.pdf S. Cruickshank, N. Hirschauer: ''The alveolar gas equation'' in Continuing Education in Anaesthesia, Critical Care & Pain, Volume 4 Number 1 2004]
 *[http://www.medfixation.com/alveolar-gas-equation-pao2/ Online Alveolar Gas Equation and iPhone application] by Medfixation.
 * [https://www.vcalc.com/wiki/vCalc/Alveolar+gas+equation A computationally functional Alveolar Gas Equation by vCalc.]
@@ Line 66: / Line 106: @@
 {{DEFAULTSORT:Alveolar Gas Equation}}
 [[Category:Respiratory physiology]]
-{{med-diagnostic-stub}}

v t e Respiratory physiology
Respiration	breath inhalation exhalation obligate nasal breathing respiratory rate respirometer pulmonary surfactant compliance elastic recoil hysteresivity airway resistance bronchial hyperresponsiveness constriction dilatation mechanical ventilation
Control	pons pneumotaxic center apneustic center medulla dorsal respiratory group ventral respiratory group chemoreceptors central peripheral pulmonary stretch receptor Hering–Breuer reflex
Lung volumes	VC FRC Vt dead space CC PEF calculations respiratory minute volume FEV1/FVC ratio Lung function tests spirometry body plethysmography peak flow meter nitrogen washout
Circulation	pulmonary circulation hypoxic pulmonary vasoconstriction pulmonary shunt
Interactions	ventilation (V) Perfusion (Q) Ventilation/perfusion ratio V/Q scan zones of the lung gas exchange pulmonary gas pressures alveolar gas equation alveolar–arterial gradient hemoglobin oxygen–hemoglobin dissociation curve (Oxygen saturation 2,3-BPG Bohr effect Haldane effect) carbonic anhydrase (chloride shift) oxyhemoglobin respiratory quotient arterial blood gas diffusion capacity (DLCO)
Insufficiency	high altitude death zone oxygen toxicity hypoxia