The zones of the lung divide the

lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...

into four vertical regions, based upon the relationship between the pressure in the

alveoli Alveolus (; pl. alveoli, adj. alveolar) is a general anatomical term for a concave cavity or pit. Uses in anatomy and zoology * Pulmonary alveolus, an air sac in the lungs ** Alveolar cell or pneumocyte ** Alveolar duct ** Alveolar macrophage * ...

(PA), in the

arteries An artery (plural arteries) () is a blood vessel in humans and most animals that takes blood away from the heart to one or more parts of the body (tissues, lungs, brain etc.). Most arteries carry oxygenated blood; the two exceptions are the pul ...

(Pa), in the

veins Veins are blood vessels in humans and most other animals that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated b ...

(Pv) and the pulmonary

interstitial An interstitial space or interstice is a space between structures or objects. In particular, interstitial may refer to: Biology * Interstitial cell tumor * Interstitial cell, any cell that lies between other cells * Interstitial collagenase, ...

pressure (Pi): * Zone 1: PA > Pa > Pv * Zone 2: Pa > PA > Pv * Zone 3: Pa > Pv > PA * Zone 4: Pa > Pi > Pv > PA This concept is generally attributed to an article by West et al. in 1964, but was actually proposed two years earlier by Permutt et al. In this article, Permutt suggests "The pressure in the pulmonary arteries and veins is less at the top than at the bottom of the lung. It is quite likely that there is a portion of the lung toward the top in an upright subject in which the pressure in the pulmonary arteries is less than alveolar pressure." The concept is as follows:

Alveolar pressure Alveolar pressure (Palv) is the pressure of air inside the lung Pulmonary alveolus, alveoli. When the glottis is opened and no air is flowing into or out of the lungs, alveolar pressure is equal to the atmospheric pressure, that is, zero cmH2O, cmH2 ...

(PA) at end expiration is equal to atmospheric pressure (0 cm H₂O differential pressure, at zero flow), plus or minus 2 cm H₂O (1.5 mmHg) throughout the lung. On the other hand, gravity causes a gradient in blood pressure between the top and bottom of the lung of 20 mmHg in the erect position (roughly half of that in the supine position). Overall, mean pulmonary venous pressure is ~5 mmHg. Local venous pressure falls to -5 at the apexes and rises to +15 mmHg at the bases, again for the erect lung. Pulmonary blood pressure is typically in the range 25–10 mmHg with a mean pressure of 15 mmHg. Regional arterial blood pressure is typically in the range 5 mmHg near the apex of the lung to 25 mmHg at the base. Zone 1 is not observed in the normal healthy human lung. In normal health pulmonary arterial (Pa) pressure exceeds alveolar pressure (PA) in all parts of the lung. It is generally only observed when a person is ventilated with positive pressure or hemorrhage. In these circumstances, blood vessels can become completely collapsed by alveolar pressure (PA) and blood does not flow through these regions. They become alveolar

dead space ''Dead Space'' is a science fiction/horror fiction, horror media franchise created by Glen Schofield and Michael Condrey, developed by Visceral Games, and published and owned by Electronic Arts. The franchise's chronology is not presented in a lin ...

. Zone 2 is the part of the lungs about 3 cm above the heart. In this region blood flows in pulses. At first there is no flow because of obstruction at the venous end of the capillary bed. Pressure from the arterial side builds up until it exceeds alveolar pressure and flow resumes. This dissipates the capillary pressure and returns to the start of the cycle. Flow here is sometimes compared to a

starling resistor The Starling resistor was invented by English physiologist Ernest Starling and used in an isolated-heart preparation during work which would later lead to the " Frank–Starling law of the heart". The device consisted of an elastic fluid-filled c ...

or waterfall effect. Zone 3 comprises the majority of the lungs in health. There is no external resistance to blood flow and blood flow is continuous throughout the cardiac cycle. Flow is determined by the Ppa-Ppv difference (Ppa - Ppv), which is constant down this portion of the lung. However, transmural pressure across the wall of the blood vessels increases down this zone due to gravity. Consequently the vessels wall are more stretched so the caliber of the vessels increases causing an increase in flow due to lower resistance. Zone 4 can be seen at the lung bases at low lung volumes or in

pulmonary edema Pulmonary edema, also known as pulmonary congestion, is excessive edema, liquid accumulation in the parenchyma, tissue and pulmonary alveolus, air spaces (usually alveoli) of the lungs. It leads to impaired gas exchange and may cause hypoxemia an ...

. Pulmonary interstitial pressure (Pi) rises as lung volume decreases due to reduced radial tethering of the lung

parenchyma Parenchyma () is the bulk of functional substance in an animal organ or structure such as a tumour. In zoology it is the name for the tissue that fills the interior of flatworms. Etymology The term ''parenchyma'' is New Latin from the word π ...

. Pi is highest at the base of the lung due to the weight of the above lung tissue. Pi can also rise due to an increased volume of 'leaked' fluid from the pulmonary vasculature (

). An increase in Pi causes extraalveolar blood vessels to reduce in caliber, in turn causing blood flow to decrease (extraalveolar blood vessels are those blood vessels outside alveoli). Intraalveolar blood vessels (pulmonary capillaries) are thin walled vessels adjacent to alveoli which are subject to the pressure changes described by zones 1-3. Flow in zone 4 is governed by the arteriointerstitial pressure difference (Pa − Pi). This is because as Pi rises, the arterial caliber is reduced, thereby increasing resistance to flow. The Pa/Pv difference remains unchanged since Pi is applied over both vessels. The

ventilation/perfusion ratio In respiratory physiology, the ventilation/perfusion ratio (V/Q ratio) is a ratio used to assess the efficiency and adequacy of the matching of two variables: * V – Ventilation (physiology), ventilation – the air that reaches the Pulmonary alve ...

(V/Q ratio) is higher in zone #1 (the

apex of lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...

) when a person is standing than it is in zone #3 (the

base of lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of th ...

) because perfusion is nearly absent. However, ventilation and perfusion are highest in base of the lung, resulting in a comparatively lower V/Q ratio.

References

External links

Description at anaesthetist.com

{{Respiratory physiology Respiratory physiology