Shunting vs dead space pulmonary8/28/2023 ![]() ![]() The easy way to tell if someone is hypoxic from a shunt at the bedside is to give 100% FiO2. Blood goes straight from the right atrium to the left atrium. The easiest example to understand is a patent foramen ovale. Shunt is one end of the spectrum: no ventilation some of the bloodstream. VQ mismatch, you should also understand dead space. I'm grunching most of the responses here, but I've read enough inaccurate information I'm going to craft my own response. Refractory hypoxia is related to all of this too, cause it's the actual thing happening in a V/Q mismatch. We know that situation is happening but aren't sure if its Deadspace or pulmonary shunt yet, so it's a V/Q mismatch. So their P (small a) O2 in their circulation is lower. V/Q mismatch: a blanket statement that is more general, meaning there's a higher PAO2 but the patient isn't getting all of it. ![]() If there's a V/Q mismatch it's the lungs fault. ![]() Secretions can clog the area, a big mucous plug, or scarring, or inflammation like ards looking lungs, or a pneumo, or Pleural fluid. In a shunt there is an obstruction happening in the lungs. Imagine breathing with a 1.0 FiO2, but for some odd reason there's a poor amount getting to the circulation. When you hear shunt think vessels, there's a problem with circulation or the V/Q mismatch is heart related. Why would no perfusion be happening? Several reasons, it could be a clot in the pulmonary vasculature, it could be just bad piping that's genetic, it could be a birthing cardiac defect. Imagine no perfusion getting to those lungs. Imagine breathing, your lungs are functioning well you're breathing in and out, ventilation and oxygenation is occurring. Deadspace: ventilation without perfusion. ![]()
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