Diffusion and perfusion limitation in alveolar O2 exchange: shape of the blood O2 equilibrium curve.

The limitations imposed by diffusion (Ldiff) and perfusion (Lperf) on alveolar gas exchange can be estimated using a simple model of alveolar-capillary gas transfer (Piiper and Scheid (1981) Respir, Physiol. 46: 193-208). These limitations indicate the fractional increase of gas exchange that would occur by raising pulmonary conductances for diffusion or perfusion to functionally infinite values. The (simple) model assumes linear relations between concentration and partial pressure for the gases studied. We have investigated in this study the effects of this assumption for estimating Ldiff and Lperf for O2 whose blood equilibrium curve is particularly non-linear in normoxia. The calculations suggest that Lperf is only slightly overestimated by the assumption of linear blood O2 binding. For Ldiff, there is a significant overestimation in normoxia, but in hypoxia the linear equilibrium curve yields sufficiently accurate estimates. Calculations for data estimated for man on the summit of Mt. Everest suggest that alveolar O2 uptake in deep hypoxia at rest is mainly limited by perfusion and to a lesser degree by diffusion (Lperf greater than Ldiff). For the sustained exercise of climbing, on the other hand, diffusion limitation is more prominent than perfusion limitation (Ldiff greater than Lperf). Large values of Ldiff are estimated for normoxic O2 uptake across the skin of the gill-less and lung-less salamander, and here, the effects of the alinearity of the O2 equilibrium curve are pronounced. It is concluded that the simplified model of alveolar-capillary gas transfer, with linear O2 equilibrium curve, can be very useful to estimate diffusion and perfusion limitations from experimental data.