The concept of deadspace with special reference to the single breath test for carbon dioxide

We present a review and a theoretical analysis of factors determining airway deadspace (VDaw) and alveolar deadspace (VDalv), the two constituents of physiological deadspace (VDphys). VDaw if the volume of gas between the lips and the alveolar/fresh gas interface, the location of which is determined by inspiratory flow pattern and airway geometry. VDalv can be caused by incomplete alveolar gas mixing and associated V/Q mismatching within the terminal respiratory units, temporal V/Q mismatching within units, spatial V/Q mismatching between units, and venous admixture. Most causes of VDphys are influenced by inspiratory flow pattern and the time available for gas diffusion and distribution. Analysis can be made from the single breath test for carbon dioxide (SBT--CO2) which is the plot of fraction of carbon dioxide in expired gas against expired volume. The common causes of VDalv are associated with a sloping SBT-CO2 phase III. Combination of SBT-CO2 with PaCO2 yields VDphys and VDalv. A sloping phase III with a negative arterial-end-tidal PCO2 gradient implies compensation by perfusion for early emptying, overventilated alveoli.