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Pulmonary circulation

Professor Savithri Wimalasekera,


Dept of Physiology,
Faculty of Medical Sciences,
University of Sri Jayewardenepura
Nugegoda
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Functions of respiratory system

1.Ventilation

2.Perfusion Blood supply

3.Diffusion

4.Transport O2
CO2
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Pulmonary Circulation
Unique circulation receives a volume of blood
similar to the entire circulation
pulmonary vascular bed = the systemic
circulation
exceptions - the walls of pulmonary artery &
large branches ~ 30% thickness of aortic wall
- small arterial vessels - endothelial tubes -
little muscle in their walls ; systemic arterioles
have more smooth muscle.
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Pulmonary Circulation
- walls of the post -
capillary vessels
contain smooth
muscle.
- pulmonary capillaries -
large, with multiple
anastomoses :. each
alveolus sits in a
capillary basket.
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Pulmonary Circulation
Major function :-
1. Supply of O2
2.Removal of CO2

Circulation Time :- 4 8 Seconds


( Pulmonary artery Left atrium)
Pulmonary artery
Blood vessels
of Lungs
Bronchial artery
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Pulmonary artery gas exchange


Bronchial artery nutrition of lung tissues and airways
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Pulmonary capillaries
At Rest At
Exercise

Effective surface area 60 m2 90 m2

Transit time 0.75 sec 0.3 sec

- Site of O2 and CO2 exchange


Contains - 100 mL blood spread over this area
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3. Pulmonary veins
- Short
-carries Oxygenated blood

4. Bronchial vessels
- 1 2% of cardiac output
- carries Oxygenated blood
- provides nutrition to bronchi respiratory
bronchioles
- drains from pulmonary vessels
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Anatomy :-
1.Pulmonary arteries
- Short
- Thin walled
- Carries deoxygenated blood

- High Compliance ( 7 mL/mmHg)

Compliance = Change in volume per unit change


in airway pressure
V /P
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Pressure changes in pulmonary circulation


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Pressure changes in the pulmonary system

Systolic pressure Diastolic


pressure

Right ventricle 25 mmHg 1 mmHg

Pulmonary artery 25mmHg 8mmHg

Left atria & 8 mmHg


Pulmonary venous
pressure
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Pressure changes in the pulmonary


system Cont..
Mean Pulmonary Artery pressure:-
- Diastolic pressure + 1/3 ( Systolic Diastolic press)

- 15mmHg
Pulmonary Arterial pulse pressure:-
- Systolic press Diastolic press
- 16mmHg
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Pressure changes in the pulmonary


system Cont..
Left atria and Pulmonary venous pressure :-
- 8mmHg
- Difficult to measure
: . Pul. Capillary Wedge Pressure is used

PCWP only 2-3 mmHg about L. atrial pressure

Thus very good indicator of left atrial pressure


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In most situations the CVP is an adequate guide to the filling


pressures of both sides of the heart; however, certain conditions
such as pulmonary hypertension or right ventricular dysfunction
may lead to raised CVP levels even in the presence of
hypovolaemia. If this is suspected, it may be appropriate to
insert a pulmonary artery flotation catheter (Fig. 8.2) so that
pulmonary artery pressure and PAWP, which approximates to
left atrial pressure, can be measured. The mean PAWP normally
lies between 8 and 12 mmHg (measured from the mid-axillary
line) but in left heart failure it may be grossly elevated and even
exceed 30 mmHg. Provided the pulmonary capillary membranes
are intact, the optimum PAWP when managing acute circulatory
failure in the critically ill patient is generally 12-15 mmHg
because this will ensure good left ventricular filling without
risking hydrostatic pulmonary oedema.
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How do we keep alveoli dry?


Negative Pulmonary Interstitial Pressure and the Mechanism for
Keeping the Alveoli "Dry." One of the most important problems in lung
function is to understand why the alveoli do not normally fill with fluid.
One's first inclination is to think that the alveolar epithelium is strong
enough and continuous enough to keep fluid from leaking out of the
interstitial spaces into the alveoli. This is not true, because experiments
have shown that there are always openings between the alveolar
epithelial cells through which even large protein molecules, as well as
water and electrolytes, can pass. However, if one remembers that the
pulmonary capillaries and the pulmonary lymphatic system normally
maintain a slight negative pressure in the interstitial spaces, it is clear
that whenever extra fluid appears in the alveoli, it will simply be sucked
mechanically into the lung interstitium through the small openings
between the alveolar epithelial cells. Then the excess fluid is either
carried away through the pulmonary lymphatics or absorbed into the
pulmonary capillaries. Thus, under normal conditions, the alveoli are
kept "dry," except for a small amount of fluid that seeps from the
epithelium onto the lining surfaces of the alveoli to keep them moist.
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Forces tending to cause movement of fluid outward


from the capillaries and into the pulmonary
interstitium
Capillary pressure 7
Interstitial fluid colloid osmotic pressure 14

Negative interstitial fluid pressure 8


TOTAL OUTWARD FORCE 29
Forces tending to cause absorption of fluid into
capillaries:
Plasma colloid osmotic pressure 28
TOTAL INWARD FORCE 28
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Special features of the pulmonary


circulation
1.Large Blood flow :-
- ~ = C. O. = 5L/min
Flow = Pressure difference = P
Resistance R
Resistance = 8L
r4
: . Resistance 1/ r4
: . Flow = P r4
8L
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Special features of the pulmonary circulation
cont.
2. Low pressure
pulmonary artery B.P 25 / 9 mmHg
Aorta - 120/80 mmHg

-Can accommodate a LARGE BLOOD


VOLUME without much increase in blood
pressure due to
- reduced resistance
- thin walled vessels
-large anastamosis
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Special features of the pulmonary circulation
cont.
3. Low resistance
- 1/6 of systemic vascular resistance
- resistance reduced by,
a) Recruitment of previously closed
vessels
b) Dilatation of open vessels
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Special features of the pulmonary


circulation cont.
4. Large Compliance

Compliance = Increased Volume


Increased Pressure

-Large compliance ( 7mL/mmHg)


compared to the systemic circulation
-Accommodates 2/3 of Right ventricle
stroke volume
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Recruitment and dilatation
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Special features of the pulmonary circulation cont.

5. Hydrostatic pressure in pulmonary


capillary < Colloid osmotic pressure)

Hydrostatic press. = 10 mmHg


Colloid osmotic press = 25 mmHg

( :. Net effect is inward gradient - :. Prevents


Pulmonary Oedema )
25 mm

10 mm
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Special features of the pulmonary circulation cont.

6. Very short pathway :-

Right Ventricle Pulmonary artery

Left atrium Pulmonary veins


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What keeps the alveoli dry ?


Pul Venous end
Pul Arterial end
HP = 8 mm
HP =12 mm
COP = 25
COP = 25
COP =25 mm
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Increased capillary permeability as in O2 toxicity, ARDS , inhaled


/circulating toxins

Increased
Factors Predisposing to Pulmonary
capillary hydrostatic Oedema
pressure - Increased left atrial
pressure due to L V infarction / M Stenosis, Overload of I V fluids
Decreased interstitial hydrostatic pressure - Too rapid evacuation of
pneumothorax or hemothorax

Decreased colloid osmotic pressure protein malnutrition and


protein loss ( proteinuria)
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Communication between the pulmonary
and bronchial vascular systems

1.Uneven alveolar ventilation of different parts


of lungs

Reduced ventilation of alveoli :. Deoxygenated


blood enters into
Normal capillary blood flow pulmon vein
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Communication between the pulmonary and
bronchial vascular systems cont
2. Bronchial veins drains to pulmonary veins
3. Pulmonary artery shunts blood to pulmonary
veins via bronchopulmonary arterial anastomosis
4.
VENOUS ADMIXTURE OF ARTERIAL BLOOD
Physiological shunt
O2 concentration in blood < O2 concentration of
in aorta blood in alveolar
capillaries
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Relationship between bronchial and pulmonary
circulations
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Bronchopulmonary anastomosis
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4) Coronary veins drain direct into left side of heart
5) Bronchial veins (few) enter the pulmonary capillaries direct left
atrium
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Regional distribution of blood flow in lungs

Varies in upright position

Apex Above level of heart -


Base Below level of heart -

Blood flow at apex is lesser


at base is - greater
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Variations of ventilation and perfusion in


upright posture
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Regional distribution of blood flow
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Blood flow with in the lung varies due to:

1.Hydrostatic pressure distance of any


region of lung above the base
2.Difference in pressure between the arterial
end and venous end of pulmonary
capillaries.
3.Alveolar air pressure.
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Due to gravity

For every 10 cm distance above the level of


the heart hydrostatic pressure decreases by
8 mm Hg
For every 10 cm distance below the level of
the heart hydrostatic pressure increases by
8 mm Hg
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How does alveolar pressure and capillary blood


pressure influence blood flow in different areas of the
upright lung:
Zone 1: apical zone
Pulmonary arterial pressure < alveolar pressure
Capillaries collapsed
Zone 2: Mid zone
Pressure at arteriolar & capillary end>alveolar pressure
capillaries open
Alveolar pressure > pressure at venous end of capillary
veins tend to collapse during normal expiration
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Blood flow depends on,


Pulmonary arterial pressure > pulmonary venous pressure forward
flow of blood

Pulmonary arterial pressure > alveolar pressure > pulmonary venous


pressure
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Intermittent flow :
Pulmonary arterial pressure in systole >alveolar pressure :. blood flows
Pulmonary arterial pressure low in diastole
<alveolar pressure no flow
water fall effect
As veins are compliant and takes the blood without causing an increase in
pressure ..
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Zone 3 :
Pressure at arteriolar end > alveolar pressure
Pressure at venous end > alveolar pressure
:. Capillaries open continuously continuous flow

Blood flow determined by arterial-venous pressure difference


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Factors increaseing / decreasing pulmonary


vasc resistence
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Control of Pulmonary Vascular Resistance


Active Influences on PVR:
Increase Decrease
Sympathetic Innervation Parasympathetic Innervation

-Adrenergic agonists Acetylcholine

Thromboxane/PGE2 -Adrenergic Agents

Endothelin PGE1

Angiotensin Prostacycline

Histamine Nitric oxide

Alveolar Hypoxemia Bradykinin


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Pulmonary Embolisation:
Normal lung filters small emboli :
: .No symptoms
Emboli obstruct Larger Pulmonary
Arteries

Rapid increase of
Pulmonary Art. Pressure
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=sustained elevation of pulmonary arterial pressure
- Def of endothelial NOS.
Occurs in : infants
Adults-mostly cause unknown
cocaine inhalers
Dexfenfluramine & other appetite suppressants
alter intracellular [serotonin]
leads to Rt Ht failure Death

Rx vasodilator Prostacyclin
vascular remodelling
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Other Functions Of The Respiratory System:

1. Humidify & cool / warm the inspired air

1. Prevents foreign matter reaching the alveoli


Hair in Nostrils
Cilia in Resp. Passages
Genetic defect-Kartageners Syndrome
Mucous in Respiratory passages.

3. Defense Mechanism:
IgA- Bronchial Secretions
Pulmonary Alveolar Macrophage-PAM-Phagocytic
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Functions of the pulmonary circulation

Gas exchange
Removal of emboli
Immunological function
Synthesis of converting enzyme which converts angiotensin 1
angiotensin II
Acts as a blood reservoir
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Regulation of pulmonary circulation

Sympathetic vasoconstrictor nerves vasoconstriction


Local reduction in PO2 vasoconstriction
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Regulation of pulmonary blood flow


1.
2.
3.
4.
Constriction of pulmonary vessels:
Autonomic a1 adrenergic
purinergic P2X
tachykinin NK2
534.of 55Synthesisof:
surfactant Lungs
Prostaglandins
Histamine Stored or released Blood
Kallikrein
5. Partially removes from blood:
Prostaglandins
Bradykinin
Serotonin
Norepinephrine
Acetylcholine
Adenine nucleotides
6. Activated in lungs
Angiotensin I Angiotensin II
6. Breakdown of Emboli:
Fibrinolytic system
54 of 55 Effect Of
Cardiac Output On Pulmonary Blood
Flow In Exercise
During heavy exercise:
Blood flow through Lungs- 4-7times
The circulation copes by:
Recruitment. No of open capillaries 3
Dilatation . Rate of flow 2
vascular Resistance

:Pul. Art. Pressure rise minimal


-converts the entire lung to Zone 3 pattern of flow
-effective wall surface area 90m2
transit time 0.3s
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Pulmonary Edema
Figure 20-11 shows a schematic diagram depicting the circulatory factors governing
the movement of edema ( E) between the pulmonary vessels and the lung
interstitial tissues; the Starling equation describing lung liquid flux is written
beneath the figure. The hydrostatic pressure in the microvessels of the lung (Pmv =
12 mm Hg) lies about halfway between Ppa (normally about 15 mm Hg) and LVEDP
(normally about 10 mm Hg). Hydrostatic pressure in the septal interstitial space (Pis
= 4 mm Hg) is subatmospheric, in part because it drains into the
peribronchovascular interstitium, which has a more negative pressure, and in part
because lymph vessels, valved like veins for unidirectional flow, actively remove
liquid from the interstitial spaces that have intrinsic structural stability to resist
collapse. 58 Accordingly, there is a positive hydrostatic pressure (Pmv Pis = 16 mm
Hg) driving edema across the microvascular endothelium to the lung septal
interstitium. The vascular wall presents a barrier to this bulk flow of liquid
characterized by its permeability to water (Kf; mL edema/min per mm Hg); Kf
includes surface area (S) and thus is heavily weighted by the characteristics of the
alveolar vessels, where so much S resides. 58 The microvascular membrane is also
characterized by its permeability to circulating proteins, dominated by albumin and
globulin. If these plasma proteins were completely reflected ( = 1), no protein
would pass from lung blood to the interstitium; in contrast, if the microvascular
membrane were freely permeable ( = 0), interstitial protein concentration (CL), as
measured in lung lymph, would equal that of plasma proteins (Cp). CL /Cp is about
0.6 in the normal steady-state edema flow in most mammals; when E, as
estimated from lung lymph flow ( L), is progressively increased by elevating Pmv,
CL /Cp decreases to a plateau value of about 0.3. This plateau value indicates the
microvascular protein reflection coefficient ( = 1 2 CL Cp = 0.7) measured in
conditions of high edema flow; at lower E levels, water diffuses from the
interstitium to the blood along the concentration gradient for water established by
Cp > CL. 58

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