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Ventilation:
The moving of Oxygen and Carbon Dioxide in and out of our body. Commonly termed breathing
Respiration:
Metabolic process that occurs in the lungs and cells of the body breaking down organic substances to simpler products to release energy
VENTILATION
3.The largest airway is the windpipe (trachea), which branches into 4. Two smaller airways (bronchi) to supply the two lungs. 6. At the end of each bronchiole are dozens of bubble-shaped, air-filled cavities (alveoli) that is surrounded by a dense network of capillaries. The extremely thin walls of the alveoli allow oxygen to move from the alveoli to the capillaries and carbon dioxide to move from the capillaries into the alveoli.
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5. The bronchi themselves divide many times before evolving into smaller airways (bronchioles).
These are the narrowest airways--one fiftieth of an inch across.
Breathing in and out is known as inhalation and exhalation (inspiration and expiration) Due to changes in the volume of the thoracic cavity. Leads to pressure changes which cause air to enter or leave the lungs.
The diaphragm which is a sheet of muscle under the lungs The intercostal muscles which connect the ribs. There are two sets. The internal intercostal muscles and the external intercostal muscles.
Air will flow from an area of higher pressure to one of lower pressure ( pressure gradient )
Inspiration Diaphragm contracts The external intercostal muscles contract moving the ribs upwards and outwards. Chest expands Lungs are pulled outwards Alveolar pressure decreases Expiration Diaphragm relaxes The external intercostal muscles relax allowing the ribs to drop back down Lungs recoil inwards Air is forced out Alveolar pressure equals atmospheric pressure
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PLEURAL PRESSURE (PPLU) The pressure in the pleura, between the lung and thoracic wall.
(PALV - PPLU) = TRANSPULMONARY PRESSURE Transpulmonary pressure determines the volume of the lung and is therefore dependent on the compliance of the lung.
The lower the compliance of the lung, the higher the transpulmonary pressure necessary to achieve an equivalent tidal volume.
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Compliance
This relationship between lung volume and pressure determine
High compliance thoracic wall and lungs expand easily Low compliance thoracic wall and lungs resist expansion
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Compliance
La PLACE relationship PRESSURE required to keep alveoli inflated = (2 Surface Tension) / r The higher the surface tension, the more pressure required to inflate alveolus. The lower the radius (size) of the alveolus, the more pressure required to inflate alveolus.
the
bigger (r), the less pressure is needed to hold them open the smaller (r) , the more pressure will be needed
Compliance decreases with lung volume. an empty lung has a higher compliance than a filled lung. This is consistent with the P/V curve leveling off as it approaches Total Lung Capacity.
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ELASTANCE
Refers to the tendency of an object to resist deformation and the ability to return to its original shape after deformation
( elastic recoil. )
Two factors explain the lung's desire to return to end expiration volume. 1. elastic fibres located throughout lung parenchyma which, when stretched by lung inflation, attempts to recoil. 2. A very thin coating of fluid lines the inner surface of alveoli which serves to enhance recoil properties of the lung. 3. This fluid, called surfactant encourages lung recoil when fully inflated yet serves to prevent collapse of alveoli when the lungs are near end expiration.
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As Compliance
: Elastance
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Compliance
Lung volume measurements reflect the stiffness or elasticity of the lungs and the rib cage.
Disorders that cause stiff lungs or that reduce the movement of the rib cage are called restrictive disorders.
Compliance decreases with conditions that Destroys lung tissues Causes it to become fluid filled Produces a deficiency in surfactant In any way impedes lung expansion or contraction
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Compliance
HIGH COMPLIANCE as in Obstructive Lung Disease
The lungs have trouble deflating because they have lost their elasticity
destruction of elastic fibers in lung great difficulty in exhaling but not inhaling.
LOW COMPLIANCE As in Restrictive Lung Disease. great difficulty in inhaling, expanding the lung. lack of surfactant as in Infant Respiratory Distress Syndrome ( IRDS )
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Compliance
"Static" Compliance is a measure of the "stiffness" or elasticity of lung and chest wall "Dynamic" compliance includes the extra pressure needed to overcome resistance to airflow, inertia of chest wall, and viscoelasticity of tissues. Total compliance varies from person to person and from time to time.
Lung compliance is an important consideration for many therapeutics routinely carried out in the critical care setting.
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RESISTANCE
Defined as the Force ( Pressure ) necessary to maintain a specific flow in a particular system It is a measure of the change in pressure per unit change in flow
R=
PA-PB V
mbar L/s
Resistance in a system is affected by Lumen of system Length of system Type of flow in system Branching of system
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The most important determinant of airway resistance in a single tube system is the radius of the tube Under laminar conditions, resistance is a function of length divided by radius to the fourth power Reduction in radius by one half would require a sixteenfold driving pressure to maintain the same flowrate of gas per unit time
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RESISTANCE
Resistance to gas flow arises because of: airway resistance friction between gas molecules and the walls of airway viscous tissue resistance friction between the tissues of the lung and the chest wall Resistance is inversely proportional to lung volume. airway resistance is lower during inspiration due to effects of changes in intrapleural pressure on airway diameter. During inspiration, pleural pressure becomes negative, a distending pressure is applied across the lung. which increases airway diameter as well as alveolar diameter decreases the resistance to gas flow. During expiration, pleural pressure increases and airways are compressed. When intrapleural pressure is high during active expiration, airways may collapse and gas may be trapped in the lung.
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AIRWAY RESISTANCE
the region of greatest resistance Highest resistance always occurs in the nose and nasopharynx..
Rtotal can be partitioned into two components Rperipheral (gen. 7 - gen. 23): low resistance (laminar & diffusive zones) Rcentral (nose - gen. 6): high resistance (turbulent flow zone) Rcentral >>> Rperipheral (50% of resistance in nasal passages alone)
Airway resistance represents approximately 80% of the total resistance of the respiratory system.
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AIRWAY RESISTANCE
The higher the pressure difference required to maintain flow, the higher the airway resistance.
Flow rate measurements reflect the degree of narrowing or obstruction of the airways. This type of disorder is called an
obstructive disorder.
Chronic obstructive pulmonary disease such as bronchitis, asthma and emphysema have some degree of obstruction of the airway which increases airway resistance
Work of Breathing
Components of Work elastic work - work to overcome: lung elastic recoil thoracic cage displacement abdominal organ displacement frictional work - work to overcome: air-flow resistance (major) viscous resistance (lobe friction, minor ) inertial work - work to overcome: acceleration and deceleration of air (negligible due to low mass of air) acceleration and deceleration of chest wall and lungs (negligible due to overdamping)
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elastic work - area a-b-c-a inspiratory flow-resistive work - area a-i-b-a expiratory flow-resistive work - area a-b-e-a
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RESPIRATION
External Respiration
Exchange of oxygen and carbon dioxide between the alveoli of the lung and pulmonary blood capillaries
Internal Respiration
Exchange of oxygen and carbon dioxide between tissue blood capillaries and tissue cells
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External Respiration
Gas exchange by "diffusion due to partial pressure gradient 1. to supply oxygen to the blood for distribution to the cells of the body,
2.
to remove carbon dioxide from the blood that has been collected from the cells of the body.
Gas exchange in the lungs occurs only in the smallest airways and the alveoli.
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Diffusion Distance
Total thickness of the alveolar-capillary membranes is only 0.5
micrometer. Thicker membranes will slow the rate of diffusion The narrow internal diameter of the capillaries also minimizes the difusion distance from alveolar airspace to the haemoglobin in the red blood cells In the presence of pulmonary oedema the build up of fluid increases diffusion distance slowing the rate of gas exchange
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Physiologic Region inspired air trachea alveolus pulmonary vein pulmonary artery
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DEAD SPACE
inspired air that is not perfused by blood thus "wasted" as it does not contribute to gas exchange. ANATOMICAL DEAD SPACE The volume of air occupying the upper airways where there are no alveoli. ALVEOLAR DEAD SPACE The volume of air that reaches the alveoli but doesn't get perfused by blood.
DEAD SPACE: VA/Q TOO HIGH. Normally dead space should only be anatomical dead space (20- 30% of tidal volume). Any dead space in excess is physiological. Alveolar air that is not perfused has the same O2 concentration as atmospheric air, 147 mm Hg So, an alveolar PAO2 of close to 147 is indicative of too much dead space.
. .
SHUNTED BLOOD: VA/Q TOO LOW. Shunted blood is defined as blood that goes through pulmonary circulation without getting ventilated (i.e. without taking up O2). This occurs when there is too little ventilation (hypoventilation) relative to perfusion. More shunted blood ------> lower PCapO2 ------> arterial gas composition (both CO2 and O2) approaches the levels of venous blood.
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MIDDLE . . OF LUNG: the VA/Q ratio most closely approximates 1. . . moderate V A, moderate Q , . . ideal V A/Q = 1 average PAO2 . &. average PACO2 due to ideal V A/Q = 1 Wests Lung Zones
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shunt unit: :VA/Q = 0, PAO2 = 40 mm Hg, PACO2 = 46 mm Hg . . alveolar Q >> V A (wasted perfusion) . . dead . space . alveolar unit: V A/Q = infinity, PAO2 = 150 mm Hg, PACO2 = 0 mm Hg Q << V A (wasted ventilation) . . ideal alveolar unit: V A/Q . = 1, . PAO2 = 100 mm Hg, PACO2 = 40 mm Hg . . . Q = V A (idealized matching) . . . . ventilation/perfusion inequality is the most common
. .
If there is low blood flow to a region of lung, the corresponding bronchioles will bronchoconstrict. Local low blood flow ------> local low PCO2 ------> Regional bronchoconstriction ------> decreased ventilation to region
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Supine
Mee Wah Ng RSO Dubai 2002
Prone
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Raised Position
90 Healthy subject FRC reduction of approx. 1 Ltr.
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Internal Respiration
Transport of gases between the lungs and body tissues
is a function of blood and cardiac output
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HYPOXIA Differential causes of hypoxia Hypoxic hypoxia - low pO2 in arterial blood due to:
Intrinsic lung problems Fluid in the lungs High altitude
Histotoxic hypoxia
Although there is adequate delivery of oxygen to tissues, the tissues are unable to utilise it properly eg as in cyanide poisoning
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Control of Breathing
Breathing is usually automatic, controlled subconsciously by the respiratory center at the base of the brain known as the respiratory centre. The respiratory centre is functionally divided into three areas: Medullary rythmicity area
controls the basic rhythm of breathing Normal inspiration time 2 secs Expiration 3 seconds
Pnuemotaxic area co-ordinate transition between inspiration and expiration Inhibits inspiratory phase ( as to prevent overinflation )
Apneustic Area
Another part that co-ordinates transition between inspiration and expiration Prolongs inspiration when pneumotaxic area is inactive
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Inflation reflex: Stretch receptors send messages along the vagus nerves to inspiratory
area
Located in walls of bronchi and bronchioles Stimulates the start of expiration Known as the inflation ( Hering - Breur ) reflex Evidence that this reflex is mainly a protective mechanism for preventing overinflation of the lungs
Chemical Regulation:
The brain and small sensory organs in the aorta and carotid arteries sense when oxygen levels are too low or carbon dioxide levels are too high, and the brain increases the speed and depth of breathing. Hypercapnia ( High pCO2 ) results in increased respiratory rate Hypocapnia ( Low pCO2 ) results in decreased respiratory rate
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Parameter
Respiratory Rate Tidal Volume Minute Ventilation Dynamic Compliance
Adult Range
10-15 breaths/minute 7-10 ml/kg 5-10 liters/minute 25-50 ml/cmH2O
Neonatal Range
30-40 breaths/minute 5-7 ml/kg
200-300 ml/kg/min
1-2 ml/cmH2O/kg
2-5 cmH2O/L/S
0.3-0.6 joules/liter 0 cmH2O 2-4 cmH2O
25-50 cmH2O/L/S
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