Mechanics of Breathing Alveolar Ventilation

SSN Block 4 Shadi (csc43)

OBJE !"VES

#no$ the definitions of all the listed l%ng vol%&es and ca'acities (nderstand ho$ l%ng vol%&es and ca'acities are &eas%red (nderstand the conce'ts of trans&%ral 'ress%re and co&'liance Be a)le to 'redict the i&'act of changes in l%ng and chest $all co&'liances on *+ (nderstand ho$ s%rface tension i&'acts on l%ng co&'liance and leads to h,steresis in the l%ng -. V relationshi' Be a)le to e/'lain ho$ s%rfactant red%ces s%rface tension and red%ces the tendenc, for alveoli to colla'se

(nderstand and )e a)le to a''l,0 1enr,2s3 *ick2s and 4alton2s 5a$s (nderstand the relationshi' )et$een alveolar ventilation3 &eta)olic rate3 and ' O2 #no$ the )asis for the res'irator, 6%otient #no$ the definition of alveolar3 anato&ic and 'h,siologic dead s'ace and %nderstand the differences )et$een the three Be fa&iliar $ith the 'rinci'les and techni6%es of &eas%ring dead s'ace ventilation Be a)le to calc%late A.a gradient %sing the alveolar gas e6%ation

!O-" S
5%ng

Vol%&es and a'acities Alveolar Ventilation

4ead S'ace Min%te and Alveolar Ventilation Alveolar Ventilation E6%ation Alveolar 7as E6%ation

o&'liance (5%ng3 hest 8all3 S,ste&) S%rface !ension and S%rfactant 7as 5a$s

 Slides
(se

$ill )e 'osted on SSN $e) site

slide n%&)ers if ,o% like

5%ng Vol%&es and a'acities

a'acit, : 2 or &ore vol%&es

"f "2& )reathing nor&all,3 then "2& )reathing at< < <
!idal
=

vol%&e

9>> &5

8hich

one is it?

!idal vol%&e

!r%e or *alse?

"ns'irator, reserve vol%&e : the "+V &a/i&%& vol%&e of air " can )reathe in< *A5SEA

A44"!"ONA5 vol%&e ins'ired a)ove tidal vol%&e

8hich one is it?

@

8hich one is E/'irator, +eserve Vol%&e?

A44"!"ONA5

vol%&e of air e/'ired BE5O8 tidal vol%&e

E+V

+esid%al Vol%&e
1o$

&%ch air is left in the l%ngs after the s%)Dect has forcef%ll, and &a/i&all, e/'ired ANNO! BE MEAS(+E4 BE S-"+OME!+E
+V

5%ng a'acities
"ns'irator, a'acit, " : !V G "+V Vital a'acit, V : "+V G !V G E+V Ma/i&%& tidal vol%&e *%nctional +esid%al a'acit,H *+ : E+V G +VH Vol%&e re&aining in l%ngs after nor&al tidal vol%&e e/'ired EI("5"B+"(M !otal 5%ng a'acit,H !5 : V G +VH

F> Hcannot )e &eas%red ), s'iro&etr,

 So

$e take a )reath in < < < Air goes into the air$a,s

FF

4ead S'ace
Vol%&e

of air$a,s and l%ngs that does NO! 'artici'ate in gas e/change Anato&ic dead s'ace (*"JE4)

Vol%&e of cond%cting air$a,s (= F &5Kl))

Alveolar

dead s'ace dead s'ace

Alveol%s not 'erf%sed3 so no gas e/change

-h,siologic

Anato&ic G alveolar Meas%red ), O Ldil%tionM 2

V4 : V! N O(-a O2 P -e O2)K-a O2Q $here V4 is 'h,siologic dead s'aceR V! is tidal vol%&eR -a O2 is arterial - O2R and -e O2 is - O2 of e/'ired air
F2

Ventilation +ate
Vol%&e

of air &oved into and o%t of l%ngs 'er %nit ti&e Min%te ventilation (&5K&in)
!idal

vol%&e N Breathing fre6%enc,

Alveolar
(!idal

ventilation (&5K&in)

vol%&e P 'h,siologic dead s'ace) N Breathing fre6%enc,

F3

Alveolar Ventilation E6%ation

PA CO2

CO 2 production alveolar ventilation

"f O2 'rod%ction is constant3 then - O2 "S 4E!E+M"NE4 BE A5VEO5A+ VEN!"5A!"ON "f ventilate &ore get rid of &ore O2 - O2 decreases

1alve ventilation - O2 do%)les (takes a fe$ &ins)

F4

 Nor&all,3

e6%ili)ration is achieved )et$een alveol%s and ca'illar,

-A
O2

: -c O2

*ick2s

D A P la$0 Move&ent of = V thickness gas is driven ), 'artial V : fl%/ 'ress%re gradient 4 : diff%sion coefficient of the gas
S sol%)ilit,KTM8 A : s%rface area F9 U- : 'artial 'ress difference of gas

 +eg%lation

of - O2 is &ain &echanis& of ac%te reg%lation of '1 O G 1 O 1 O 1G G 1 O . 2 2 2 3 3

#idne,s

for long ter& reg%lation

F;

8hat a)o%t o/,gen?

Alveolar 7as E6%ation

PA O2 = P O2
2

PA CO R

-AO2 : alveolar O2 -"O2 : ins'ired O2

= F O (Patm PH 2O )

PA CO R

+es'irator, 6%otient (+)0 ratio of O2 'rod%ction to O2 cons%&'tion + = ><B -12O0 )eca%se air is h%&idified in trachea - : 4@ && 1g 12O F@ *" : 2FVR changes if on ventilator

 E6%ili)ration
-A
O2

is achieved

: -cO2

-cO2

is NO! O2 content

4issolved3

not )o%nd3 O2 is $hat drives &ove&ent

4issolved

O2 : -cO2 N ><>>3 &l O2 K d5

A.a

gradient

FB

o&'liance
1o$

vol%&e changes as a res%lt of 'ress%re change ( : VK-) 4escri)es distensi)ilit, of the s,ste& o&'liance of l%ngs and chest $all inversel, correlated $ith their elastic 'ro'erties
!he

greater the a&o%nt of elastic tiss%e3 the greater the tendenc, to Lsna' )ack3M and the lo$er the co&'liance
FC

-ress%re.Vol%&e %rve for 5%ngs3 hest 8all3 and o&)ined 5%ngK hest 8all
Slo'e

: co&'liance

!rans&%ral (in P o%t)

*or l%ng

alveolar P 'le%ral 'le%ral P at& alveolar P at&

*or chest $all

*or %nit

5%ng 'ress%res referred to at& 'ress (Wero) hest $all likes to e/'and 5%ng likes to colla'se 2>

-ress%re.Vol%&e %rve for 5%ngs3 hest 8all3 and o&)ined 5%ngK hest 8all
Vol%&e : *+ E6%ili)ri%& 'osition olla'sing force : e/'anding force Vol%&e X *+ 5ess vol%&e in l%ng colla'sing (elastic) force s&aller E/'anding force on chest $all still greater S,ste& $ants to e/'and Vol%&e Y *+ More vol%&e in l%ng colla'sing force greater E/'anding force on chest $all s&aller S,ste& $ants to colla'se 2F

At *+ (end.e/'iration)

- alveolar : > -'le%ra X >

-ne%&othora/

-'le%ra : >

!ension 'ne%&othora/ (air st%ck in)

-'le%ra rises and kee's rising ( &ediastin%& shifts to contralateral side)

22

 E&'h,se&a
5%ng

is &ore co&'liant chest $all stronger higher *+ is less co&'liant $ill )e stronger lo$er *+
23

*i)rosis
5%ng

S%rface tension and S%rfactant

S%rface

tension )c of attractive forces )t$n li6%id &olec%les lining the alveoli

7enerates 'ress%re given ), la$ of 5a'lace - : 2!Kr
- : colla'sing 'ress%reK'ress%re to kee' alveol%s o'en ! : s%rface tension (constant) r : radi%s of alveol%s

S&aller alveol%s has higher 'ress%re

S%rfactant

forces

&olec%les )reak %' the attractive

red%ces s%rface tension (&ore red%ction at lo$er vol%&es) decreases tendenc, of s&aller alveoli to e&'t, into larger alveoli Z decreases 'ress%re re6%ired to o'en a closed alveol%s increases l%ng co&'liance 24

o&'liance of the 5%ngs

1,steresis

o&'liance different for ins'iration and e/'iration

S%rfactant

h,steresis

red%ces

29

7as la$s
*ick2s

la$ (see a)ove) 4alton2s la$0

-artial

'ress%re of gas in &i/t%re is e6%al to 'ress%re gas $o%ld e/ert if it occ%'ied entire vol%&e

1enr,2s

la$0

oncentration of dissolved gas de'ends on 'artial 'ress%re and sol%)ilit,

2;