Pulmonary Ventilation

FUNDAMENTAL OF BIOMEDICAL SCIENCE VII FRESHMEN YEAR PROGRAM

Meaning of Respiration
There are two quiet different meaning of respiration

1. Utilization of oxygen in the metabolism of organic molecules by cells 2. The exchange of oxygen and carbon dioxide between an organism and the external environment Ventilation

General Function of Respiratory System

1. 2. 3. 4. 5. 6. Provide oxygen Eliminates carbon dioxide Regulates the blood concentration of hydrogen ions (pH) Form speech sounds (phonation) Defends against microbes Influences arterial concentration of chemical messenger by removing some from pulmonary capillary blood and producing and adding others to this blood Traps and dissolves blood clots

7.

Review of the Structure of Respiratory System

Structure of Respiratory System

Upper R.S Nose Pharynx Associated structure Lower R.S

Larynx Trachea Bronchus Lungs

Bronchiole

Artery & Vein

Terminal bronchiole Capillary vessel

Respiratory bronchiole
Alveolar duct

Alveolus

1. 2. 3. 4. 5. 6. 7.

Trachea Primary bronchus Secondary bronchus Tertiary bronchus Bronchiole Terminal bronchiole Respiratory bronchiole 8. Alveolar duct 9. Alveolus

1
4 2

TRANSVERSE SECTION OF AN ALVEOLUS

1. Type II alveolar cell

1 2 6 7 8 9 10 11

2.

Alveolar capillary membrane

3. Type I alveolar cell 4. Alveolar macrophage

3 4 5

5. Red blood cell

TRANSVERSE SECTION OF AN ALVEOLUS

DETAILS OF ALVEOLAR CAPILLARY MEMBRANE

6 7 8 9 10 11

Red blood cell Capillary endothelium Capillary basement membrane Epithelial basement membrane Type I alveolar cell Surfactant layer

Muscular Control of Breathing

Inspiration muscles: Diaphragm External Intercostals

Sternocleidomastodeus
Scalenus

Abdominal muscles

Expiration muscles: Internal Intercostals Abdominal Muscles

Extrinsic elastic recoil Intrinsic elastic recoil

Abdominal muscles

STERNUM AND DIAPHRAGM DURING INSPIRATION AND EXPIRATION

S.E = Sternum during Expiration S.I = Sternum during Inspiration D.E = Diaphragm during Expiration D.I = Diaphragm during Inspiration

Ventilation
Ventilation is defined as the exchange of air between the atmosphere and alveoli Like blood, air moves by bulk flow, from a region of high pressure to one of low pressure by the equation: F = P/R. For air flow into and out the lungs, the relevant pressure are the gas pressure in the alveoli (PALV) and the gas pressure in the atmosphere (PATM). The pressure difference P = |PATM PALV| All pressure in the respiratory system are given relative to atmospheric pressure, which is 760 mmHg at sea level

Ventilation (cont)
During ventilation air moves into and out of the lungs because the alveolar pressure is alternately made less than and greater than atmospheric pressure (remember the Boyles law) During inspiration and expiration the volume of the container the lungs is made to change, and these changes then cause, by Boyles law, the alveolar pressure changes that drive air flow into or out of the lungs There are no muscles attached to the lungs surface to pull the lungs open and push them shut the volume of the lungs depend on the transpulmonary pressure and how stretchable the lung are.

Boyles Law

The movement of air into and out of the lungs depends on pressure change

ALVEOLI

Chest Wall
PALV = 0 mm Hg

Intrapleural fluid
ELASTIC RECOIL PALV PIP = 4 mm Hg

PALV = ALVEOLAR PRESSURE PIP = INTRAPLEURAL PRESSURE

PIP = - 4 mmHg

Transpulmonary pressure: the difference in pressure between the inside and the outside of the lungs (PALV PIP)

THE PRESSURE CHANGES

Inspiration
During inspiration, the contractions of the diaphragm and inspiratory intercostal muscles increase the volume of the thoracic cage
a. This make intrapleural pressure more subatmospheric, increase transpulmonary pressure, and causes the lungs to expand to a greater degree than between breath b. This expansion initially makes alveolar pressure subatmospheric, which create the pressure difference between atmosphere and alveoli to drive air flow into the lungs

SEQUENCE OF EVENTS DURING INSPIRATION

NEURAL IMPULSE DIAPHRAGM AND INSPIRATORY INTERCOSTAL MUSCLE CONTRACT

THORAX EXPANDS

PIP BECOMES MORE SUBATMOSPHERIC

TRANS PULMONARY PRESSURE

LUNGS EXPAND PALV BECOMES SUBATMOSPHERIC

AIR FLOWS INTO ALVEOLI

Expiration
During expiration, the inspiratory muscles ceases contracting, allowing the elastic recoil of the chest wall and lungs to return them to their original between-breath
a. This initially compresses the alveolar air, raising alveolar pressure above atmospheric pressure and driving air out of the lungs b. In forced expiration, the contraction of expiratory intercostal muscles and abdominal muscles actively decreases chest dimensions.

SEQUENCE OF EVENTS DURING EXPIRATION

DIAPHRAGM AND INSPIRATORY INTERCOSTALS STOP CONTRACTING

CHEST WALL MOVES INWARD

PIP BACK TOWARD PREINSPIRATION VALUE

TRANSPULOMONARY PRESSURE BACK TOWARD PREINSPIRATION VALUE

LUNGS RECOIL TOWARD PREINSPIRATION SIZE

AIR IN ALVEOLI BECOMES COMPRESSED

PALV BECOMES GREATER THAN PATM

AIR FLOWS OUT OF LUNGS

Relationship Between Flow and Pressure

P F R
Flow (F) is proportional to the pressure difference (P) between two points and inversely proportional to the resistance (R) determined by their radius

Patm Palv F R

Air moves into and out of the lungs because the alveolar pressure is made alternately less than and greater than atmospheric pressure

Airways Resistance
Patm Palv F R

Factors determine airways resistance:

Directly proportional to the magnitude of the frictional interaction between the flowing gas molecules the viscosity of the air which much less than that of blood Directly proportional to the length of the airways Large diameter airways have decreased resistance Autonomic nerve especially sympathetic decreased resistance

Major Factor Influencing the Airway Resistance

Physical factors
Airways are held open by transpulmonary pressure and by lateral traction open wider during inspiration and may collapse during forced expiration Airways may partially or totally occluded by mucous accumulation

Neuroendocrine agents
Parasympathetic nerves (neurotransmitter = acetylcholine) constrict Circulating epinephrine dilates (action is on beta adrenergic)

Paracrine agents
Histamine constricts Several eicosanoids, notably the leukotrienes, constrict Several eicosanoids dilate

Compliance
The compliance is expressed as the volume increase of the lungs for each unit increase in intra-alveolar pressure (cm3/mm Hg) The greater the increase in volume for a given increase in pressure, the greater the compliance. Lung compliance is determined by the elastic connective tissues of the lungs, the surface tension of the fluid lining the alveoli, and the muscle tones. The surface tension of the fluid is decreased by surfactant that is produced by the type II cells of the alveoli

V L CL ( Palv Patm )
The greater the increase in volume for a given increase in pressure, the greater the compliance.

Alveolar Surface Tension

The alveolar surface tension tends to collapse the alveoli the greater the surface tension the lesser the compliance

Law of La Place
2T r P = inward-directed collapsing pressure T = Surface tension R = Radius of Bubble of Alveolus P=

PULMONARY VENTILATION

BREATHING PATTERNS

Eupnea
Apnea Dyspnea

= Normal quiet breathing

= A temporary cessation of breathing = A painful or labored breathing + tachypnea

Costal breathing = Shallow (chest) breathing Diaphragmatic breathing = Deep (abdominal) breathing

Breathing Pattern
Eupnoea is normal quiet breathing Apnea is a temporary cessation of breathing Dyspnea is a painful or labored breathing + tachypnea Costal breathing is shallow (chest) breathing Diaphragmatic breathing is deep (abdominal) breathing

Modified Respiratory Movement (cont)

Yawning: A deep inspiration through the widely opened mouth producing an exaggerated depression of the mandible. It may be stimulated by drowsiness, fatigue, or someone elses yawning, but precise cause is unknown Sobbing: A series of convulsive inspiration followed by a single prolong expiration. The rima glottidis closes earlier than normal after each inspiration so only a little air enters the lungs with each inspiration Crying: An inspiration followed by many short convulsive expirations, during which the rima glottidis remains open and the vocal folds vibrate; accompanied by characteristic facial expressions and tears

Modified Respiratory Movement

Coughing: along drown and deep inspiration following by a complete closure of the rima glottidis, which results in a strong expiration that suddenly pushes the rima glottidis open and sends a blast of air through the upper respiratory passage. Stimulus for this reflex act may be a foreign body lodged in the larynx, trachea, or epiglottis Sneezing: Spasmodic contraction of muscles of expiration that forcefully expels air through the nose and mouth. Stimulus may be an irritation of the nasal mucosa. Sighing: A long drown and deep inspiration immediately followed by a shorter but forceful expiration