Professional Documents
Culture Documents
(Generation #1)
Conducting Airways
Generations 1-16 Primary Bronchi
(Generation #2)
2o Bronchi
(Generation #3)
Respiratory Zone
Generations ~17-23
Respiratory
Bronchioles
Alveoli
Zone 1 PB=0
PA
Pa Pv PA>Pa>Pv
Low Flow
Flow=P/R
PA Zone 2
Pa Pv
Pa>PA>Pv
Waterfall
PA<0
PA Zone 3 O2
venous arterial
Pa Pv Pa>Pv>PA
Hi Flow CO2
Atmospheric Air
PB=0 High O2 (150 mmHg) PB=0
CO2 ~ 0
Inspiration Expiration
Alveolar Air
O2 ~100 mmHg
PA<0 PA>0
CO2 ~ 40 mmHg
venous
O2 arterial venous
O2 arterial
CO2 CO2
Chest Wall
Lung Lung
Stuck
Together
Air leak
Pneumothorax
Fick’s law Lung collapses
& Chest expands
J = DA (C/ X)
Hemoglobin-O2 Binding Curve
100 Arterial 20
80 Venous
15
60
CO2 10
40
5
20
0 0
0 20 40 60 80 100
PaO2 (mm Hg)
Inspiratory Inspiratory
Reserve Capacity
Vital
Capacity
VT
Expiratory
Reserve
FRC
Residual
Volume
Inspiratory Inspiratory
Reserve Capacity IR
IC
Vital
Capacity VC
TLC
VT VT
Expiratory
Reserve ER
FRC
FRC
Residual
Volume RV RV
V1 V1 Equilibrate
Concentration
Ppl - Pleural pressure (pressure in space between visceral and parietal plurae)
PTP - Transpulmonary pressure (distending pressure of airway)
PACO2 - Alveolar PCO2 (partial pressure of CO2).
PaCO2 - arterial PCO2.
PvCO2 - venous PCO2
PAO2 - Alveolar PO2
PaO2 - arterial PO2
PvO2 - venous PO2
PECO2 - PCO2 of exhaled air
FECO2 – fraction of exhaled air which is CO2
(i.e. A= Alveolar, a= arterial, v= venous, E = exhaled, I = inspired)
VE – Expired volume (liters)
.
VE – ventilation (liters/min)
.
VA – Alveolar ventilation (liters/min)
Q – Blood Flow (liters/min)
Some Normal Values For Some Key Pulmonary Parameters
FRC 2.5 0.5 L Max. exp flow 6-9 L/sec
RV 1.2 0.3 L Compliance 60-100 mL/cm H20
TLC 6.5 0.5 L
VT 500 100 ml
FVC 4.5 0.5 L PAO2 100 mm Hg
PaO2 (21% O2) 90-95 mm Hg
FEV1.0 / FVC >75% PaO2 (100% O2) >500 mm Hg
Frequency 10-12/min PaCO2 40 3 mm Hg
V A (norm) 5 0.5 L/min Arterial pH 7.37-7.43
V E (norm) 7 0.7 L/min PvO2 40 mm Hg
V E (max) 120-150 L/min PvCO2 46 mm Hg
Max. insp flow 7-10 L/sec [Hb] 14-15 g/dL
Inspiratory Inspiratory
Reserve Capacity
Vital
Capacity
~6.5 L
5L
VT 600 ml
Expiratory
Reserve
FRC 2.5 L
Residual
Volume
1.2 L
Chest Wall
Lung Lung
Stuck
Together
As we remove air
from pleural space
the lung expands
& the chest wall
gets pulled in.
Balance of Forces Determines FRC
Hooke’s Law: F = -kx
Chest
Increasing
Wall
volume
Recoil
Force Intrapleural
space
Ppl = -2
Normal
FRC
Ppl = -5 Ppl= -8
Decreasing
Lung
volume
Wall Ppl = 0
Recoil
Force
P1
P2
Detergent Water
30 60 80
Surface Tension (dynes/cm)
Surface Area Surface Tension
Surface Area (relative)
Lung
Surfactant
1. Reduces Work of Breathing
2. Increases Alveolar Stability
(different sizes coexist)
3. Keeps Alveoli Dry
Detergent Water
30 60 80
Surface Tension (dynes/cm)
Static Compliance Curves
Normal
Lung Volume
Expiration
VT
FRCN
Inspiration
Normal
Lung Volume
VT
FRCE
Fibrosis
VT (low compliance)
FRCN
VT
FRCF
Chest
Wall
Increasing
volume
Recoil
Intrapleural
Force space
Ppl = -2
Normal
FRC
Ppl = -5 Ppl= -8
Decreasing
Lung
volume
Wall Ppl = 0
Recoil
Force
Base Ppl = -2
Regional- Apex to Base Differences
Norm Lung Volume
Inspiration
Apex
Lung Volume
Apex
V
Apex Base
Alveolar Volume ++
Alve Ventilation ++
Base
Normal Lung V
Lung Volume
Apex
V
Low Lung V
Base
0 Inspiration Expiration
Air -8 Inspiration
Flow -
-5 Ppl (cm H2O)
End
PB=0 PA= 0 -8 Inspiration
+ -6 Expiration
-8
+0.5
Air Flow 0 End Expi-
-5
(L/s) ration-FRC
0 The linear Dashed trace is the Ppl
required to overcome recoil forces.
-0.5 More Ppl (solid curve) is required to
overcome airway resistance to flow.
+1
N.B. P = PA-PB Resist•Flow.
PA (cm H2O)
0
-1 1 2 3 4
time (sec)
Static Compliance Curves
Normal
Lung Volume
Expiration
VT
FRCN
Inspiration
0 Inspiration Expiration
Air -8 Inspiration
Flow -
-5 Ppl (cm H2O)
End
PB=0 PA= 0 -8 Inspiration
+ -6 Expiration
-8
+0.5
Air Flow 0 End Expi-
-5
(L/s) ration-FRC
0 Case of ZERO
Resistance
-0.5
+1
PA (cm H2O)
0
-1 1 2 3 4
time (sec)
Respiratory Cycle
Ppl time
VT (L)
0.4
Respiratory Cycle
Single VT Breath
0.2 0 -5 Rest FRC
0 Inspiration Expiration
Air -8 Inspiration
Flow -
-5 Ppl (cm H2O)
End
PB=0 PA= 0 -8 Inspiration
+ -6 Expiration
-8
+0.5
Air Flow 0 End Expi-
-5
(L/s) ration-FRC
0 The linear Dashed trace is the Ppl
required to overcome recoil forces.
-0.5 More Ppl (solid curve) is required to
overcome airway resistance to flow.
+1
N.B. P = PA-PB Resist•Flow.
PA (cm H2O)
0
-1 1 2 3 4
time (sec)
Respiratory Cycle
Ppl time
VT (L)
0.4
Respiratory Cycle
Single VT Breath
0.2 0 -5 Rest FRC
0 Inspiration Expiration
Air -8 Inspiration
Flow -
-5 Ppl (cm H2O)
End
PB=0 PA= 0 -8 Inspiration
+ -6 Expiration
-8
+0.5
Air Flow 0 End Expi-
-5
(L/s) ration-FRC
0 Case of HIGH
Resistance
-0.5
+1
PA (cm H2O)
0
-1 1 2 3 4
time (sec)
Dynamic Compression of Airways
Mild Expiratory Effort (P+13)
-5 Normal at FRC
0 0
PTP=+5
PPl - PA= -5
Dynamic Compression of Airways
Mild Expiratory Effort (P+13) Strong Expiratory Effort (P+30)
+13
0 +13 8 4 0 30 25 20 15 10 5 0
PTP=+5
PPl - PA= -5 EPP EPP
Equal Pressure Point
(in supported airways)
0 13 10 8 6 4 2 0 30 25 20 15 10 5 0
Resistance
8 l
R= ———
r4
Conducting Resp
k•number Zone Zone
R= —————
A2
5 10 15 5 10 15
Recoil
Normal Emphysema
Fibrosis
Lung Volume
Normal
Volume
Inspiration
Recoil
Restrictive
Resistance
Obstructive FRC
time (sec)
Forced Vital Capacity
Obstructive Restrictive
Normal airway resist lung recoil
TLC TLC TLC
FEV1.0
FEV1.0
FEV1.0 FVC FVC
FVC
RV 1 sec RV 1 sec
RV 1 sec
Due to Dynamic
Airway Compression
and airway collapse.
Inverted
Inspiration
Inspiration
9
Normal
Flow Rate (L/sec)
Obstructive
Restrictive
9 8 7 6 5 4 3 2 1
Lung Volume (L)
Critical Closing Volume Test
TLC RV
4.
N2 Concentration (%)
40
1. 2. Dead Space 3. Alveolar
Washout Plateau
20
Closing
Volume
6 5 4 3 2 1
Normal Lung V
Lung Volume
Apex
V
Low Lung V
Base
4.
N2 Concentration (%)
40
1. 2. Dead Space 3. Alveolar
Washout Plateau
Increased
Closing
20 Volume
Closing
Volume
6 5 4 3 2 1
PO2=100 mm Hg PO2=100 mm Hg
O2 0.3 ml O2/dL O2 0.3 ml O /dL dissolved
2
20 ml O2/dL HB-O2
40
Alveolar
Plateau
N2 Concentration (%)
A Inspired O2 diluted
by alveolar N2
20
Vd
Fowler’s Test
Area A = Area B
E.Alveolar Ventilation
. . .
VE = VD + VA = VT frequency
. . .
VA = VE - VD
.
1.For VT = 500 ml, f = 10/min, VD = 150 ml, what is VA?
.
VA = 5000 - 1500
= 3500 ml/min
. .
2.If VE is doubled by increasing VT what is VA?
= 10,000 - 1500
= 8500 ml/min
. .
3.If the same VE is obtained by doubling frequency, what is VA?
= 10,000 - 3000
= 7000 ml/min
.
Thus increasing VT rather than frequency is more effective for VE.
F. Alveolar Ventilation and CO2 production
.
VCO2 = Expired CO2 - Inspired CO2
.
=VA FACO2
.
VA x PACO2
=
PA
.
.VCO2 K
VA =
PACO2
XIII. RESPIRATORY EXCHANGE RATIO
. .
RQ = VCO2/VO2
The relative amounts of O2 consumed and CO2 produced depends upon the fuel.
Carbohydrate RQ = 1
Fat RQ = 0.7
Protein RQ = 0.8
A typical "normal" RQ is 0.8
PACO2 40
RQ = =
PIO2 - PEO2 50
Thickened
80
Alveolar
PO2 mm Hg
Membrane
60
Normal
40
Transit
Exercise Time
20 Shortens
Transit
time
80
Hb-O2 content
75
15
Hemoglobin
60
50 10
40
5
20
26
0 0
0 20 40 60 80 100
PaO2 (mm Hg)
Bohr Shift Hb-02 Curve
100
H+],CO2
% Saturation of
80 Temp
Hemoglobin
Normal Hb
60
40 Bohr Shift
H+], CO2, Temp or DPG
20
0
0 20 40 60 80 100
PaO2 (mm Hg)
(ml O2 /100 ml blood) 20 Normal Hb
Myoglobin
Hb-O2 content
15
Carbon Monoxide
10
5
Anemia
0
0 20 40 60 80 100
PaO2 (mm Hg)
CO2 Tissue
O2
CO2 Loading & O2 Unloading
Capillary Wall
CO2 Cl- O2
CO2 + H2Oc.a.
— H2CO3 H+ + HCO3-
H+ + HbO2 HHb + O2
Carbamino
HHb-CO2
CO2 Lungs
O2
CO2 Unloading & O2 Loading
Alveolar Wall
CO2 HCO3- O2
Cl-
c.a.
CO2 + H2O — H2CO3 H+ + HCO3-
H+ + HbO2 HHb + O2
Carbamino
HHb-CO2
HALDANE SHIFT
54 Exercise Venous
(ml CO 2 /100 ml blood)
Rest Venous
CO2 Content
52
50 Arterial (O2)
46
37 40 43 46 49 52
PCO2 (mm Hg)
Ventilation Perfusion Ratios
PO2 = 150
PCO2 = 0
CO2 = 45
. . .
Low VA/Q Normal VA/Q High VA/Q
PO2 = 40
PCO2 = 45
PO2 = 100
50 PCO2 = 40
.
Low VA/Q Base
PCO2 (mm Hg)
.
Normal VA/Q
PO2 = 150
PCO2 = 0
Apex
.
High VA/Q
50 100 150
PO2 (mm Hg)
3
Ratio
VA/Q
Ventilation
1
Local Control
a. Low PAO2 vasoconstriction
b. Low PVCO2 bronchoconstriction
Medulla Pneumotaxic
Oblongata Center
Apneustic Center
Fourth
Ventricle +
Cut-off
C signal
Nucleus
Cut-off
– thresh
tractus
Solitarius A +
(dorsal) Insp
+ Dors ts
Nucleus
retroambiguous
(ventral) +
B
vent
C1 +
Periph &
Central
Vagus Chemo-
Stretch receptors
Respiratory
Muscles
Peripheral Chemoreceptor Responsiveness
75
% maximal firing rate
50
25
50 100 500
Arterial PO2 (mm Hg)
Plasma BBB CSF
Pumped
HCO3
CNS Acidosis
+ then HCO3 is pumped in
(& restores pHCNS faster than
H+ kidneys can restore pHsystemic)
Respiratory
Acidosis (PaCO2)
Plasma BBB CSF
HCO3
H+
50
40
PCO2 = 45 mm Hg
30
20
10 PCO2 = 40 mm Hg
PCO2 = 20 mm Hg
0
30 60 90
PaO2 (mm Hg)
Ventilatory Response to CO2
60 PaO2 ~ 60 mm Hg
Ventilation (L/min)
40 PaO2 ~100 mm Hg
PaO2 200 mm Hg
20
0
35 40 45 50 55
PaCO2 (mm Hg)
Ventilatory Response to CO2
50
Metabolic Acidosis
Normal
40
Ventilation (L/min)
Metabolic Alkalosis
30
20
10
0
35 40 45 50 55
PaCO2 (mm Hg)
EFFECTS OF HIGH ALTITUDE
A. At 10,000 ft PB=525 mmHg inspired PO2 is ~100 mmHg PAO2 is ~50 mmHg.
At 15,000 ft PB=380 mmHg inspired PO2 is ~70 mmHg PAO2 is ~20 mmHg.
At Mt Everest PB=250 mmHg, inspired PO2 is ~42 mmHg PAO2 is ~0 mmHg.
At 63,000 ft PB=47 mmHg, inspired PO2 is ~0 mmHg tissues boils, H2O vapor.
1 Hr low low high high -
HCO3
H+
When pHCNS
Respiratory high pHCSF limits returns to norm
Alkalosis Hyperventilation (HCO3 pumped out)
VE is less restrained