24/05/55

Lung volume Conditions of measurement Pulmonary ventilation Alveolar ventilation Alveolar ventilation equation Alveolar gas equation Regional difference in ventilation

Lung volumes
1. Static lung volumes

Condition of measurement
1. ATPS (Ambient Temperature, 1 Temperature Pressure, Pressure saturated with water vapor) (VC) (TLC) 2. BTPS (Body Temperature, Pressure, saturated with water vapor) 3. STPD ( (Standard Temperature, p Pressure, and dry)

(IRV)

(IC)

(ERV) (RV)

(FRC)

VC = IC+ERV or TV+IRV+ERV TLC = VC+RV or IC+FRC

24/05/55

Pulmonary ventilation

Anatomical dead space A+B = Physiological p dead space

MV) Minute ventilation (VE, (t t l ventilation, (total til ti minute i t respiratory i t volume, l expired i d total ventilation) MV = VT X RR 500 X 15 7.5 l/min VT = Tidal volume RR = Respiratory rate

Alveolar dead space

alveolar dead space anatomical dead space

-Size of subject: j / = . - Posture: > - Position of neck and jaw : 143 . : 119 . : 73 - Age: elderly > children - Tracheostomy: anatomical dead space - : alveolar dead space blood flow ) - Pulmonary hypotension - (embolism) pulmonary circulation obstruction of pulmonary circulation -

physiological dead space

- : - : / - : - pulmonary circulation physiological dead space

24/05/55

Alveolar ventilation (VA) VD 30% VT VA = ?

VT = 500 ml ( 7 ml/BW 1 kg) RR = 12 breath/min (12 20) (12-20)

Alveolar hypoventilation
VA

PAO2

PaO2 (hypoxaemia)

VD

( 0.2 0 2 0.35) 0 35)

PACO2

PaCO2 (hypercapnia)

pHa (acidosis)

Alveolar hyperventilation
VA = VE VD = (VTxRR) (VDxRR) = (VT-VD) x RR VA

PAO2 (hypocapnia) PaCO2

PaO2 (hyperoxaemia)

= (500 -150) x 12 = 4200 ml/min

PACO2

pHa (alkalosis)

Alveolar ventilation equation

Alveolar gas equation

PAO2 = PIO2 - PACO2 + F R
F = PACO2 x FIO2 x [(1-R)/R] 1-3 mmHg

VA =

VCO 2 x K

PCO2

PCO2 =

VCO 2 (STPD) x 863 VA (BTPS)

PAO2 =

PIO2 - PACO2 R

R (respiratory exchange ratio) = VCO 2/ VO2 R = 0.8 (200/250 ml/min)

Hypercapnia or Hypocapnia
Alveolar-arterial O2 difference [DO2(A-a)]

24/05/55

Regional difference in ventilation

FRC

RV

Normal lung

Compliance

Ventilation

Compliance

no ventilation

Resistance

Ventilatory failure
: a pathological reduction of alveolar ventilation below the level required for maintenance of normal alveolar gas partial pressure
Respiratory centre

Upper airway obstruction Increased resistance of small airways Loss of structural integrity of chest wall and pleural cavity

Upper motor neuron

Altered elasticity of lungs or chest wall NMJ Anterior horn cell Lower motor neuron Respiratory muscles

24/05/55

Respiratory failure
: Respiratory failure is a syndrome in which the respiratory system fails in one or both of its gas exchange functions: oxygenation and carbon dioxide elimination - Type 1 (hypoxic respiratory failure): is characterized by an arterial oxygen tension (PaO2) < 60 mmHg with a normal or low arterial carbon dioxide tension (PaCO2) e.g. pulmonary edema, pneumonia - Type 2 (hypercapnic hypoxic respiratory failure) : hypoxemia (PaO2 < 60 mmHg) and hypercapnia (PaCO2 > 50 mmHg) structure RS

respiratory failure
1. Ventilation-perfusion mismatch e.g. emphysema PaO2 , PaCO2 2. Hypoventilation e.g. res. center depression PaO2 , PaCO2 3. Impairment of diffusion e.g. pulmonary fibrosis PaO2 , PaCO2 4 Shunt 4. Sh e.g. pulmonary l edema d PaO2 , PaCO2