Respiratory Physiology

Ventilation , Gas Exchange and Oxygen Transport

Marc Imhotep Cray, M.D Website: http://www.imhotepvirtualmedsch.com/ E-Mail: drcray@imhotepvirtualmedsch.com

IVMS-Respiratory Anatomy and Physiology Global Overview/Review

Respiratory Physiology
Ventilation , Gas Exchange and Oxygen Transport Respiration Total process where oxygen is supplied to & used by cells, and carbon dioxide is eliminated Ventilation Movement of gases in and out of the alveoli Varies w/ metabolic needs of the body Terms: Apnea Apneustic ventilation Bradypnea Dyspnea Eupnea Hyperpnea Hypopnea Polypnea Tachypnea

Reference Resource: http://update.anaesthesiologists.org/category/all-articles/update-basic-sciences/

Lung Volumes & Capacities

Ventilation & Gas Exchange (1)

Components of the ventilatory system: neural control mechanisms bellows mechanism (chest wall & diaphram) upper airway lung parenchyma

Ventilation & Gas Exchange (2)

Control of respiration is via an integrated feedback control system, and involves central respiratory centers, central & peripheral chemoreceptors, pulmonary reflexes, and nonrespiratory neural input

Ventilation & Gas Exchange (3)

Transfer of gases requires a pressure gradient between the atmosphere & alveoli normal ventilation relies on a slight negative pressure within the alveoli during inspiration to draw air into the lungs, and a slight positive pressure within the alveoli during expiration to move air back out of the lungs
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Ventilation & Gas Exchange (4)

assisted or controlled ventilation provides a positive pressure at the mouth to move air into the lungs - this positive intrapleural pressure has significant cardiovascular effects

Ventilation & Gas Exchange (5)

Matching of alveolar ventilation & capillary blood flow is influenced by gravity, and also that the pulmonary circulation is a low pressure system Anesthesia can cause significant abnormalities in ventilation: perfusion matching (termed V/Q mismatching)
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Relationship between alveolar ventilation, hemoglobin oxygen saturation, oxygen content, and PaCO2

Oxygen transport
At complete saturation, each gram of hemoglobin caries 1.36 ml of oxygen normal blood contains about 15 gm of hemoglobin/dl

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The Oxyhemoglobin Dissociation Curve

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Oxygen transport (1)

Very little change in saturation (& oxygen content) above 70 mm Hg PO2 Marked change in saturation (& oxygen content) between 10 - 40 mm Hg PO2 (which is commonly found in metabolizing tissues)

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Oxygen transport (2)

Plasma oxygen only a small component of the total amount of oxygen carried by blood (0.3 ml/dl at 100 mm Hg PO2) high inspired oxygen contents can increase the amount of plasma oxygen modestly (1.8 ml/dl at 650 mm Hg PO2), which results in about a 10% increase in the total oxygen content of blood at normal hemaglobin levels anemia & reduced blood hemoglobin levels dramatically reduces the oxygen carrying capacity of blood, even with 100% oxygen saturation
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The Oxyhemoglobin Dissociation Curve

Factors that affect the affinity of hemoglobin for oxygen: 2,3-DPG - enhances dissociation of oxygen by competing for oxygen binding sites; decreases 2,3-DPG levels reduce the ability of hemoglobin to deliver oxygen to tissues Carbon dioxide & lactate (metabolic by products) - enhances dissociation of oxygen increased temperature - enhances dissociation of oxygen
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Relationship between oxygen content, hemoglobin levels, and inspired oxygen levels

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Ventilation/Perfusion relationships
Hypoxic pulmonary vasoconstriction limits blood flow to poorly ventilated regions of the lung inhalant anesthetics cause marked reduction in HPV, resulting in continued perfusion of poorly ventilated areas of the lung this results in ventilation: perfusion mismatching, which most greatly affects oxygenation

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Further Study:

update.anaesthesiologists.org/wpcontent/uploads/file/Update%2024,2.pdf
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