BSF.

17,18,19 Mechanics of Ventilation

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19.

1. distensibility 2. stiffness 2 things determining lung compliance 3 common causes of airway resistance 3 factors determining airway resistance 3 forces to overcome for inspiration

1. ease w/ which lungs can be stretched (inflated) 2. resistance to stretch (inflation) - CT of lung (elastin, collagen) - surface tension b/w alveoli (reduced by surfactant) - swelling of bronchial wall (edema) - obstruction (mucus, tumor) - bronchospasm (airway constriction, like w/ asthma) - lung volume - elastic recoil - airway smooth muscle tone - elastic recoil of lung & chest wall (volume dependent) - frictional resistance of airways & tissues (flow dependent) - inertia of gas, opposes acceleration (flow dependent)

36.

4 parts to dynamics of tidal breathing 4 pressures across layers

23.

- lung volume - airflow (w/ pneumotachograph) - esophageal pressure (~pleural pressure) - alveolar pressure - P(L): across lung = P(A) - P(pl) = P(tp): transpleural P - P(w): across chest walls = P(pl) - P(bs) - P(rs): across resp. system = P(A) - P(bs) - P(ta): across airway = P(aw) - P(pl) - P(atm): atmospheric (barometric) - P(pl): intrapleural (pleural) - P(A): alveolar (intrapulmonary) - P(bs): at body surface, us. = P(atm) - P(aw): airway pressure

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16.

51.

5 pressures in respiratory system

40.

49.

Airway generation & zones

8.

4 lung capacities - 23 generations of branching total: - 1-16: conducting zone - 17-19: transitional zone - 20-23: respiratory zone
47.

Airway resistance in lower conducting zone Airway resistance in respiratory zone

- large bronchi is major site of R - most airway R occurs in first 8 airway generations - low total resistance - smallest airways contribute little, b/c large effective cross-sectional area - airways in parallel: 1/R(total) = 1/R + 1/R + ... - nose to glottis, 25-40% total airway R - resistance higher when breathing thru nose - physical interaction of surrounding alveoli opposes tendency for alveolus to collapse / expand (at expense of other alveoli) mechanical tethering stabilizes alveoli PV = PV - basis of respiration: mechanically changing lung volume creates pressure gradients to drive gas flow C V /V = T/T - air expands as it's warmed during inspiration

1. VC: vital cap. 2. TLC: total lung cap. 3. IC: inspiratory cap. 4. FRC: functional residual cap.
9.

48.

4 lung capacities: sums of volumes

- cap's are combos of 2 or more volumes: 1. VC = IRV + V(T) + ERV 2. TLC = IRV + V(T) + ERV + RV 3. IC = IRV + V(T) 4. FRC = V(T) + ERV

46.

Airway resistance in upper resp. tract Alveolar interdependence

30.

7.

4 lung volumes (& normal values)

2.

Boyles law & application

3.

1. IRV: inspiratory reserve volume (3L) 2. *V(T): tidal volume (0.5L) 3. ERV: expiratory reserve volume (1L) 4. RV: residual volume (1.2L)

Charles' law & application

21.

Compliance

- reflects distensibility (elastic properties) = C = V/P = 1/recoil (inverse) - change in lung volume made by a change in pressure across lung compliance, recoil - due to destruction of elastic tissue & alveoli TLC at lower pressure compliance, recoil - stiff lung from CT proliferation TLC at higher pressure

68.

Dynamic flow limitation in lung disease

24.

Compliance in emphysema

- R to airflow and/or recoil premature airway closure occurs in smaller airways w/out cart. equal pressure point moves closer to alveolus - dyn = static at resting state, resp. rate (RR) of 15/min, V(T) of 0.5L - dyn > static: RR & V(T), in exercise - dyn < static: RR & V(T), in resistance - resp. muscles relaxed (no tension) - inward lung recoil forces = outward chest wall forves - lung volume = FRC, no air flow - P(pl) ~ -4mmHg, P(atm) = P(A) - P(atm) = P(A) (alveolar) - no air flow - P(pl) ~ -7mmHg (more neg.) - lung volume = FRC + V(T) - contraction of inspiratory muscles: - lung volume, air flow starts, P(pl) - P(A) < P(atm) - ability of stretched (inflated) lung to return to its resting volume - inverse of compliance ( = 1/C) - tendency of lung to oppose stretch - affects airway width thru direct traction & effects on intrapleural pressure - determines normal breathing: passive process of normal exhalation - to overcome elastic recoil forces of lungs & chest wall - to overcome surface tension of alveoli - 65% of work - surfactant Dyn C(L): deeper & faster breathing induces more secretion - resistance Dyn C(L): lowers filling volume during course of breathing - parasymp. stim'n (ACh) - histamine - serotonin pCO in small airways - symp. stim'n (-AR agonists) - nitric oxide, NO - pCO , pO , in small airways

61.

Dynamic vs. static compliance

25.

Compliance in pulmonary fibrosis Compliance: varies w/ lung volume

22.

39.

Dynamics at end of exhalation

38.

Dynamics at end of inhalation

37.

- varies w/ inhalation / exhalation (hysteresis), due to surfactant - max C (V/P) at FRC (greatest change) - min at TLC & RV: little V w/ high P
4.

Dynamics at start of inhalation

20.

Elastic recoil

Dalton's law & application Driving force of air flow thru tube Dynamic compliance in exercise Dynamic compliance, Dyn C(L)

P(total) = P(gas) + P(gas) + ... - for atm. air, P(B) = P(N) + P(O ) - pressure diff b/w 2 ends of tube: - airflow = Q = P/R - for lungs, P = P(atm) - P(A) - raises Dyn C(L), compared to tidal breath - stim's surfactant exocytosis, w/ mas at 5 min. after signals, until 30min after - change in volume of lung over distending pressure during course of breathing - slope of line b/w end-inspiratory & endexpiratory points - due to airway compression - occurs where airway diameter is narrowed (from neg. transmural pressure) - occurs at end of expiration - dynamic airway compression occurs in forced exhalation, not in tidal breathing - equal pressure point occurs in airways w/ cart. (higher up bronchi)
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41.

Elastic recoil on airway resistance

60.

58.

Elastic work of breathing

63.

Dynamic expiratory flow limitation

59.

Factors affecting dynamic compliance

67.

Dynamic flow limitation in healthy person

55.

Factors that constrict bronchial smooth muscle Factors that dilate bronchial smooth muscle

56.

64.

Flow limitation: end of inspiration

62.

Increased resistance vs. decreased compliance on alveolus

- no airflow, at TLC (completely filled) - P(A) = P(tp) + P(pl) = 30+(-30) = 0 - P(A) = 0 b/c same as P(atm) - P(tp) pos. (inward), P(pl) neg. (outward)
66.

- R: alveolus fills more slowly, ventilation distributes to others b/c there is time to fill - C: less volume fills alveolus in inhalation, won't distribute to others
14.

Flow limitation: later in forced exhalation

Intrapleural pressure, P(pl)

- pressure in intrapleural space - indirectly attaches lungs to thoracic wall (no direct attachment) - always neg., from pulling apart of 2 layers

15.

Intrapleural pressure: effects of gravity

- expiratory airflow is effort independent - as P dissipates, there will be equal pressure point where P(pl) = P(aw) high P(pl) will collapse airway as much as it driving gradient flow
65.

Flow limition: start of forced exhalation

- when upright, P(pl) more neg. at apex than base of lung - b/c lungs push pleural fluid down toward diaphragm, making more pos. pressure
50.

- P(A) = P(tp)+P(pl) = 30+60 = 90 - P dissipates thru exh. due to airway resistance & cross-sectional area ( v distending P)
5.

Inward & outward forces determining airway diameter & their factors Laminar vs. turbulent flow: where, factors, sound LaPlace's law & surface tension

- inward: smooth muscle, elastic forces - outward: pos. transpulmonary pressure P(L), alveolar interdependence

44.

Henry's law & application

C(x) = K P(x) - volume of dissolved gas is proportional to its partial pressure - K = solubility constant - lack of surfactant & lung compliance causes debris to line alveolar sacs - made of damaged cells, necrosis, protein - this lining stains like hyaline cart.
26.

- small airways, alveoli vs. trachea, bronchi - at airflow, radius, vs. airflow, radius - silent vs. detected by stethoscope P = 2T/r (pressure depends on surrounding surface tension & radius) more pressure needed to keep smaller bubble inflated w/ same surface tension - R(aw) w/ lung volumes - reciprocal of conductance: R = 1/C - patients w/ R(aw) have FRC

32.

Hyaline membrane disease (HMD)

52.

Lung volume on airway resistance, R(aw)

6.

Lung volume: role in gas exchange

- determine work of breathing - determined by interaction b/w lung & chest wall -> don't self-inflate, so force supplied by respiratory muscles

31.

Respiratory distress syndrome

- absence of surfactant in premature infants lung compliance, work of breathing atelectasis (progressive lung collapse) hypoxia, acidosis, gas exchange

11.

Lung volumes in pathology

72.

Respiratory rate on work of breathing

1. normal: RV w/ age 2. COPD: chronic obstructive pulmonary disease: RV 3. restrictive disease: TLC, from fibrotic tissue 4. obesity: fat lung vol., abdom. pressure
1.

Movement of gas from atmosphere to tissue Normal (tidal) breathing Pneumothorax & treatment

- atmosphere lungs (bulk flow) blood (diffusion) heart & vasculature (bulk flow) tissues & mitochondria (diffusion) - breath lasts 5 sec, for 12 breaths/min - inhal.:exhal. = 1:2 to 1:3 - lung collapse, from injury to chest wall, pleura, or lung - treat: add pos. pressure to airway, OR remove air from pleural space for neg. P(pl) - surface tension to collapsing pressure around alveoli (P = 2T/r) lung compliance (recoil) work of breathing = surface active agent, from type II pneumocytes lining alveolar walls - DPPC (dipalmitoyl phosphatidylcholine) - hydrophobic part interacts w/ alveolar membrane (lipid bilayer) - hydrophilic part interacts w/ aqueous fluid lining membrane 1. airway R: in tubes of whole airway 2. pulmonary (lung) R: airway + lung parenchyma, combined 3. chest wall R: friction of walls (treat w/ OMT) - depends on radius & length (& viscosity): R = 8 L / ( r) = P / flow - when turbulent (Re = 2rv/ > 2000) - non-elastic, frictional work - to overcome resistance to air flow (28%) - to overcome viscous resistance (lobe friction, 7%)

35.

- people breathe at resp. rate that minimizes total work of breathing (arrow) - work of breathing done mostly by muscles
33.

18.

Respiratory system compliance, C(rs)

29.

Pulmonary surfactant: effects Pulmonary surfactant: origin Pulmonary surfactant: structure & interactions Resistance to airflow in resp. system (3 types)

27.

28.

1/C(rs) = 1/C(l) + 1/C(w), in parallel - combo of individual lung & chest wall C's - greater functional range when the 2 parts work as a unit
54.

Smooth muscle tone on airway resistance

45.

- contraction/ relaxation of submucosal smooth muscle changes diameter of bronchi - independent of lung volume or P(pl) - contraction constriction resistance - old tool, measures lung volumes - can find IRV, V(T), & ERV - can not find residual volume - tendency depends on lung volume: expand from outward elastic recoil, for lung volume from RV to 60% VC collapse, for lung from 60% VC to TLC

10.

Spirometer: uses Static property of chest wall

42.

Resistance to laminar flow

13.

71.

Resistive work of breathing

12.

Static property of lungs Static vs. dynamic properties of resp. system Which will airflow resistance: O , NO:O , or He:O (80:20) ? Work of breathing & 2 components

- tendency to collapse, for any lung volume - due to inward elastic recoil - static: no airflow, involves pressure & volume - dynamic: lungs in motion, airflow in airways, involves airflow & resistance He:O (80:20): / = 0.31 (lowest) - / of O = 1.00; / of NO:O = 1.49 - Reynold's number dependent on /, so / turbulence resistance - W = PV - elastic component - resistive component

34.

43.

69.

73.

Work of breathing in pathology

- A. normal B. w/ elastic work: restictive pulm. disease (pulmonary fibrosis) smaller tidal volume at higher resp. rate C. w/ resistive work: obstructive disease (COPD, asthma, bronchitis) larger volumes w/ lower resp. rate