INTRODUCTION

ANATOMY AND PHYSIOLOGY

OF THE AIRWAY

! A person can live for weeks without food and a few days
without water but only a few minutes without oxygen.

! Every cell in the body needs a constant supply of

oxygen to produce energy to grow, repair or replace itself,
and maintain vital functions.

! The oxygen must be provided to the cells in a way that

they can use.
CONTINUING PROFESSIONAL DEVELOPMENT
ANESTHESIOLOGY AND REANIMATION

THE BODYS NEED FOR OXYGEN

Living tissue must have oxygen to survive.

Brain death in humans occurs within 6 to 10 minutes of
tissue anoxia.
Rapid and safe airway control is paramount to the
successful management of critically ill and injured
patients.

! It must be brought into the body as air that is cleaned,

cooled or heated, humidified, and delivered in the right
amounts.

AIRWAY ANATOMY
Upper airway structures include the:
! Mouth
! Nose
! Pharynx (throat)
- Oropharynx
- Nasopharynx
- Laryngopharynx
! Larynx (voice box)

Vocal cords
The lower airway structures include the:
! Trachea (windpipe)
! Bronchi (airways)
! Bronchioles
! Terminal bronchioles
! Alveoli

RESPIRATORY TRACTS AND STRUCTURE

The upper airway functions to warm, filter, and humidify the air
before it enters the lower airway
The functions of the lower airway include air conduction, filtration,
warming, humidification, and removal of foreign particles.
Respiration occurs in the respiratory bronchioles of the lower
airway
!
!
!
!

EXTERNAL NASAL
STRUCTURES
BONY FRAMEWORK
frontal bone
nasal bone
maxilla
CARTILAGINEUS
FRAMEWORK
lateral nasal cartilages
septal catrilages
alar cartilages
external nares (nostril)
fibrous connective and
adipose tissue

! Mouth
! Nose
! Pharynx
- Oropharynx
- Nasopharynx
- Laryngopharynx
! Larynx
! Trachea
! Bronchi
! Bronchioles
! Terminal bronchioles
Respiratory bronchioles
Alveolar ducts
Alveolar sacs
Alveoli

NOSE
AND NASAL CAVITIES
! Olfactory epithelium for
sense of smell
! Pseudostratified ciliated
columnar with goblet cells
lines nasal cavity
! Nose hairs at the entrance
to the nose trap large inhaled
particles.

frontal
sinus

conducting zone
- cavities and tubes
- anatomic dead space

respiratory zone

superior
concha

sphenoid
sinus

middle
concha
internal
nares
inferior
concha
external
nares

! Nasal concha provide air turbulence and

promotes filtration and extra time for warming and humidifying air

PARANASAL SINUSES

frontal
sinus

sphenoid
sinus

! to reduce the weight of the

skull,
! to produce mucus
! to influence voice quality by
acting as resonating chambers.

hard palate

PHARYNX (THROAT)
external nares

! connects nasal cavity with

larynx ( 5 inch)
! extends from the base of
the skull to 6th cervical
vertebrae

nasal cavity

internal nares

hard palate

NASO-PHARYNX
nasal cavity

Soft
palate
uvula

pharynx

! from choanae to soft

palate
! openings of auditory
(Eustachian) tubes from
middle ear cavity

epiglottis
glottis

- nasopharynx
- oropharynx
- laryngopharynx
(hypopharynx).

naso
pharynx
uvula

! adenoids or
pharyngeal tonsil in roof

! serves both the respiratory

and digestive systems
! three regions according to
location:

Soft
palate

trachea

epiglottis

! area above where

food enters thus towards
the nasal cavity
! during swallowing, uvula projects upwards
closing off passage to the nasal cavity

glottis

trachea

hard palate

OROPHARYNX

nasal cavity

Soft
palate
uvula

hard palate

LARYNGO-PHARYNX
nasal cavity

! posterior to the epiglottis and

extends to the larynx

Soft
palate
uvula

! the portion of the

pharynx that is posterior
to the oral cavity.

oro
pharynx

! at larynx, food and air take

different passageways
laryngo
pharynx

! extends from soft

palate to the epiglottis
epiglottis

! area where both food

and air passes

epiglottis

glottis

trachea

LARYNX (VOICE BOX)

glottis

Histology of the pharynx changes from

pseudostratified epithelium to stratified squamous
epithelium when going from naso-to oro-to laryngopharynx

trachea

BRONCHIALE TREE

Epiglottis
Hyoid bone
Thyrohyoid membrane
Corniculate cartilage
Thyroid cartilage
(Adams apple)
Arytenoid cartilage
Crycothyroid ligament

The trachea and bronchi have

supporting cartilage to keep
airways open
Bronchiole walls contain
more smooth muscle,
a feature used in airflow
regulation

Cricoid cartilage
Cricotracheal ligament
Thyroid gland
Parathyroid gland
Tracheal cartilage

THE RESPIRATORY ZONE

ALVEOLI AND PULMONARY CAPILLARIES

! The pulmonary artery carry
blood which is low in oxygen
from the heart to the lungs

! contains alveoli,
tiny walled sacs where
gas exchange occurs

! These blood vessel branch

repeatedly, forming dense
network of capillaries that
completely surround each
alveolus

! alveolar ducts end in

cluster of alveoli called
alveolar sacs

! O2 and CO2 are

exchanged between the
aveoli and pulmonary
capillaries.
! Blood leaves the
capillaries via the pulmonary
vein which transport
oxygenated blood back to
the heart

photomicrograph

STRUCTURE OF THE RESPIRATORY

MEMBRANE

O2
CO2
O2
alveolar macrophage
simple squamous epithelium
(type 1 cell)

O2
CO2

surfactan secreting cell

(type 2 cell)
capillary

IMPORTANT DEFINITIONS
Ventilation
the process of moving a volume of
gas in and out of the lungs

VENTILATION AND RESPIRATION

Respiration
! gas exchange (O2/CO2) across the
alveolar - capillary membrane
(external)
! or at the tissue/cellular level
(internal)

INSPIRATION

BOYLES LAW
relationship between pressure and volume

volume

pressure

muscle contraction

volume

pressure
pressure

volume

pressure

volume

EXPIRATION
Muscle relaxation

INTRAPULMONARY (INTRAALVEOLAR) PRESSURE

CHANGES
Intrapulmonary (intraalveolar) pressure is the pressure within the alveoli.
Between breaths, it equals atmospheric pressure (760 mmHg)

INTRAPULMONARY (INTRAALVEOLAR) PRESSURE

CHANGES

INTRAPLEURAL PRESSURE
the pressure within the pleural cavity, always negatiive, and acts like a
suction to keep the lungs inflated

the negative intrapleural

pressure is due to:
Surface tension of alveolar
fluid
Elasticity of lungs
Elasticity of thoracic wall

the negative intrapleural pressure is due to:

the negative intrapleural pressure is due to.

SURFACE TENSION OF ALVEOLAR FLUID

ELASTICITY OF LUNGS

the elastic tissue in the lungs tends

The surface tension of the alveolar
fluid tends to pull each of the alveoli
inward and therefore pulls the entire
lung inward. Surfactan reduce this
force

to recoil and pull the lungs inward.

As the lung moves away from the
thoracic wall, the cavity becomes
slightly larger, decreasing pressure

the negative intrapleural pressure is due to:

ELASTICITY OF THORACIC WALL

INTRAPLEURAL PRESSURE CHANGES

The elastic thoracic wall tends to

pull away from the lung, further
enlarging the pleural cavity and
creating this negative pressure

The surface tension of pleural

fluid resist the actual separation of
the lung and thoracic wall

INTRAPLEURAL PRESSURE CHANGES

FACTORS AFFECTING VENTILATION:

! resistance within the airways

! lung compliance
! thoracic wall compliance

RESISTANCE WITHIN THE AIRWAY

parasympatic neuron
as air flow into the lungs, the gas molecules encounter
resistance when they strike the walls of the airway.
Therefore the diameter of the airway affects resistance

smooth muscle

elastic fibres

LUNG COMPLIANCE

histamin

epinephrine

the stretchability of elastic

fibres within the lungs

The ease with which the lung expand is called lung compliance.
It is primary determined by two factors:
The stretchability of elastic fibres within the lungs
The surface tension within the alveoli
Comp : " V / " P
the surface tension within
the alveoli

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THORACIC WALL COMPLIANCE

! obesity
! intraabdominal distension

..thank you..

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