APPLICATION OF

ANATOMY PHYSIOLOGY
OF RESPIRATORY SYSTEM
JCCA-Tangerang, November 23th 2016

dr. Hanudjaja Subroto SpAn KIC

 RESPIRATORY SYSTEM
A SYSTEM TO MAINTAIN ADEQUATE CONCENTRATION OF O2, CO2 and
ion Hydrogen
Normal
Regulation of respiration
anatomy /
Pulmonary of ventilation
structure
Diffusion ofOfO2, CO2
Transport
The of O2,CO2
airway
 RESPIRATION

Pulmonary ventilation (breathing):

movement of air into and out of the
lungs Respiratory
External respiration: O2 and CO2 System
exchange between the lungs and the
blood
Transport : O2 and CO2 in the blood
Internal respiration : O2 and CO2 Circulatory
System
exchange between systemic blood
vessels and tissues
 Detect
Aortic
Increase in pCO2
Decrease in pO2
Peripheral
Decrease pH

Carotid
Chemoreceptors
Detect

Decrease pH
Increase pCO2
Central Medullary
Control
Pons
Rate
Pattern
 Nasopharynx Nasal Air Passages
Upper Airway Soft Palate Hard Palate
Pharynx
Uvula Mouth
Oropharynx Tounge Upper Airway
Epiglottis
Larynx Vocal Cords
Esophagus Thyroid Cartilage
Crico-Thyroid Membrane
Cricoide Cartilage
Trachea
Alveoli
Lower Airway Lower Airway
Carina
Bronchi

Lung
Bronchioles
 NASAL CAVITY

BREATHING THROUGH RESISTANCE 1.5 > than

THE NOSE mouth
CLEANING Intubated px need
WARMING THE INHALED correct humidification &
AIR warming of the inspired
gas
HUMIDIFICATION OF
THE INHALED AIR
DRIVING FORCE

AIRFLOW OBSTRUCTION Normal airway

IN THE AIRWAY resistance : 0.5 2.5
cmH20/L/sec
1. Changes inside the
airway Higher in Intubated px
2. Changes in the wall of Ett should be shortened
airway for easy airway mx,
3. Changes outside the reduced deadspace
airway reduction of airway
resistance
 Pressure
or Flow =
Raw

P reflects Work of Breathing If patient unable to overcome

R aw inversely related with Flow ( V ) The airway Resistance by increasing
WOB HYPOVENTILATION

PRESSURE
V, flow =
Raw
 If an abnormal high airway resistance is sustained
over a long time

FATIQUE
VENTILATORY FAILURE OXYGENATION FAILURE
TO MAINTAIN NORMAL CO2 TO PROVIDE ADEQUATE
LEVEL OXYGEN NEEDED TO
METABOLISM
 LARYNX & TRACHEA
Closing Glottis to protects
airway
16-20 Horseshoe
Narrowest at vocal cord
L: 10-12 cm
D: 11-12.5 cm
Extension of Head :
Length of Trachea
accidental extubation
Flexion : L of Trch
endobrochial intubation
 Subdivides into 23rd gen
In the 10th gen the
Bronchioles begin,
diameter < 1mm
Up to 16th gen still no
gas exchange
The 23rd gen begin
Alveoli
LARGER AIRWAY = HIGHER FLOW & VELOCITY
SMALLER AIRWAY = LOWER FLOW & VELOCITY
0.3mm
 Mechanics of Pulmonary ventilation
INSPIRATION PHASE EXPIRATION PHASE
DIAPHRAGM ABDOMINAL M
EXTERNAL INTERCOSTAL M INTERNAL INTERCOSTAL M
STERNOCLEIDOMASTOID M
SCALENI M
ANTERIOR SERRATI M
Internal intercostal
Muscles contract
 illustration

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17/04/2017 15
The normal PLEURAL PRESSURE AT THE BEGINNING OF INSPIRATION : - 5 cm H2O
The GLOTTIS OPEN : NO MOVEMENT OF AIR. PRESSURE ALL PARTS OF REPIRATORY TREE EQUAL TO
ATMOPHERIC PRESSURE
INSPIRATION PHASE : ALVEOLI PRESSURE - 1 CM H2O, AIR MOVE IN 500 CC
IN 2 SECONDS
EXPIRATION PHASE : ALVEOLI PRESSURE + 1 CM H2O, AIR MOVE OUT 500 CC
IN 2-3 SECONDS
SPONTANEUOS BREATHING
OR POSITIVE PRESSURE
NEGATIVE PRESSURE BREATHING VENTILATION
BREATHING INSPIRATION

DECREASED IN ITP INCREASED IN PALV

RELATIVE TO PALV RELATIVE TO ITP

PTA INCREASES PTA INCREASES

LUNG INFLATION LUNG INFLATION

 Pulmonary Ventilation (breathing) :
movement of air into and out of the Lungs

EXTERNAL RESPIRATION: INTERNAL RESPIRATION :

O2 and CO2 exchange between 02 and CO2 exchange between
LUNGS and BLOOD SYSTEMIC BLOOD VESSELS
and TISSUE
 DIFFUSION OF GAS
EXTERNAL RESPIRATION

FICKS LAW
5 m AREA
PRESSURE GRADIENT
THICKNESS
0.6 m

EXTERNAL RESPIRATION
 DEADSPACE VENTILATION

A WASTED VENTILATION OR
A CONDITION IN WHICH VENTILATION IS IN EXCESS OF PERFUSION
ANATOMIC DEADSPACE ALVEOLAR DEADSPACE
PHYSIOLOGIC DEADSPACE

ANATOMIC DS
PLUS
ALVEOLAR DS

Guyton C. Arthur and Hall E. John : Textbook of Medical Physiology, 11 th edition

ANATOMIC DEADSPACE

30 % OF DEADSPACE
VENTILATION IS ON
CONDUCTING AIRWAY
(ANATOMIC DEADSPACE)
150/500 = 0.3 ( 30% )
150/ 300 = 0.5 ( 50% )
 ALVEOLAR DEADSPACE

LOW CARDIAC OUTPUT

BLOOD LOSS
PULMONARY EMBOLISM
OR VASOCONTRICTION
V/Q > 1

WHEN VENTILATED ALVEOLI ARE NOT

ADEQUATELY PERFUSED BY PULMONARY
CIRCULATION
 TOP
V>Q
INFINITY

V=Q

V<Q
ZERO BOTTOM

JOHN B. WEST If ALVEOLI POORLY VENTILATED, PO2 DECREASES, LOCAL VESSEL WILL CONSTRICT.
BLOOD FLOW GOES TO ALVEOLI MORE AERATED

Layon A Joseph, Gabrielli Andrea, Friedmann A William : Textbook of neurointensive care, 2013
TRANSPORT O2 TO TISSUE

19,4ml of O2
P97%

P75% 14,4 ml of O2

P50%

INTERNAL RESPIRATION

PaO2 95mmHg
Guyton C. Arthur and Hall E. John : Textbook of Medical Physiology, 11th edition
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17/04/2017 25
TRANSPORT CO2 TO CIRCULATION

10% dissolved in plasma

20% bound to globin
70% transported as ion
HCO3- in plasma
Under resting condition,
only 4 ml of CO2 are
transported from the
tissues to the Lungs in
each 100 ml of blood
 SUMMARY

Understanding anatomy and physiology of respiratory is a basic

standard to understand pathophysiology of the Lungs
Maintain the normal structure and anatomy is the key point to have
normal physiology
Thank you