Basic Respiratory

Mechanics

Agus Suryanto
Division Pulmonologi
Departement of Internal Medicine
Diponegoro University / Kariadi Hospital
Semarang
 Respiration
Definition;
Respiration refers to the processes
involved in oxygen transport from
the atmosphere to the body tissues
(cells) and the release and
transportation of CO2 produced in
the tissues to the atmosphere
Respiratory tract
Airway Branching
Respiratory unit
Airway wall structure at the three principal levels. The epithelial layer
gradually becomes reduced from pseudostratified to cuboidal and then to
squamous but retains its organization as a mosaic of lining and secretory
cells.The smooth muscle layer disappears in the alveoli. The fibrous layer
contains cartilage only in bronchi and gradually becomes thinner as the
alveolus is approached Fishmans Pulmonary Diseases and Disorde
 Control of Respiration
Control system of respiration is achieved in
the brainstem ( Medulla and Pons) which
receives information from various sources in
the body where sensors monitor:
1.Partial pressures of O2 and CO2 in the blood
2.pH of the extracellular fluid within the brain
3.Mechanical changes in the chest wall
4.Metabolic changes
Respiratory Control System

Fishmans Pulmonary Diseases and Disorde

 Mechanics of breathing
The pressure differences which
generate airflow
Respiratory muscles, including
diaphragma
Elastic recoil of the lung
Lung compliance
Chest wall compliance
Basic concept of breathing (1)
Basic concept of breathing (2)
 Discription of lung volume and capacities
Air in lungs is divided into 4 volumes
Tidal volume (TV) Volume of air breathed in and out in a single
breath: 0.5 L
Inspiratory reserve volume Volume of air breathed in by a maximum
(IRV) inspiration at the end of a normal inspiration
: 3.3 L
Expiratory reserve volume Volume of air that can be axpelled by a
(ERV) maximum effort at the end of a normal
expiration: 1.0L
Residual volume (RV) Volume of remaining in lungs at end of a
maximum expiration: 1.2 L
Pulmonary capacities are combinations of 2 or more volume
Inspiratory capacity (IC)= TV Volume of air breathed in by a maximum
+ IRV inspiration at the end of a normal expiration:
3.8 L
Functional residual capacity Volume of air remaining in lung at the end of
(FRC) = ERV + RV a normal expiration. Acts as buffer against
extreme changes in alveolar gas levels with
each breath: 2.2 L
Vital capacity (VC) = Volume of air that can be breathed in by a
Lung volume

Adam Myers Respiratory System

 Measuring lung volume
Spirometry
Nitrogen washout
Helium dilution
Plethysnography
 Patterns of lung function
disorders
Obstructive disorders
Asthma
COPD
Bronchiectasis
Cystic fibrosis
Tumors
Restrictive disorder
Pulmonary fibrosis
Sarcoidosis
Silicosis
Asbestosis
 Respiratory function
Metabolism
Excrete
Hormonal activity
pH regulator
Body temperature regulator
 Three Steps Involved In
Respiration
1. Ventilation
2. Diffusion
3. Perfusion
Key steps involved in
Respiration

Adam Myers Respiratory System

 Ventilation
Ventilation is the movement of air in
and out of the respiratory system. It
is determined by both;
- The respiratory rate ( number of
breaths per minute )
- The volume of each breath (Tidal
volume)
 Ventilation...
The function of ventilation is to
maintain blood gases at their
optimum level, by delivering air to
the alveoli where gas exchange can
take place.
The movement of air in and out of
the lungs occurs due to pressure
differences brought about by
changes in lung volume
 Diffusion
Diffusion is gas exchange between
alveolar air and blood in the
pulmonary capillaries
- Diffusion occurs from an area of high
concentration to an area of low
concentration.
- Diffusion will occur until the
concentration in the two areas is
equalized
Diffusion and Perfusion

Adam Myers Respiratory System

 Diffusion...
Rate of oxygen diffusion into the blood
increases:
- Increased surface area of the
alveolus
- Decreased thickness of the alveolar
wall
- Increased alveolar partial pressure of
oxygen
 Diffusion...
Factors that decrease the rate of diffusion;
- Thickening of the alveolar capillary
membrane (e.g. Pulmonary fibrosis)
- Edema of the alveolar capillary wall
- Increased lining fluid within the alveoli
- Increased area of alveolar for gaseous
diffusion (eg Emphysema)
- Reduced area of alveolar capillary
membrane (e.g. Emphysema.
- Reduced flow of fresh air to the alveolus
- Hypoventilation
 Perfusion
The walls of the alveoli contain a
dense network of capillaries bringing
mixed venous blood from the right
heart thats separating with the
extremely thin.
Perfusion of blood through these
pulmonary capillaries allows diffusion
and therefore gas exchange, to take
place
Pulmonary and Systemic
Capilary beds

Adam Myers Respiratory System

 Ventilation : Perfusion
inequility
The flow of gas (ventilation:V) and the
flow of blood (perfusion:Q) are closely
matched
The V : Q ratio in normal, healthy lung is
1:1
Ventilation and perfusion mismatching;
Normal alveolar ventilation but no perfusion is
called dead space ventilation
Normal perfusion but no air reaching the lung
unit is called shunt flow
Ventilation & Verfusion Ratio

Adam Myers Respiratory System

 Oxygen transfort in the
blood
Oxygen is carried in the blood in:
Dissolved in plasma
Bound to hemoglobin
PaO2 normal is 100 mmHg, for each ml of
the blood is only 0,003% ml of dissolved O 2
Normal cardiac output is supplying:
5,0L/min x 1000 x 0.003 ml = 15 ml O2 /
min
At rest the body requires approximatelly
250 ml O2 / min
Cardiac output would meet only 6% of the
demand at rest.
 Hemoglobin (Hb)
Hb is found in red blood cell and is a
conjugate protein molecule,
containing iron within its structure.
The molecule consists of four
polypeptide subunits, two alpha and
two beta, associated with each
polypeptide chain is a heme group
that acts as a binding site for O2
 The heme group consists of a porphyrin ring
containing iron and is responsible for
binding of oxygen:
Hemoglobin contains iron in a ferrous (Fe2+)
or ferric (Fe3+) state
Only hemoglobin in the ferrous form can
bind O2
Methemoglobin (containing iron in a ferric
state) cannot bind O2
Hemoglobin is capable of binding up to four
molecule of O2
Hb + 4O2 Hb (O2)4
Hemoglobin

Adam Myers Respiratory System

 Carbon dioxide transport
Dissolved in plasma
As bicarbonate ions
As carbamino compounds
CO2 transport

Adam Myers Respiratory System

 Comparison of hyperventilation and hypoventilation

Hyperventilation Hypoventilation
Causes Causes
Anxiety Obstruction:
Brainstem lesien Asthma
Drugs Chronic obstructive airways
disease
foreingn body
Brainstem lesion
Pneumothorax or lung collape
Trauma (e.g. Fractured rib)
Drug, notably opioids
Consequences Consequencies
Ventilation too great for metabolic Ventilation is too low for
demaand metabolic demand not enough
Too mush CO2 blown oof from the CO2 is blown oof at the lungs
lungs PaCO2 > 40 mmHg respirasi
PaO2 < 40 mmHg respiratory acidosis
alkalosis