Respiratory Physiology

DR. DEEPAK SOLANKI M.D.ANAESTHESIOLOGY dr.dsolanki@gmail.com

Respiratory System Functions

l Gas

exchange: Oxygen enters blood and carbon dioxide leaves l Regulation of blood pH: Altered by changing blood carbon dioxide levels l Voice production: Movement of air past vocal folds makes sound and speech l Olfaction: Smell occurs when airborne molecules drawn into nasal cavity l Protection: Against microorganisms by preventing entry and removing them

Non-Respiratory Lung Functions

l l l l

l l

Reservoir of blood available for circulatory compensation Filter for circulation: thrombi, microaggregates etc Metabolic activity: activation: l angiotensin III inactivation: l noradrenaline l bradykinin l 5 H-T l some prostaglandins Immunological: IgA secretion into bronchial mucus

The Respiratory Defense System

l Consists

of a series of filtration mechanisms l Removes particles and pathogens l * Components of the Respiratory Defense System l Goblet cells and mucous glands: produce mucus that bathes exposed surfaces l Cilia: sweep debris trapped in mucus toward the pharynx (mucus escalator) l Filtration in nasal cavity removes large particles l Alveolar macrophages engulf small particles that reach lungs

The Airways
lConducting

zone: no gas exchange occurs Anatomic dead space lTransitional zone: alveoli appear, but are not great in number lRespiratory zone: contain the alveolar sacs

Respiration
l Ventilation:

Movement of air into and out

of lungs l External respiration: Gas exchange between air in lungs and blood l Transport of oxygen and carbon dioxide in the blood l Internal respiration: Gas exchange between the blood and tissues

Intrapulmonary Pressure
l Also l In

called intra-alveolar pressure l Is relative to Patm relaxed breathing, the difference between Patm and intrapulmonary pressure is small:
about 1 mm Hg on inhalation or +1 mm Hg

on expiration

Intrapleural Pressure
l Pressure

in space between parietal and visceral

pleura l Averages 4 mm Hg l Maximum of 18 mm Hg l Remains below Patm throughout respiratory cycle

Transpulmonary Pressure
l Transpulmonary l l *With

pressure = Alveolar pressure* Pleural pressure no air movement and an open upper airway, mouth pressure equals alveolar pressure

Pulmonary Pressures

The Mechanics of Breathing

lInhalation:

always active
lExhalation:

active or passive

3 Muscle Groups of Inhalation

l Diaphragm: contraction draws air into lungs 75% of normal air movement l External intracostal muscles: assist inhalation 25% of normal air movement l Accessory muscles assist in elevating sternocleidomastoid serratus anterior pectoralis minor scalene muscles

ribs:

Muscles of Active Exhalation

l Internal

intercostal and transversus thoracis muscles: muscles:

depress the ribs

l Abdominal

compress the abdomen force diaphragm upward

Alveolar Pressure Changes

Inspiration

Expiration

Passive process muscles relax

Airway resistance
l Caused

by:

Elastic recoil of lung and chest wall Inertia of the respiratory system Frictional resistance of the lung and chest wall Frictional resistance of the airways to airflow Pulmonary tissue resistance

l Airway

resistance (80%)+ pulmonary tissue resistance (20%) = Pulmonary resistance

Airway Resistance
l Friction

(F), pressure (P), and resistance (R) is: F= P R lP

Pressure gradient
lGas

l Flow

flow is inversely proportional to resistance with the greatest resistance being in the medium-sized bronchi

Resistance
l Length l Viscosity l Radius l
R L /r4

of substance

Surface Tension
l Lung

collapse l Surface tension tends to oppose alveoli expansion l Pulmonary surfactant reduces surface tension

Surfactant
l Produced

and secreted into the alveolar airspace by alveolar Type II cells l Begins week 25 of fetal development in humans reaching functional levels at 32 weeks, eight weeks before normal delivery l Respiratory distress syndrome: Premature infants born before 32 weeks

Surfactant
l Increases

compliance l Decreases surface tension in alveoli and prevents small alveoli from collapsing, equalizing pressure between large and small alveoli l Prevent Pulmonary oedema.

Compliance of the Lung

l An

indicator of expandability l Low compliance requires greater force l High compliance requires less force Factors That Affect Compliance l Connective-tissue structure of the lungs l Level of surfactant production l Mobility of the thoracic cage

Compliance varies within the lung according to the degree of inflation

l

lPoor

compliance is seen at low volumes (because of difficulty with initial lung inflation) and at high volumes (because of the limit of chest wall expansion) lBest compliance is in the mid-expansion range.
l

Work of breathing
l Work

to overcome the elastic forces of the lung l Work to overcome the viscosity of the lung and the chest wall structures. l Work to overcome airway resistance. l Normal respiration uses 3-5% of total work energy l Heavy exercise can require 50 x more energy

Volumes Versus Capacities.

l There

are four volume subdivisions which:

do not overlap. can not be further divided. when added together equal total lung

capacity.
l Lung

capacities are subdivisions of total volume that include two or more of the 4 basic lung volumes.

Pulmonary Volumes
l Tidal

volume
inspiration or expiration

Volume of air inspired or expired during a normal

l Inspiratory

reserve volume reserve volume

Amount of air inspired forcefully after inspiration of

normal tidal volume

l Expiratory

Amount of air forcefully expired after expiration of

normal tidal volume

l Residual

volume

Volume of air remaining in respiratory passages and lungs

after the most forceful expiration

Pulmonary Capacities
l Inspiratory l Functional l Vital

capacity residual capacity

Tidal volume plus inspiratory reserve volume Expiratory reserve volume plus the residual volume

capacity
expiratory reserve volume

Sum of inspiratory reserve volume, tidal volume, and

l Total

lung capacity
plus the tidal volume and residual volume

Sum of inspiratory and expiratory reserve volumes

Respiratory volumes

Spirometer and Lung Volumes/Capacities

Partial Pressure
l The

pressure contributed by each gas in the atmosphere l All partial pressures together add up to 760 mm Hg
l

Henrys Law
l The

amount of gas absorbed by a liquid with which it does not combine chemically is directly proportional to the partial pressure and the solubility of the gas in the liquid.

Henrys Law
When gas under pressure comes in contact with liquid: gas dissolves in liquid until equilibrium is reached At a given temperature: amount of a gas in solution is proportional to partial pressure of that gas

Gas solubility
l CO2

20 times more soluble in water than O2 l N2 almost insoluble

H2O Carbondioxide

H2O Oxygen

H2O Nitrogen

Physical Principles of Gas Exchange

l Diffusion

of gases through the respiratory membrane Depends on membranes thickness, the diffusion coefficient of gas, surface areas of membrane, partial pressure of gases in alveoli and blood, volume of capillary network, contact time l Relationship between ventilation and pulmonary capillary flow Increased ventilation or increased pulmonary capillary blood flow increases gas exchange

Ficks Law for Diffusion for Gases

O2 P2

A
P1 T

CO2

gas = A D ( P1 P2 ) V T

Gas Diffusion
l l

l l l

The alveoli provide an enormous surface area for gas exchange with pulmonary blood (between 50-100m2) Under resting conditions pulmonary capillary blood is in contact with the alveolus for about 0.75 second in total and is fully equilibrated with alveolar oxygen after only about a third of the way along this course. Lung disease impairs diffusion: At rest there is usually still sufficient time for full equilibration of oxygen During exercise, pulmonary blood flow is quicker, shortening the time available for gas exchange, and so those with lung disease are unable to oxygenate the pulmonary blood fully and thus have a limited ability to exercise. Carbon dioxide diffuses across the alveolar-capillary membrane 20 times faster than oxygen so the above factors are less liable to compromise transfer from blood to alveoli.

Pathway for diffusion

Herring-Breuer Reflex
l Limits

the degree of inspiration and prevents overinflation of the lungs

Infants l Reflex plays a role in regulating basic rhythm of breathing and preventing overinflation of lungs Adults l Reflex important only when tidal volume large as in exercise

Overall function
l Movement

of gases l Gas exchange l Transport of gas (oxygen and carbon dioxide)

PULMONARY VENTILATION
l BOYLES

LAW l Gas pressure in closed container is inversely proportional to volume of container l Pressure differences and Air flow

Pressures
l Atmospheric

pressure 760 mm Hg, 630 mm Hg here l Intrapleural pressure 756 mm Hg pressure between pleural layers l Intrapulmonary pressure varies, pressure inside lungs

Inspiration/Inhalation
l Diaphragm

& Intercostal muscles l Increases volume in thoracic cavity as muscles contract l Volume of lungs increases l Intrapulmonary pressure decreases (758 mm Hg)

Expiration/Exhalation
l Muscles

relax l Volume of thoracic cavity decreases l Volume of lungs decreases l Intrapulmonary pressure increases (763 mm Hg) l Forced expiration is active

Factors that influence pulmonary air flow

lF

= P/R l Diameter of airways, esp. bronchioles l Sympathetic & Parasympathetic NS

Surface Tension
l Lung

collapse l Surface tension tends to oppose alveoli expansion l Pulmonary surfactant reduces surface tension

Lung Volumes & Capacities

l Tidal

Volume (500 mls) l Respiratory Rate (12 breaths/minute) l Minute Respiratory Volume (6000 mls/min)

Lung Volumes & Capacities

l Inspiratory

Reserve Volume (3000, 2100

mls) l Inspiratory Capacity (TV + IRV)

Lung Volumes & Capacities

l Expiratory

Reserve Volume (1200, 800

mls) l Residual Volume (1200 mls) l Functional Residual Capacity (ERV + RV)
Air left in lungs after exhaling the tidal

volume quietly

Lung Volumes & Capacities

l Vital

Capacity l IRV + TV + ERV = 4700, 3400 mls l Maximum amount of air that can be moved in and out of lungs

Lung Volumes & Capacities

l Total

Lung Capacity (5900, 4400) l Dead air volume (150 mls) air not in the alveoli

Alveolar Ventilation Efficiency

l RR

X (TV-DAV) = Alveolar Ventilation = 4200 mls/min l If double RR: AV = 8400 mls/min l If double TV: AV = 10200 mls/min

Matching Alveolar air flow with blood flow

l Pulmonary

vessels passageways

Vessels can constrict in areas where oxygen

flow is low
l Respiratory
Airways can dilate where carbon dioxide

levels are high

Gas Exchange
l Partial Pressure Each gas in atmosphere contributes to the entire

atmospheric pressure, denoted as P

l Gases in liquid Gas enters liquid and dissolves in proportion to its

partial pressure

l O2

and CO2 Exchange by DIFFUSION

PO2 is 105 mmHg in alveoli and 40 in alveolar

capillaries PCO2 is 45 in alveolar capillaries and 40 in alveoli

Partial Pressures
l Oxygen

is 21% of atmosphere l 760 mmHg x .21 = 160 mmHg PO2 l This mixes with old air already in alveolus to arrive at PO2 of 105 mmHg

Partial Pressures
l Carbon

dioxide is .04% of atmosphere l 760 mmHg x .0004 = .3 mm Hg PCO2 l This mixes with high CO2 levels from residual volume in the alveoli to arrive at PCO2 of 40 mmHg

Controls of Respiration
l Medullary

Rhythmicity Area

Medullary Inspiratory Neurons are main

control of breathing
Pons neurons influence inspiration, with Pneumotaxic area limiting inspiration and Apneustic area prolonging inspiration. l Lung stretch receptors limit inspiration from being too deep
l

Controls
l Medullary

Rhythmicity Area

Medullary Expiratory Neurons l Only active with exercise and forced expiration

Controls of rate and depth of respiration

l Arterial l Arterial

PO2 PCO2
increases in PCO2, greatly increases ventilation

When PO2 is VERY low, ventilation increases The most important regulator of ventilation, small

l Arterial

pH
increases, but hydrogen ions cannot diffuse into CSF as well as CO2

As hydrogen ions increase, alveolar ventilation

EXERCISE
l Neural

signals (rate & depth) l PCO2 (PO2 and pH) l Cardiac Output l Maximal Hb saturation l Dilate airways

Thanks