Respiratory system disorders

The oxygen supply of the cells is depended on

pulmonary ventilation, lungs perfusion, on exchange
of respiratory gases and on capacity of blood to
transport the oxygen
Important mechanism of gas exchange in animals and
human beings is air diffusion - from high concentration to
lower concentration, but transportation by this way is
possible only for 1 mm length. For further transportation
convectional transportation is needed. Air molecules are
transported trough respiratory ways and also blood
transports them by means of convectional transportation.
Thus Oxygen is transported from the environment to the
tissues by the following sequence: 1. convectional
transport till alveoli (ventilation), 2.Diffusion from alveoli
to pulmonary capillaries, 3. Convectional transport of airs
by blood to tissue capillaries. 4. Diffusion from capillaries
to tissues. Carbon dioxide is being carried out from
tissues on the contrary way.
The main mechanisms of respiratory failure are the
disturbances of ventilation, lungs perfusion, diffusion or
their combinations.
Ventilation, perfusion and exchange of the respiratory
gases in the lungs are the primary functions of the
cardiopulmonary system. Ventilation includes the
mechanics of inspiration and the providing of atmospheric
air to the alveoli, and the mechanics of expiration during
which the air with decreased oxygen and increased carbon

dioxide levels is expired. Ventilation depends on many

factors neurogenic and chemical factors, respiratory
muscles, the lung tissue, and the airways resistance to the
airflow. The exchange of respiratory gases in the
organism depends on oxygen diffusion from alveoli to the
blood and then from the blood to the tissues. In this way,
but vice versa carbon dioxide is eliminated from the body.
The exchange of respiratory gases depends also on the
integrity, thickness and area of the membrane which
represents the site of the gas exchange. It further depends
on the relative gradient of gases and their solubility on
both sides of the membrane, on the affinity of hemoglobin
to oxygen, and on the distribution of ventilation and
perfusion. The perfusion of the lung represents the blood
flow enabling the oxygen transport between alveoli and
blood.
Respiratory failure is a syndrome of inadequate gas
exchange due to dysfunction of one or more essential
components of the respiratory system:
CNS or Brain Stem
Chest wall (including pleura and diaphragm)
Airways and Alveoli
capillary units of Pulmonary circulation
Nerves
Pulmonary ventilation and its disorders
Ventilation of the lungs is a complex of processes
ensuring the transport of air into the lungs and the
expiration of air enriched in carbon dioxide with low
oxygen content.

During inspiration the thoracic cavity enlarges due to the

contraction of the respiratory muscles. The inspiration is
an active process which depends on several factors. The
expiration is a passive process, depending on relaxation of
inspiratory muscles. The elastic properties of chest and
lungs are important factors.
The essence of lung ventilation is gas exchange between
atmospheric and alveolar air. In this process, central
neural system (respiratory centers located in medulla
oblongata and pons), sensitive and motoric peripheral
nerves, upper respiration ways, and lungs are involved.
Lung ventilation disorder takes place at any of their
dysfunction.
Respiratory dysfunction related with the respiratory
center disorders
Respiratory centers located in medulla oblongata and
pons (Pneumotaxic center) provide the certain depth,
rate and rhythm of respiration. They permanently receive
impulses from upper neural systems (brain bark,
hypothalamus) and peripheral chemo-, baro-, mechano-,
and thermo receptors. High temperature has significant
meaning at high temperature respiration gets frequent as
well as certain hormones (e.g. adrenalin and
progesterone) increase lung ventilation.
The excitation of respiratory center and lung ventilation is
depended on CO2 tensity and PH of blood. Respiratory
centre neurons react only on H+ ions, CO2 action is
related with their capacity of H+ ions formation.

The excitation of respiratory center and consequently lung

ventilation decreases at central neural system impairment
(brain blood vessels sclerosis and spasm, hemorrhage,
brain compression, intoxications).
Chemoreceptors involved in respiratory regulation react
mainly on oxygen tensity decrease in blood; In this case
ventilation is increased. Vegetative neural system is very
important: by symphatic prevalence bronches are dilated,
and excess parasyphatic impulses cause bronchospasm.
Sensitive termination of vagus nerve play important role
at normal and pathologic conditions; at inspiration alveoli
are stretched, sensitive receptors are irritated that
reflectively causes expiration (HeringBreuer reflex).
E.g. at inflammation acid exudates increase sensitivity of
stretching receptors and inspiration ends earlier
therefore superficial respiration develops.
Ventilation disorders related with Chest wall
dysfunctions (including pleura and diaphragm).
Obstruction in upper respiratory ways cause respiratory
failure of obstructive type (foreign body, tumor,
laryngospasm. Lower respiratory ways obstruction
(e.g. bronches or bronchioles obstruction with vomited
masses, water, and mucus.) also cause obstructive type
of respiratory failure.
Ventilation disorders at lung respiratory surface
decrease are characterized by severe decrease of
external respiration of restrictive type. The lung
stretching capacity decrease restricts alveolis ability to

enlarge that can be met at pneumonia, minor circle

dam, at emphysema, fibrosis, some toxic impairments.
Important role plays deficiency of surfactant
substance that resists lung atelectasis via decrease of
surface tension in alveoli.
Forms of ventilation disorders are: hyperventilation,
hypoventilation. Physiologic or compensative
hyperventilation (e.g. at exercise) is an organisms
reaction to excessive demand for oxygen and is being
stopped when the cause is eliminated.
Pathologic hyperventilation develops at respiratory
centre excitation during brain and its membranes
inflammation.
Prolonged and severe hyperventilation causes
hypocapnia and alkalosis that inhibits respiratory
centre and cause hypoventilation.
Respiration act changes
Normally a man breathe without any effort paying
no attention to the process, this condition is called
respiratory comfort - eupnoea.
Bradypnoea is a rare breathing. This reflex
decreasing breathing rate may be observed at
increased arterial pressure (reflex from he
baroreceptors of aortic arch and carotidal sinus), at
hyperoxia.
Polipnoea or tachipnoea is frequent superficial
respiration. Tachipnoea occurs when there is

increased stimulation of pneomotaxic centres or

excessive inactivation of their inhibiting factors.
Hyperpnoea or deep and frequent breathing develops
e.g. at mountain disease because of oxygen partial
pressure decrease. At this time excess CO2 is
eliminated that cause hypocapnia, alkalosis,
respiratory arrhythmia and rarely stopping of
breathing.
Apnea is an absence of breathing but usually this is
temporary respiratory stand still.

Dyspnoea is a ventilation disorder together with

feeling of breathing difficulty.
Inspirational (prolonged inspiration phase) and
expirational dyspnoea (expiration process disorder)
are classified.
Periodic breathing it is a breath rhythm disorder
when breaths are separated by intervals of apnea (no
breathing). As opposed to normal breathing which is
usually regular. Following types of breath disorders are
observed: Cheyne-Stokes respirations, Biots
Breathing, Kussmaul respirations.
.
Cheyne-Stokes respirations are a phase, or cyclic,
type of breathing in response to hypercapnia in the
system. The cycle starts with a smooth increase, in the
rate and depth of respirations followed by a gradual

smooth decrease, in the rate and depth of respirations

ending in a short period of apnea that can last from 15
to 60 seconds. Then the cycle repeats itself. Cheyne
Stokes respirations result from any condition that
slows the blood flow to the brain stem because it slows
impulses sending information to the respiratory center.
An injury of the brain above the brain stem will also
contribute to the development of Cheyne-Stokes
respirations. Causes include CNS dysfunction, cardiac
failure with low cardiac output, sleep, hypoxia,
profound hypocapnia.
Biots Breathing is irregular respirations with irregular
periods of apnea. There is no cyclic nature to them as
in Cheyne-Stokes breathing. Breaths are generally of
equal depth (also distinguishing them from CheyneStokes). It may be seen with respiratory depression and
brain damage at the level of the medulla.
Kussmaul respirations, or hyperpnoea, are deep, rapid
respiration with no end-expiratory pause and indicate
the body is trying to compensate for severe metabolic
acidosis (blow off the excess carbon dioxide in the
system) or after strenuous exercise. They have an
increased rate and no expiratory pause. In other words
there is no stopping between inhaling and exhaling.
It is seen in profound metabolic acidosis, i.e. diabetic
ketoacidosis.