Respiratory Physiology - the essentials. Recognize the units used in the measurement
6th Edition, 1999, by John B. West . of respiratory variables
Excellent. Easy to read. Concise. Will easily
meet the requirements of this course. Understand the importance of partial
Figure 1.
Overview of the respiratory system.
higher brain
center
ventilatory control
of breathing
brain stem
respiratory
chemoreceptors
neurons
spinal cord
muscles
mechanics
mechanoreceptors of breathing
lung and
chest wall
gas transport
TISSUES arterial blood gases
trachea generation 0
main, lobar and segmental bronchi generations 1-4
small bronchi generations 5-11
bronchioles generations 12-16
respiratory bronchioles generations 17-19
alveolar ducts generations 20-22
alveolar sacs generations 23
alveoli 200-600 million in number
diameter ~ 250 microns
definitions:
conducting zone = generations 0 to 16 (‘wasted ventilation’)
respiratory zone = generations 17 to alveoli
acinus or lobule= portion of lung distal to a terminal bronchial
(‘the terminal respiratory unit’)
Barometric pressure (PB) The partial pressure for any gas (PG) is obtained
PB is the total pressure exerted by the kinetic by multiplying PB by the fractional concentration
energy of all the molecules in our atmospheric (FG) of that gas.
mixture. At sea level, the total weight of the
atmosphere on the earth's surface is equal to the Calculation of the partial pressure of O2 and CO2
weight of a column of mercury 760 mm in height in the gas phase.
(760 mm Hg ). PB decreases with increasing
altitude. At the summit of Mt. Everest (29,028 Question 2
feet) the PB is only 253 mm Hg.
On the top of Mount Everest, where the PB is
253 mm Hg, what is the partial pressure of
Fractional concentrations of gases
oxygen in the dry atmospheric air? Make the
Fractional concentrations of gases in the gas
same calculation at sea level.
phase are expressed as fractions of the total gas
volume, e.g., FatmO2 = 0.2093.
Answer
Irrespective of altitude, the composition of the
atmospheric air expressed as a fractional
concentration of dry air is:
Fatmnitrogen = 0.78
Fatmoxygen = 0.21 (0.2093 to be exact!)
Fatmcarbon dioxide = 0.0003
eg. gases in lung are CO2, O2, N2 and H2O
Answer
For oxygen, K = 0.03 mL O2 /L blood/mm Hg. At
a normal PaO2 of 100 mmHg, only 3 mL of O2/L
of blood is stored in physical solution. Therefore,
very little O2 is carried in the blood in the
dissolved form at normal partial pressures of O2.
More about this later (Blood Gas Transport
lecture)!
4. Definitions*
ACIDEMIA ALKALEMIA
• A pH less than normal. • A pH greater than normal
ACIDOSIS ALKALOSIS
• A clinical term indicating a disturbance that can • A clinical term indicating a disturbance that can
lead to acidemia. It is usually indicated by a lead to alkalemia. It is usually indicated by an
reduced blood bicarbonate level when metabolic increased blood bicarbonate level when
(non-respiratory) in origin and by hypercarbia metabolic (non-respiratory in origin) and by
when respiratory in origin. The term should hypocarbia when respiratory in origin. The
always be qualified as metabolic (non- term should always be qualified as metabolic
respiratory) or respiratory. (non-respiratory) or respiratory.
ACINUS APNEA
• The portion of lung parenchyma distal to the • Cessation of air flow for greater than ten
terminal bronchiole and consisting of seconds.
respiratory bronchioles, alveolar ducts, alveolar
sacs and alveoli. ATELECTASIS
• Less than normal inflation of all or a portion of
ACUTE RESPIRATORY FAILURE lung with corresponding diminution in volume.
• Rapidly occurring hypoxemia or hypercarbia due
to a disorder of the respiratory system. The BTPS
duration of the illness and the values of arterial • Gas volumes expressed at conditions of body
oxygen tension and arterial carbon dioxide temperature (37°C), ambient pressure, and
tension used as criteria for this term should be saturated with water vapor
given. The term "acute ventilatory failure"
should only be used when the arterial carbon BRONCHUS
dioxide tension is increased. The term • A conducting airway distal to the trachea
"pulmonary failure" has been used to indicate bifurcation that contains cartilage in its wall.
respiratory failure due specifically to disorders
of the lungs. BRONCHIOLE
• An airway that contains no cartilage in its wall.
AIRWAY C(a-v- )O2
• A collective term for the air-conducting
• Arteriovenous oxygen content difference.
passages from the larynx to and including the
respiratory bronchioles.
CENTRAL APNEA
• Apnea without respiratory effort.
AIR SPACE
• The gas-containing portion of lung parenchyma,
CHRONIC RESPIRATORY FAILURE
including the acini and excluding the
• Chronic hypoxemia or hypercarbia due to a
interstitium and purely conductive portions of
disorder of the respiratory system
the lung.
COLLAPSE
• A state in which lung tissue has undergone FVC
complete atelectasis. • Forced vital capacity;
Vital capacity performed with a maximally
CONSOLIDATION forced expiratory effort.
• The process by which air in the lung is replaced
by the products of the disease, rendering the HYPERCARBIA (Hypercapnia)
lung solid (as in pneumonia). • An increased arterial carbon dioxide tension.
PULMONARY INSUFFICIENCY
OVERVENTILATION • Altered function of the lungs that produces
• A general term indicating excessive ventilation. clinical symptoms, usually indicating dyspnea.
When unqualified, it refers to alveolar over-
ventilation; excessive ventilation of the gas Pv- O2
exchanging areas of the lung manifested by fall
• Mixed venous blood oxygen tension.
in arterial CO2 tension.
RESTRICTIVE PATTERN
P(A-a)O2
(Restrictive ventilatory defect)
• Alveolar-arterial oxygen pressure difference. • Reduction of vital capacity but non-explainable
by airways obstruction.
PaO2
• Arterial oxygen tension. RESPIRATORY FAILURE
• A state characterized by an arterial PO2 below
PaCO2 60 mmHg., or an arterial PCO2 above 50 mmHg.,
• Arterial carbon dioxide tension. at rest at sea level, resulting from impaired
respiratory function.
PARENCHYMA
• The gas exchanging portion of the lung RV (Residual volume)
consisting of the alveoli and their capillaries, • That volume of air remaining in the lungs after
estimated to comprise approximately 90% of maximal exhalation.
the total lung volume
SaO2
PEF
• Arterial oxygen saturation.
• Peak expiratory flow being the highest forced
expiratory flow measured with a peak flow
STPD
meter.
• Volume of gas expressed at conditions of
standard temperature (0°C or 273°K) and
PERFUSION
pressur e(760 mmHg) and dry.
• The passage of blood into and out of the lung.
PNEUMOTHORAX
UNDERVENTILATION
• A state characterized by the presence of gas
• A general term indicating reduced ventilation.
within the pleural space
When otherwise unqualified, it refers to
alveolar underventilation; decreased effective
PULMONARY EDEMA
alveolar ventilation manifested by an increase in
• The accumulation of liquid in the interstitial
arterial CO2 tension.
compartment of the lung with or without
associated alveolar filling
VA .
VD
• Alveolar gas volume.
. • Ventilation per minute of the physiologic dead
VA space (wasted ventilation).
• Alveolar ventilation per minute.
VDan
VC (Vital capacity) • Volume of the anatomic dead space.
• The maximal volume of air exhaled from the .
point of maximum inspiration. VE
. • Expired volume per minute.
V CO2 .
• Carbon dioxide production per minute. VI
• Inspired volume per minute.
VD .
V O2
• The physiologic dead space volume.
• Oxygen consumption per minute.
VT (Tidal volume)
• That volume of air inhaled or exhaled with each
breath during quiet breathing.
Cardiopulmonary
Cardiac output L blood /min 5
Heart rate per min 60
PaO2 mmHg 100
SaO2 % 97
CaO2 mL O2/L blood 200
Oxygen delivery to the tissues (DO2) mL O2/min 1000
(CaO2 x cardiac output)
PvO2 mmHg 40
SvO2 % 75
CvO2 mL O2/L blood 150
Oxygen returned back to the heart mL O2/min 750
(CvO2 x cardiac output)
Oxygen consumption (VO2) ml/min STPD 1000 - 750 = 250
Carbon dioxide production (VCO2) ml/min STPD 200
Respiratory exchange ratio (VCO2/VO2) none 0.80
Ventilation, BTPS
Tidal volume mL, BTPS 500
Respiratory Rate per min 12
Minute ventilation L, BTPS/min 6.0
Anatomic dead space mL, BTPS 150
Physiologic dead space/tidal volume ratio none 0.30
Alveolar ventilation L, BTPS/min 4.2
Lung Mechanics
Pleural pressure, mean at FRC cm H2O -5
Chest wall compliance, at FRC L/cm H2O 0.2
Lung compliance, at FRC L/cm H2O 0.2
Airway resistance cm H2O/L/sec 2.0
Work of breathing, at rest mW (0.001 watts) 50
Work of breathing, at maximal exercise mW (0.001 watts) 5000