Clinical Respiratory Physiology

Clinical Respiratory Physiology

LUKE HARRIS, MB, BS (LOND), MRCP (EDIN)

Consultant Chest Physician and Consultant in Charge, Respiratory Physiology Laboratory, Aintree Unit, Fazakerley Hospital, Liverpool

Consultant Chest Physician, Newsham General Hospital, East Liverpool University Hospital Group

Table of Contents

Cover image

Title page

Copyright

PREFACE

Dedication

SYMBOLS AND ABBREVIATIONS

Chapter 1: Ventilatory Capacity (Timed Spirometry)

Publisher Summary

1 Expiratory Measurements

Inspiratory Measurements

Predicted values for FEV1 based on Age, Height and Sex

Chapter 2: Lung Volumes

Publisher Summary

Closed Circuit Helium Dilution Method for FRC

Open Circuit Nitrogen Washout Method

Whole-body Plethysmography Method

Total Lung Capacity based on Height for Males and Height and Age for Females

Residual Volume as Percentage of Total Lung Capacity

Chapter 3: Ventilation

Publisher Summary

Illustration of Inter-relationship between and

Chapter 4: Oxygen Consumption and Carbon Dioxide Output

Publisher Summary

Chapter 5: Diffusion

Publisher Summary

Steady State Methods

Single Breath Method

Rebreathing Method

Diffusion Coefficient (kCO)

Transfer Factor (Tl) based on Age and Height

Chapter 6: Cardiac Output (Pulmonary Blood Flow)

Publisher Summary

Direct Fick O2 Method

Indirect Fick CO2 Method

Body Plethysmograph Method

Dye Dilution Method

Chapter 7: Ventilation—Perfusion Ratios

Publisher Summary

Radioactive Xenon Method

Anatomical Shunt (Oxygen test)

DETECTION OF SHUNT

MEASUREMENT OF SHUNT

Physiological Shunt and Venous Admixture Effect

Physiological Dead Space

Single Breath CO2 Test

Alveolar-arterial O2 Difference (A – aDO2)

Arterio–alveolar CO2 Difference (a – ADCO2)

Diagrammatic Representation of Effects of Changes in Ventilation–perfusion Ratios

BRONCHOSPIROMETRY

Chapter 8: Compliance and Work of Breathing

Publisher Summary

Work of Breathing

Respiratory Frequency and Work of Breathing

Chapter 9: Airway Resistance

Publisher Summary

Airway Conductance

Chapter 10: Blood Gases

Publisher Summary

Rebreathing Method for P⊽CO2

CO2 dissociation curve for whole blood betweenPco240 and Pco260

HbO2 dissociation curve (pH7.4, temp. 37°C)

Chapter 11: Acid-base Regulation

Publisher Summary

pH

Primary CO2 Retention (Respiratory Acidaemia)

Primary CO2 Depletion (Respiratory Alkalaemia)

Metabolic Acidaemia

Metabolic Alkalaemia

Mixed Disturbances

Chapter 12: Exercise Studies

Publisher Summary

Appendix One: Patterns of Disturbed Function

Appendix Two: Temperature and Pressure Corrections

BIBLIOGRAPHY

INDEX

Copyright

© JOHN WRIGHT & SONS, LTD. 1975

All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of the copyright owner.

ISBN 0 7236 0374X

PRINTED IN GREAT BRITAIN BY HENRY LING LTD.

AT THE DORSET PRESS, DORCHESTER

A SUBSIDIARY OF JOHN WRIGHT AND SONS LTD.

PREFACE

The purpose of this short text is to try to clear up some of the difficulties which a succession of Housemen and Registrars have asked me to explain. I have therefore stressed the practical aspects of applied respiratory physiology together with those theoretical concepts that I feel are necessary for proper understanding. The book will, I hope, meet the basic requirements of junior doctors working in respiratory units and those studying for higher qualifications. It should be of value to technicians in respiratory laboratories, and to General Physicians wishing for a brief review of the subject. It may even stimulate an interest in senior medical students, whose knowledge of respiratory physiology is regrettably often precarious.

I have deliberately refrained from cluttering up the text with references. Indeed to quote them all would at least double the size of the book. Instead I have included a bibliography at the end. The books listed have been of great value to me over the years and contain many hundreds of references. The really interested reader of my little book will undoubtedly wish to turn to them.

L.H.

November 1974

Dedication

TO MY WIFE AND CHILDREN

IN GRATITUDE FOR THEIR ENCOURAGEMENT

SYMBOLS AND ABBREVIATIONS

Ventilatory

PRIMARY

V= volume

= volume/unit time

P = pressure

F= fractional concentration

R= respiratory exchange ratio (without subscript) and also resistance (with subscript)

TL= transfer