REGULATION OF

VENTILATION
Physiology Department

Universidad Autónoma de Guadalajara A.C.© 2017

RESPIRATORY CONTROL SYSTEM

West. Respiratory Physiology. 2008

Universidad Autónoma de Guadalajara A.C.© 2017

ORGANIZATION OF THE
RESPIRATORY CENTER

▪M e d u l l a r y
respiratory center

▪Apneustic center

▪P n e u m o t a x i c
center

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APNEUSTIC CENTER
▪In the lower pons
▪Slower respiration and larger tidal volume
▪When the vagi is cut there are prolonged inspiratory spasm
(apneusis)
▪ By sustained discharge of medullary inspiratory neurons

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PNEUMOTAXIC CENTER
▪ Located in the upper ponds
▪ Transmits signals to the inspiratory area.
▪ Inhibits inspiration, regulate inspiratory volume, and secondarily
respiratory rate. “fine tuning”
▪ Normal rhythm can exist in the absence of this center

Universidad Autónoma de Guadalajara A.C.© 2017

 OBJECTIVES
▪List the anatomical locations of chemoreceptors
sensitive to changes in arterial PO2, PCO2, and
pH that participate in the control of ventilation.

▪Identify which chemoreceptor population is most

important in sensing short-term (acute) and long-
term (chronic) alterations in blood gases.

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 SENSORS
Central
▪CHEMORECEPTORS
Peripheral

Pulmonary stretch
▪LUNG RECEPTORS Irritant Receptors
“J” Receptors

Upper airway Receptors

Gamma Receptors
▪ OTHERS Joint & muscle
Arterial Baroreceptors
Pain & temperature

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 CENTRAL CHEMORECEPTORS
▪ Near ventral surface of
medulla

▪ Surrounded by brain ECF

▪ Local blood
▪ Cerebrospinal fluid (CSF)

▪ Blood and CSF separated

by Blood Brain Barrier

■ Sensitive to [H+] West. Respiratory Physiology. 2008

■ An ↑ [H+] ! Stimulates ventilation

■ A ↓ [H+] ! Inhibits ventilation

Universidad Autónoma de Guadalajara A.C.© 2017

CENTRAL CHEMORECEPTORS

▪High sensitivity to CO2

and H+
▪ CO2 levels in blood
regulates ventilation
chiefly by its effect on pH
of the CSF

▪Also … The cerebral

vasodilation with
increased PCO2
enhances diffusion

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PERIPHERAL CHEMORECEPTORS

▪Location:
▪Carotid bodies (high blood flow)
▪Aortic bodies

▪Respond to:
▪↓ arterial PO2 & pH
▪↑ arterial PCO2

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PERIPHERAL CHEMORECEPTORS

▪Very high sensitivity

to changes in
arterial PO2

▪Responsible for all

the increase of
ventilation in
response to
hypoxemia***

Universidad Autónoma de Guadalajara A.C.© 2017

PERIPHERAL CHEMORECEPTORS

Universidad Autónoma de Guadalajara A.C.© 2017

 “HERING BREUER REFLEX”
HB Inflation Reflex
▪Activation by Stretch receptors located in bronchi
and bronchioles.
▪Transmit signals through the vagi into dorsal
respiratory group.
▪When lung over-inflates, stretch receptors activates
and switches off the inspiration preventing over
inflation.
▪Obtained with tidal volumes 3 times above normal
(1500 ml)
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IRRITANT RECEPTORS
▪Location: Airway epithelial cells
▪Rapidly adapting receptors

▪Stimulated by noxious gases

▪Impulses travel up vagus myelinated fibers

▪Reflex: Bronchoconstriction

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J RECEPTORS
▪“Juxta pulmonary–capillary”
▪Location: Alveolar walls close to capillaries
▪Respond to chemicals into pulmonary circulation
▪Impulses pass up vagus by non myelinated fibers
■ Respond to engorgement of capillaries and
increased interstitial fluid volume of alveolar walls
■ Rapid, shallow breathing ! dyspnea
■ Responsible of the dyspnea of LVF and onset of
exercise

Universidad Autónoma de Guadalajara A.C.© 2017

 OBJECTIVES

▪Describe the interaction of hypoxia and

hypercapnia in the control of alveolar
ventilation.

▪Describe the significance of the feed

forward control of ventilation (central
command) during exercise, and the effects
of exercise on arterial and mixed venous
PCO2, PO2 and pH.

Universidad Autónoma de Guadalajara A.C.© 2017

INTEGRATED RESPONSES
▪Changes in CO2

▪Changes in O2

▪Changes in pH

▪Exercise

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RESPONSE TO CO2
▪Sleep

▪Age

▪Personality factors

▪Athletes (decreased sensitivity)

▪Drugs

▪Genetic determined
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Response to CO2
▪Inputs to ventilatory control
system in establishing
breath-to-breath levels
▪CSF PCO2
▪PaCO2
▪P h y s i o l o g i c r e s p o n s e
depends on its concentration
and the PAO2
▪At normal PAO2, ventilation
increases 2-3 L/mmHg of
CO2
Universidad Autónoma de Guadalajara A.C.© 2017 West. Respiratory Physiology. 2008
RESPONSE TO O2
▪Hypoxia
▪Sensed by peripheral
chemoreceptors

▪Carotid bodies

▪Increasing the PCO2

increases the
ventilation at any
PO2

West. Respiratory Physiology. 2008

Universidad Autónoma de Guadalajara A.C.© 2017
 EXERCISE
▪O2 consumption of 4L/min
▪Total ventilation of 120L/min
▪15 times greater than resting level
▪PCO2 no changes
▪PH normal/heavy exercise decreases
(lactic acid)
▪Temperature

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ABNORMAL PATTERNS OF BREATHING

A. Eupnea

B. Kussmaul breathing.
The breathing is fast and
has a high amplitude (large
VT)

Severe metabolic acidosis –

diabetic ketoacidosis --

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ABNORMAL PATTERNS OF
BREATHING

▪Cheyne – Stokes respiration

▪Caused by severe hypoxemia
▪Periods of apnea 10 – 20 sec with periods of
hyperventilation
▪High altitude during sleep
▪Severe heart disease
▪Brain damage

Universidad Autónoma de Guadalajara A.C.© 2017

 Hypercapnia in Respiratory failure
Patient with COPD with severe hypoxemia
and CO2 retention over a period of months
Who is driving ventilation?
Low PO2 stimulating peripheral receptors

How is arterial and CSF pH in this patient?

Arterial pH is normal (compensated respiratory acidosis)
and pH of CSF is normal (↑ HCO3)

Universidad Autónoma de Guadalajara A.C.© 2017

Hypercapnia in Respiratory failure
▪The patient developed mild respiratory infection
and is treated with high inspired O2
▪ What can be expected?
Hypoxic ventilatory drive may be abolished and the
work of breathing increased (retained secretions &
bronchospasm)

▪ What is the consequence of this?

Ventilation is grossly depressed, high levels of

PaCO2
Universidad Autónoma de Guadalajara A.C.© 2017
How to treat this patient?
▪Give relatively low O2 concentration
24 to 28% O2

▪Monitor the arterial blood gases to

detect depression of ventilation

▪Intubation and mechanical ventilation

may become necessary

Universidad Autónoma de Guadalajara A.C.© 2017

 Summary
▪Control of the respiration by the CNS
▪Brainstem & cortex
▪Apneustic center
▪Pneumotaxic center
▪Effector muscles
▪Receptors of the lungs
▪Abnormal patterns of the breathing

Universidad Autónoma de Guadalajara A.C.© 2017

Images Reference

▪Boron & Balpeaup. Medical Physiology. 2009

▪Guyton & Hall. Medical physiology. 2016

▪West. Respiratory Physiology. 2008

Universidad Autónoma de Guadalajara A.C.© 2017

 Bibliography

Boron, W., Boulpaep, E. (2009). Medical Physiology. (2nd

Ed.). Philadelphia: Mosby-Elsevier.
Guyton, A., Hall, J. (2006). Textbook of Medical Physiology.
(11th Ed.). Philadelphia: Elsevier-Saunders.
Koeppen, S., Stanton, S. (2008). Berne & Levy Physiology.
(6th Ed.). Philadelphia: Mosby-Elsevier.
West. (2008). Respiratory Physiology. (8th Ed.): Lippincott.
Williams & Wilkins

Universidad Autónoma de Guadalajara A.C.© 2017