Lung Ventilation and Spirometry:

2 Methods of measuring Residual Volume:

- Helium dilution technique
- Nitrogen Washout Technique

Acid-Base Balance:
- Septal barrier between capillary and alveolus is 1.5 micrometers

Bohr Effect: pH and Pco2 determine Hb-O2 affinity:

- Increase H+ shifts curve to the right  lower pH = right shift
- Increased PCO2 shifts curve to the right as well
- H+ and CO2 are considered allosteric modulators of O2 affinity

Acid-Base Disorders:
- -emia disorders  means within the blood
o Acidemia: blood pH < 7.36
o Alkalemia: blood pH > 7.44
- -osis disorders  means primary process increasing or decreasing [H+]
o Acidosis
o Alkalosis
Assessing Acid-Base Balance:
1. Check Arterial pH
a. pHa < 7.36  acidosis
b. pHa > 7.44  alkalosis
2. Check PaCO2
a. In acidosis:
i. PaCO2 < 40 mmHg, metabolic acidosis
ii. PaCO2 > 40 mmHg, respiratory acidosis
b. Alkalosis:
i. PaCO2 < 40 mmHg, respiratory alkalosis
ii. PaCO2 > 40 mmHg, metabolic alkalosis
3. Calculate Anion Gap
a. Most important in metabolic acidosis

Causes of Respiratory Acidosis (Hypoventilation):

1. Obstructive lung disease
2. Impaired function of respiratory center
3. Hypoventilation by mechanical ventilator

Causes of Respiratory Alkalosis:

1. Hypoxemia
2. Anxiety
3. Hyperventilation
4. Metabolic acidosis
5. Septicemia
6. Trauma

Causes of Metabolic Alkalosis:

1. Hypokalemia
2. Administration of HCO3-
3. Vomiting of GI suction
4. Corticosteroid excess
 5. Primary hyperaldosteronism

Causes of Metabolic Acidosis:

- Anion Gap “MUDPILES”
o Methanol
o Uremia
o Diabetic KA
o Paralehyde
o INH, Iron
o Lactic Acid
o Ethanol
o Salicylates
- Non-ion Gap “HARDUP”
o Hypertonic saline
o Acetazolamide
o Renal tubular acidosis
o Diarrhea
o Ureteral diversion
o Pancreatic Fistula

Henry’s Law of Gas Solubility: Cx = Kx * Px

- Cx – dissolved concentration of substance X
- Kx – temperature dependent solubility coefficient of substance X
- Px – pressure of substance
- Allows estimation of small amount of O2 dissolved in the plasma

Compliance in Air vs. Saline Filled Lungs:

- Saline filled lungs are more compliant than air-filled
o Show no Pco or hysteresis
- Post-lavage has lower lung volume since surfactant was removed on lavage

Compliance vs. Distensibility:

 - Distensible: expandable with gas or liquid
- Compliant: rubber walls resist inflation and assist deflation
- Emphysema  elasticity is reduced by leukocyte proteases

Synthesis Pulmonary Sufactant:

- Occurs 32-34 weeks in gestation
- Protein components synthesized in rough ER
- Stored in lamellar bodies
- Lamellar bodies are shed by exocytosis  measurable by amniotic fluid

Lab evaluation on Surfactant Production:

- Analyze amniotic fluid
- Physical methods  detergent properties of surfactant or presence of lamellar bodies
- Chemical Methods  quantification of phospholipid components of surfactant
- Considerations:
o Blood or meconium contamination can interfere
o Platelets can increase LB count
o Serum L/S ratio is 1.5-2  bloody specimens with borderline ratios cannot be
interpreted
Foam Stability Index:
- FSI ≥ 0.47 is interpreted as mature
- Based on Lecithin-FSI compared with neonatal outcome
Lamellar Body Counts:
- Maturity cutoff is 35,000 microliters
- Test is rapid and sensitive but not specific

PG Assay:
- High positive results are highly predictive of maturity
- Negative results are highly unpredictable
- Useful when dealing with specimen with blood or meconium contamination

Changes in Lung and Chest Volumes after

Pneumothorax:
- Allows lung to collapse
- Chest volume to approach TLC
o Ribs sping outward
o Diaphragm moves caudally

Lung and Chest Wall Compliance Curves:

- Lung + chest wall is always equal to the
sum of:
o Compliance curve for excised lungs
o Compliance curve for empty thorax
Hyperinflation:
- Experienced by patients with obstructive lung diseases  cannot exhale fully
- Still breathing at tidal volume, but much closer to TLC
- Work of breathing increased
o Need to distend both lung tissue and thoracic elements

Ohm’s Law and Poiseuille’s Equation  Airway Resistance decreases as Cross Sectional Area
Increases
- Increase in cross sectional area by 2, decreases resistance by 16 times
- Highest resistance in intermediate airways
- Lowest resistance in terminal bronchioles

Airflow Patterns in Different Diseases:

Expiratory Flow-Volume Curves:

Regional Gradients in Pulmonary Compliance:

- Apical alveoli are well distended even at FRC
- Basal alveoli are smaller by compression from above
o Has a much greater increase in volume during
inspiration

Positive End-Expiratory Pressure (PEEP):

- Main use: mechanical ventilation is optimized by PEEP
- Effect:
o PEEP increases effective RV and offsets low
interpleural pressure to recruit atelectatic
alveoli with an air stent
o PEEP setting of 5-10 cm H2O is normally
sufficient

Vascular Waterfall Model of Non-Uniform Pulmonary Blood Flow:

- Diameter of pulmonary capillaries will depend on their position relative to the heart in a
gravitational field

Starling’s Law of Capillary:

- Blood fluids leave at arterial end  forms lymph
- Lymph returns to blood at venous end
- Net fluid loss collects at lymphatics
- Extravasation excess causes edema