Beruflich Dokumente
Kultur Dokumente
1
Introduction
y The fundamental goals of respiration are to
provide O2 to the tissues and to remove CO2
y To achieve this, respiration can be divided into
four major functions:
y Pulmonary
P l ventilation
til ti
y Diffusion of O2 and CO2 between the alveoli
and the blood
y Transport of O2 and CO2; and
y Regulation
g of ventilation and other facets of
respiration.
2
Components of Respiratory System
Components of
y system
respiratory y
y Respiratory tract
– Ventilation
y Alveolo-capillary
p y membrane
– Gas exchange
3
Pulmonary ventilation
y Pulmonary ventilation is the movement of air into and
out of the lungs
y Air
Ai moves from
f an area off higher
hi h pressure to t an area
of lower pressure – pressure gradient
y The process of pulmonary ventilation requires a
pressure gradient between the outside of the body
and the alveoli
y At rest,
t the
th process off inspiration
i i ti isi an active
ti process
and expiration is a passive process
y Inspiration needs muscular contraction. The chief
muscle of inspiration is the diaphragm
y Expiration is due to elastic recoils of the lungs and
thoracic wall, and the inspiratory muscles relax.
4
Components of Respiratory Tract
y Conducting zone:
y All the structures air
passes through before
reaching the respiratory
zone.
zone
y Mouth, nose, pharynx,
trachea, glottis, larynx,
bronchi
y Respiratory zone
y Region
R i off gas
exchange between air
and blood.
y bronchioles
y alveoli 5
Mechanics of Ventilation
y Mechanics of ventilation include forces that support
and move the chest wall & the lungs, together with
resistances that they need to overcome
y To understand the mechanisms involved in
ventilation, it is necessary to identify the forces that
are responsible for enlargement of thorax and lung
y Respiratory muscles are used to generate forces
during ventilation
y Inspiratory Muscles
y Expiratory Muscles
6
Inspiratory Muscles
Di h
Diaphragm
y The chief muscle of inspiration
y The diaphragm is a sheet of striated muscle
divides anterior body cavity into 2 parts:
thoracic cavity & abdominal cavity
y Innervated by phrenic nerve; C3 C3,4,5
45
y Dome shaped - moves down on contraction
Æ increase the length of the thoracic cavity
Æ lung increases in height
8
Expiratory Muscles
y Involved in active breathing
y Abdominal muscles: rectus abdominis, internal
and external oblique and transverse abdominis
muscles
y Innervated
I t d by
b th
thoracic
i and
d llumbar
b spinal
i l nerves
y Contraction Æ pull the ribs downward and squeeze the
abdomen to increase abdominal p
pressure Æ move the
diaphragm upward and decrease the thoracic volume
y Internal intercostals muscles
y Contraction
C t ti Æ pulling
lli th
the ribs
ib ddownward
d
Upper Airway
y Muscles
y Upper airway muscles in the pharynx and larynx also
contract in phase with breathing and important in
determining airway resistance
y Pharyngeal muscles: stiffens the soft palate and hold the
tongue out of the way for breathing during inspiration
y Laryngeal muscles: dilate the airway during inspiration
y Dilatation of nares byy the alae nasi: decrease the
resistance to airflow
y Mouth breathing: decrease the resistance to airflow
10
INSPIRATION
11
EXPIRATION
12
Muscles of respiration
13
Pressure changes
g during
g respiration
15
Pulmonary Pressures
Intrapleural Pressures (Pplr)
y is the pressure within the pleural cavity
y space between the lungs and the walls of
the thoracic cavity
y The pressure is ALWAYS negative for the
following reasons
y Surface tension of the fluid inside the alveoli
always makes the alveoli try to collapse.
y Elastic fibers spread in all directions through the
lung tissues and tend to contract the lungs
y These factors creating a negative pressure, -2
mmHg at the end of expiration to -6 6 mmHg at
the end of inspiration
y Factors affecting intra-pleural pressure
y Physiological factors - deep inspiration,
inspiration gravity
y Pathological factors - injury to thoracic wall
16
Pulmonary
y Pressures
Transpulmonary pressure (Tpp)
y The pressure difference between
intrapulmonary
i t l pressure andd
intrapleural pressure.
Tpp
pp = Palv – Pplr
p
y Tpp is the distending pressure which
helps to prevent airway collapse
Transthoracic pressure (Ttp)
y The pressure difference between
intrapulmonary pressure and
atmospheric pressure
17
Pressure changes
g during
g respiration
y Intrapulmonay pressure
y Reduces from 0 to -1mmHg during
inspiration and comes back to 0 at
the end of inspiration
y Increases to +1mmHg and comes
back to 0 at the end of expiration
y Intraplueural pressure
y At the start of q
qiuet breathing,
g, it
is -2mmHg. At the end of
inspiration it becomes -6mmHg
18
Respiration
During normal inspiration following events occurs
22
Compliance
y Is defined as the change in volume per unit change in the
pressure,
Compliance
C li = ΔV/ΔP
y Distensibility or stretchiness of lungs when under tension
y A lung stretches easily (high compliance)
compliance), does not
necessary mean that it will return to its resting volume when
the stretching force is release (elastance).
y The greater the amount of elastic tissue, the greater the
elastance (elastic recoil force), but the lower the compliance
y Factors that affect Compliance:
y Elastic fibers in the alveoli
y Pulmonary surfactant in the alveolar fluid
23
Pressure-Volume Curve
y relating lung volume changes to changes in transpulmonary
pressure,
y the inspiratory compliance curve and the expiratory compliance curve
y is
i called
ll d the
th compliance
li diagram
di off the
th lungs
l
y The characteristics of the compliance diagram are
determined by the elastic forces of the lungs:
y elastic forces of the lung tissue itself and
y elastic forces caused by surface tension of the fluid
24
Pressure-Volume Curve
Compliance diagrams of saline filled and air
saline-filled filled
air-filled.
y The compliance diagram of the lungs demonstrate three
important features
y The
Th pressure–volume
l relationship
l ti hi is
i nonlinear
li
y changes with volume, the air curves show hysteresis, i.e., a difference
between inflation and deflation,
y the curves are different for inflation with air and saline
y The curves also show the work required to expand air-filled and
saline-filled lungs
y It requires less work/pressure to expand
saline-filled lung compared to air-filled lungs
y the surface tension effect is not present,
only tissue elastic forces are operative in
the saline solution–filled lung
.
Pressure-Volume Curve (cont’)
y The transpleural pressures required to expand air-filled lungs
are about three times as great as those required to expand
g
saline solution–filled lungs
y This shows that the tissue elastic forces tending to cause
collapse of the air-filled lung represent only about one third of
the total lung
g elasticity,
y, whereas the fluid-air surface tension
forces in the alveoli represent about two thirds
Comparison
p of the compliance
p diagrams
g of
saline-filled and air-filled lungs
26
Alveolar Surface Tension
y Thin layer of fluid in alveoli causes inwardly directed
force alveolar surface tension
y Causes alveoli to remain as small as possible
27
Surfactant
S f
y Surface ti material
acting t i l or agentt that
th t is
i responsible
ibl ffor
lowering the surface tension of a fluid is called surfactant.
y The surfactant ppresent in the alveoli of lungsg pprevents the
collapsing tendency of lungs.
y It is secreted by type II alveolar epithelial cells (surfactant
secreting alveolar cells or pneumocytes)
pneumocytes).
y Composition of surfactant:
y Phospholipids & other lipids (90-95%),
y Proteins (alb,
(alb globulin,
globulin surfactant proteins)
y Carbohydrate, and ions.
28
Surfactant
Functions:
y The surfactant reduces the surface tension in the
alveoli of lungs and thereby prevents the collapsing
tendency of lungs.
y The surfactant is responsible for stabilization of the
alveoli, which have the tendency to deflate.
y It plays an important role in the inflation of lungs
during birth.
y The deficiency of surfactant causes respiratory
distress syndrome or hyaline membrane disease (in
infants) and adult respiratory distress syndrome (in
adults).
29
Function of surfactant
y promote alveolar stability
32
Airway
y Resistance
Airway resistance, Raw= ΔP/V
Where, ΔP = pressure difference, (ΔP= Pmouth-Palveoli ) and
V = volume of airflow
Poiseuille-Hagen
g formula,, air flow
V= ΔPπr4/8ηl
Where, r =radius of tube, η = viscosity, and l = length of the
tube
Therefore,
Raw =8ηl/πr4
y Radius of the tube has critical importance
33
Factors affecting airway resistance
y Lung volume
y Tone of the bronchial smooth muscle
y Airwayy generation
g
y Type of flow
Lung volume
• Increase lung volume (inspiration)
g
– Negative p
pleural ppressure ((NPP))
– Elastic pull of the lung tissue
visceral pleura
NPP
Elastic pull
Resistance
expiration > inspiration
Tone of the bronchial smooth muscle
y r (airway diameter) is the primary determinant
p
y Smooth muscle tone responds y stimuli
to many
Stimulus Bronchial Bronchial
constriction relaxation
Neural cholinergic β2 adrenergic
Chemical histamine,
histamine prostaglandin E2
leukotriene
Physical
y smoke,, dust
36
Airway generation
y Trachea and bigger airways upto
7th generation - 80% of Raw
y The
Th highest
hi h t regional
i l resistance
i t is
i
at generation 4, medium sized
bronchi of short length and
f
frequent branching,
b hi h
have an
extreme turbulence
y Small airways represent silent
zone
y In disease conditions, the smaller
bronchioles often determine air
flow resistance because of their
smaller size (easily obstruct) and
y have ggreater % of smooth muscle
in the walls (easily constrict)
37
Type of flow
Resistance of turbulent flow is
effectively greater than of
laminar flow
Medium sized bronchi of short
length and frequent branching,
have an extreme turbulence Laminar (streamlined flow)
40
Work of Breathing
Work of inspiration can be divided into three fractions
41