Mechanics of Breathing Alveolar Ventilation

SSN Block 4 Shadi (csc43)

OBJECTIVES

Know the definitions of all the listed lung volumes and capacities Understand how lung volumes and capacities are measured Understand the concepts of transmural pressure and compliance Be able to predict the impact of changes in lung and chest wall compliances on FRC Understand how surface tension impacts on lung compliance and leads to hysteresis in the lung PV relationship Be able to explain how surfactant reduces surface tension and reduces the tendency for alveoli to collapse

Understand and be able to apply: Henrys, Ficks and Daltons Laws Understand the relationship between alveolar ventilation, metabolic rate, and pCO2 Know the basis for the respiratory quotient Know the definition of alveolar, anatomic and physiologic dead space and understand the differences between the three Be familiar with the principles and techniques of measuring dead space ventilation Be able to calculate A-a gradient using the alveolar gas equation

TOPICS

Lung Volumes and Capacities Alveolar Ventilation

Dead Space Minute and Alveolar Ventilation Alveolar Ventilation Equation Alveolar Gas Equation

Compliance (Lung, Chest Wall, System) Surface Tension and Surfactant Gas Laws
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Slides will be posted on SSN web site

Use slide numbers if you like

Lung Volumes and Capacities

Capacity = 2 or more volumes

If Im breathing normally, then Im breathing at. . .

Tidal volume

~ 500 mL

Which one is it?

Tidal volume

True or False?

Inspiratory reserve volume = the IRV maximum volume of air I can breathe in.

FALSE!

ADDITIONAL volume inspired above tidal volume

Which one is it?

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Which one is Expiratory Reserve Volume?

ADDITIONAL volume of air expired BELOW tidal volume

ERV

Residual Volume

How much air is left in the lungs after the subject has forcefully and maximally expired CANNOT BE MEASURED BY SPIROMETRY
RV

Lung Capacities

Inspiratory Capacity IC = TV + IRV Vital Capacity VC = IRV + TV + ERV Maximum tidal volume Functional Residual Capacity* FRC = ERV + RV* Volume remaining in lungs after normal tidal volume expired EQUILIBRIUM Total Lung Capacity* TLC = VC + RV*
*cannot be measured by spirometry
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So we take a breath in . . . Air goes into the airways

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Dead Space

Volume of airways and lungs that does NOT participate in gas exchange Anatomic dead space (FIXED)

Volume of conducting airways (~ 1 mL/lb) Alveolus not perfused, so no gas exchange Anatomic + alveolar Measured by CO2 dilution

Alveolar dead space

Physiologic dead space

VD = VT [(PaCO2 PeCO2)/PaCO2] where VD is physiologic dead space; VT is tidal volume; PaCO2 is arterial PCO2; and PeCO2 is PCO2 of expired air
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Ventilation Rate
Volume of air moved into and out of lungs per unit time Minute ventilation (mL/min)

Tidal volume Breathing frequency (Tidal volume physiologic dead space) Breathing frequency

Alveolar ventilation (mL/min)

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Alveolar Ventilation Equation

PACO

CO 2 production alveolar ventilation

If CO2 production is constant, then PCO2 IS DETERMINED BY ALVEOLAR VENTILATION If ventilate more get rid of more CO2 PCO2 decreases

Halve ventilation PCO2 doubles (takes a few mins)

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Normally, equilibration is achieved between alveolus and capillary

PACO2 = PcCO2

D A P Ficks law: Movement of V thickness gas is driven by partial V = flux pressure gradient

D = diffusion coefficient of the gas solubility/MW A = surface area 15 P = partial press difference of gas

Regulation of PCO2 is main mechanism of acute regulation of pH CO2 + H2O H2CO3 H+ + HCO3-

Kidneys

for long term regulation

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What about oxygen?

Alveolar Gas Equation

PA O PIO
2 2

PA CO2 R

PAO2 = alveolar O2 PIO2 = inspired O2

FIO2 (Patm PH 2O )

PA CO2 R

Respiratory quotient (R): ratio of CO2 production to O2 consumption R ~ 0.8 PH2O: because air is humidified in trachea PH2O = 47 mm Hg 17 FIO2 = 21%; changes if on ventilator

Equilibration is achieved

PAO2 = PcO2
Dissolved, not bound, O2 is what drives movement

PcO2 is NOT O2 content

Dissolved O2 = PcO2 0.003 ml O2 / dL

A-a gradient
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Compliance
How volume changes as a result of pressure change (C = V/P) Describes distensibility of the system Compliance of lungs and chest wall inversely correlated with their elastic properties

The greater the amount of elastic tissue, the greater the tendency to snap back, and the lower the compliance
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Pressure-Volume Curve for Lungs, Chest Wall, and Combined Lung/Chest Wall

Slope = compliance
Transmural (in out)

For lung

alveolar pleural pleural atm alveolar atm

For chest wall

For unit

Lung pressures referred to atm press (zero) Chest wall likes to expand Lung likes to collapse 20

Pressure-Volume Curve for Lungs, Chest Wall, and Combined Lung/Chest Wall

Volume = FRC Equilibrium position Collapsing force = expanding force Volume < FRC Less volume in lung collapsing (elastic) force smaller Expanding force on chest wall still greater System wants to expand Volume > FRC More volume in lung collapsing force greater Expanding force on chest wall smaller 21 System wants to collapse

At FRC (end-expiration)

P alveolar = 0 Ppleura < 0

Pneumothorax

Ppleura = 0

Tension pneumothorax (air stuck in)

Ppleura rises and keeps rising ( mediastinum shifts to contralateral side)

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Emphysema

Lung is more compliant chest wall stronger higher FRC

Lung is less compliant will be stronger lower FRC
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Fibrosis

Surface tension and Surfactant

Surface tension bc of attractive forces btwn liquid molecules lining the alveoli

Generates pressure given by law of Laplace P = 2T/r

P = collapsing pressure/pressure to keep alveolus open T = surface tension (constant) r = radius of alveolus

Smaller alveolus has higher pressure

Surfactant molecules break up the attractive forces

reduces surface tension (more reduction at lower volumes) decreases tendency of smaller alveoli to empty into larger alveoli & decreases pressure required to open a closed alveolus increases lung compliance

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Compliance of the Lungs

Hysteresis

Compliance different for inspiration and expiration

Surfactant reduces hysteresis

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Gas laws
Ficks law (see above) Daltons law:

Partial pressure of gas in mixture is equal to pressure gas would exert if it occupied entire volume Concentration of dissolved gas depends on partial pressure and solubility
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Henrys law: