RESPIRATORY PHYSIOLOGY
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1 Yerevan State Medical University Department of Anaesthesiology and Intensive Care Yerevan, Armenia RESPIRATORY PHYSIOLOGY Dr. Armen VAROSYAN Associate Professor, DEAA, PhD
2 Lecture Outline Structure and functional anatomy Ventilation Mechanics of breathing Blood flow Ventilation-perfusion relationship Diffusion Gas transport Control of ventilation Non-respiratory functions 2 Dr. Armen Varosyan, DEAA, PhD
3 SOURCES OF INFORMATION Dr. Armen Varosyan, DEAA, PhD 3
4 Fundamental Textbooks of Anaesthesiology Dr. Armen Varosyan, DEAA, PhD 4
5 John B. West Video Lectures in Respiratory Physiology Dr. Armen Varosyan, DEAA, PhD 5
6 Dr. Armen Varosyan, DEAA, PhD 6
7 STRUCTURE AND FUNCTIONAL ANATOMY Dr. Armen Varosyan, DEAA, PhD 7
8 STRUCTURE AND FUNCTIONAL ANATOMY Upper respiratory tract (from nostrils to vocal cords) Lower respiratory tract (from vocal cords to alveoli) Dr. Armen Varosyan, DEAA, PhD 8
9 Ewald Weibel Classification of the human airways according to Weibel Weibel ER. Morphometry of the human lung. Heidelberg: Springer-Verlag, New York: Academic Press;
10 larger airway = higher flow & velocity small cross-sectional area smaller airway = lower flow & velocity large cross-sectional area 10 Dr. Armen Varosyan, DEAA, PhD
11 Significant increase in total crosssectional area of the airways in the respiratory zone Dr. Armen Varosyan, DEAA, PhD 11
12 VENTILATION Dr. Armen Varosyan, DEAA, PhD 12
13 Dr. Armen Varosyan, DEAA, PhD 13
14 Volume vs. Capacity Volume is the amount of 3D space taken up by an object, e.g. a solid, a liquid or a gas Capacity is the measure of an object s ability to hold a substance, e.g. a solid, a liquid or a gas Dr. Armen Varosyan, DEAA, PhD 14
15 Total ventilation = tidal volume (V T ) x respiratory frequency Minute volume of ventilation Anatomic dead space = the volume of the conducting airways, which does not take part in gas exchange (V D ) Alveolar ventilation = (V T - V D ) x respiratory frequency the amount of fresh inspired air available for gas exchange Physiologic dead space = the volume of gas that does not eliminate CO 2 V D / V T = 0.3 in spontaneous ventilation V D / V T = 0.5 in mechanical ventilation Dr. Armen Varosyan, DEAA, PhD 15
16 MECHANICS OF BREATHING Dr. Armen Varosyan, DEAA, PhD 16
17 MECHANICS OF BREATHING Muscles of Respiration 17
18 Pressure volume relationship and compliance Compliance is an index of distensibility of elastic organs and defined as the change in volume per unit change in pressure (ΔV/ΔP). Compliance Elastance Dr. Armen Varosyan, DEAA, PhD 18
19 Normal lung compliance ~ 0.2 to 0.3 L/cm H 2 O) Dr. Armen Varosyan, DEAA, PhD 19
20 Regional Differences in Ventilation Dr. Armen Varosyan, DEAA, PhD 20
21 Surface Tension Dr. Armen Varosyan, DEAA, PhD 21
22 Surface Tension Laplace's law. P = 2γ/R Pierre-Simon, marquis de Laplace Dr. Armen Varosyan, DEAA, PhD 22
23 Surfactant Composition ~40% dipalmitoylphosphatidylcholine (DPPC) 40% other phospholipids ~5% surfactant-associated proteins (SP-A, B, C and D) Cholesterol (neutral lipids) Traces of other substances Surfactant = surface active agents Dr. Armen Varosyan, DEAA, PhD 23
24 Surface Tension and Surfactant Dr. Armen Varosyan, DEAA, PhD 24
25 Type II pneumocyte Start to develop at about 24 weeks of gestation secreting small amounts of surfactant Adequate amounts are not secreted until about 35 weeks of gestation Electron micrograph of type II epithelial cell (x ) Dr. Armen Varosyan, DEAA, PhD 25
26 Pulmonary Surfactant Reduces the surface tension of the alveolar lining layer Increases lung compliance Increases the stability of alveoli Prevents pulmonary edema Has a short half-life Absence reduced lung compliance, alveolar atelectasis and tendency to pulmonary edema Dr. Armen Varosyan, DEAA, PhD 26
27 Commercially available surfactant medications Dr. Armen Varosyan, DEAA, PhD 27
28 Airway Resistance R = 8ηl πr 4 Derived from Hagen Poiseuille equation Jean Louis Marie Poiseuille Dr. Armen Varosyan, DEAA, PhD 28
29 Main site of airway resistance Dr. Armen Varosyan, DEAA, PhD 29
30 Pulmonary blood flow Dr. Armen Varosyan, DEAA, PhD 30
31 Gravitational Distribution of Blood Flow in the Lung John B. West Dr. Armen Varosyan, DEAA, PhD 31
32 Gravitational Distribution of Blood Flow in the Lung Dr. Armen Varosyan, DEAA, PhD 32
33 Non-gravitational causes of uneven blood flow Random variations in the resistance of blood vessels Some evidence that proximal regions of an acinus receive more blood flow than distal regions In some animals some regions of the lung have an intrinsically higher vascular resistance
34 Hypoxic Pulmonary Vasoconstriction alveolar hypoxia constricts small pulmonary arteries the precise mechanism is not known occurs in excised isolated lung probably a direct effect of the low PO 2 on vascular smooth muscle a compensatory mechanism aimed at reducing blood flow in hypoxic lung regions Dr. Armen Varosyan, DEAA, PhD 34
35 Shunt Dr. Armen Varosyan, DEAA, PhD 35
36 Ventilation-Perfusion Relationship Dr. Armen Varosyan, DEAA, PhD 36
37 Ventilation-Perfusion Relationship Distribution of V, Q and V/Q ratio in the normal, upright lung Dr. Armen Varosyan, DEAA, PhD 37
38 Ventilation-Perfusion Relationship Dr. Armen Varosyan, DEAA, PhD 38
39 Ventilation-Perfusion Relationship Dr. Armen Varosyan, DEAA, PhD 39
40 V D CO 2 elimination Q S arterial oxygenation Dr. Armen Varosyan, DEAA, PhD 40
41 Diffusion Dr. Armen Varosyan, DEAA, PhD 41
42 Diffusion Fick's Law of Diffusion Adolf Fick, 1855 Dr. Armen Varosyan, DEAA, PhD 42
43 Diffusion O 2 vs CO 2 MW MW Solubility Net diffusion 32 < ~ 6.6 < 30 times < 20 times Dr. Armen Varosyan, DEAA, PhD 43
44 Diffusion of Oxygen Across the Blood-Gas Barrier At rest PaO 2 virtually reaches PAO 2 after about 1/3 of its time in the capillary The diffusion process is challenged by exercise, alveolar hypoxia, and thickening of the blood-gas barrier True diffusion defects that create arterial hypoxemia are rare Dr. Armen Varosyan, DEAA, PhD 44
45 Gas transport Dr. Armen Varosyan, DEAA, PhD 45
46 Gas transport O 2 dissolved combined with Hb Dr. Armen Varosyan, DEAA, PhD 46
47 Gas transport Dissolved O 2 For each mmhg of PO ml O ml -1 of blood or vol. % In normal arterial blood PO 2 of 100 mmhg 0.3 ml O ml -1 Dr. Armen Varosyan, DEAA, PhD 47
48 Gas transport O 2 capacity: 1 g Hb ml O 2 O 2 saturation of Hb = O 2 combined with Hb O 2 capacity X 100 CO 2 = 1.39 x Hb x SO 2 (%)/ PO 2 Dr. Armen Varosyan, DEAA, PhD 48
49 O 2 dissociation curve Dr. Armen Varosyan, DEAA, PhD 49
50 Shifts of the O 2 dissociation curve Dr. Armen Varosyan, DEAA, PhD 50
51 Gas transport CO 2 dissolved as bicarbonate in combination with proteins as carbamino compounds Dr. Armen Varosyan, DEAA, PhD 51
52 CO 2 carriage in the blood Dr. Armen Varosyan, DEAA, PhD 52
53 Dr. Armen Varosyan, DEAA, PhD 53
54 Control of respiration Dr. Armen Varosyan, DEAA, PhD 54
55 BASIC ELEMENTS OF THE RESPIRATORY CONTROL SYSTEM West, John B. Respiratory Physiology: The Essentials, 9th Edition Copyright 2012 Lippincott Williams & Wilkins, a Wolters Kluwer business Dr. Armen Varosyan, DEAA, PhD 55
56 Respiratory centres in brainstem Medulla DRG - inspiration VRG - expiration Pre-Bötzinger Complex (ventrolateral) pattern generator? Pons Apneustic excitatory function Pneumotaxic inhibits inspiration Dr. Armen Varosyan, DEAA, PhD 56
57 Dr. Armen Varosyan, DEAA, PhD 57
58 Dr. Armen Varosyan, DEAA, PhD 58
59 Peripheral chemoreceptors Dr. Armen Varosyan, DEAA, PhD 59
60 Carotid bodies respond to PO 2, PCO 2, ph little response to normoxia very high blood flow respond to arterial, not venous PO 2 response to PCO 2, ph is < important fast response Dr. Armen Varosyan, DEAA, PhD 60
61 Lung receptors pulmonary stretch receptors (slowly adapting pulmonary stretch receptors) Hering-Breuer inflation reflex irritant receptors (rapidly adapting pulmonary stretch receptors) J receptors (juxtacapillary) bronchial C fibers Dr. Armen Varosyan, DEAA, PhD 61
62 Other Receptors nose and upper airway receptors joint and muscle receptors gamma system arterial baroreceptors pain and temperature Dr. Armen Varosyan, DEAA, PhD 62
63 Non-Respiratory Functions of the Respiratory System Dr. Armen Varosyan, DEAA, PhD 63
64 Non-Respiratory Functions of the Respiratory System Protective functions of respiratory tract Non-respiratory functions of pulmonary circulation Metabolic functions of the lung Dr. Armen Varosyan, DEAA, PhD 64
65 Protective functions of respiratory tract Warming Humidification Raises incoming air to 37 Celsius Raises incoming air to 100% humidity mucociliary escalator Filtration Removal of filtered particles (cough, cilia) Defense mechanisms of terminal respiratory units (macrophages and other relevant cells) Olfaction Dr. Armen Varosyan, DEAA, PhD 65
66 Non-Respiratory Functions of the Respiratory System Non-respiratory functions of pulmonary circulation Reservoir for left ventricle (contains about 500 ml blood) Fluid and electrolyte exchange Filter to protect the systemic circulation Dr. Armen Varosyan, DEAA, PhD 66
67 Non-Respiratory Functions of the Respiratory System Non-respiratory functions of pulmonary circulation Filter to protect the systemic circulation traps particles entering mixed venous blood as a result of: natural processes trauma therapeutic measures including: small fibrin or blood clots, fat cells, bone marrow, detached cancer cells, gas bubbles, agglutinated RBC's, masses of platelets or WBC's, debris in stored blood, particles in i.v. solutions Dr. Armen Varosyan, DEAA, PhD 67
68 Non-Respiratory Functions of the Respiratory System Metabolic functions of the lung Uptake or conversion of chemical substances by lungs Formation of chemical substances Pulmonary surfactant Release into blood of substances stored in pulmonary tissues Bradykinin Histamine Serotonin PGE 2, PGF 2 Heparin Dr. Armen Varosyan, DEAA, PhD 68
69 Thank you for attention Dr. Armen VAROSYAN
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