RESPIRATION

When these 2 structures are connected, The moment knlfe/rods enters the pleural space,
there is going to be disconnectlon between thoracie
The net voLume - 2.5 LFunctiondl resldual capacity
wall and lungs.

Happens when Thismakes chest wall to look more inflated.

1. Elasticty of lung Is compensated by elastlictty of Lungs go for collapse.
chest wal.
2. These In no net force acting on thorax. Separation of chest wall and ungs
VNo 0nward recoiling
No outward recoiling.
Connection of lung and chest wall.by Chest wall Lungs collapse in
Expands out CAtelectasis]
Pleural Membranes Parieta.

Visceral Signitksbsplkad5A 4dlaag24c8ad33

Both layer s moves in opposite direction. |18:04|

-ve intrapleural pressure

(Negative)

Also facilitated by sucking eftect of lymphatics

Stab injury to thorax

Penetrates al. the way to pleural cavity

Skin
’Pectoralis fascia
Disorder that decreases lung elasticity
’P.major 1. Emphysema Chest wa expansion
Serratus arterior
Intercostal musdes
2. Old age
Normal thoracic shape - transversely elliptical

BAGTIVE SPACE

eGurukul 3.0/2022 185

 RESPIRATION

Tronsverse dia.
AP dometer duoys less than transverse diameter.

Chest wdll expansion

Normal 22:36

AP BeralShaped Chest

Barrel shaped chest

Decreased lung elasticity

<

Disorder tht decreases chest wd elasticity:

2 Severe ancemia
2 Neuromuscular disorders.
3. Kyphosis | Scoliosis
When lung loses its elastiity, the chest udll. pulled
aut.
when chest uall loses elasticity, chest uoll is pulled in
by lungs.
GACTIVE SPACE
63b79aba4554da6d24c8ad33

eGurukul 3.0/ 2022 186


RESPIRATION
Pulreras Vertilatie - Respinatey luscles,
hesswnes
a Sution Rmp
9176579g&5
Prestuve
Pussove
Balleen
The gas jar is going to be connected to a
membrane.
There is a thread to pull. the membrane.
These are 2 openings in the glass chamber.
< expanded -This is positive pressure ventilation.
Through opening 1-connect a balloon.
Through an other opening ’inserta tube
Possibilities to inflate the balloon
Open up the space over the balloon-’mouth
exposed to air.
1. Take air pump and push air into the balloon
with high pressure ,so that balloon gets
expanded.
2. Use asuction pump and suck air out of
second tube creating avaccum(negative
pressure around the balloon. By artificially
creating a negative pressure around the
bdloon. I would be able to suck air from
eGurukul 3.0/ 2022
oficial Notes Partner:
atmosphere. Again this leads to inflation of
balloon.
3. If we pul. the thread of membrane downwards
again going to create a negative pressure and
air is sucked in.
Balloon can be inflated by 2 methods.
1. By administering positive pressure.
2. By creating negative pressure around the
balloon.
Alung which has got natural tendency to stay
collapsed to inflate it. I need to use a huge
degree of force -’ elther Ineed to push air into
ungs with agreater pressure -called as positive
pressure.
If ladnlnister more pressure than auready
present in the lung ->the lung isgoing to get
On the otther hand, if l create negative pressure
around the ungs using suction purmps or pulling
the membrane down. If I use a negative pressure
around the lung. negative pressure is going to be
inflated.
So these are 2 methods of expanding a ung
1. Positive pressure ventilation (breathing)
2. Negative pressure ventilation
Whatever pressure we are going to use- it is
golng to be active process.
187
 RESPIRATION

Inspiration Explratlon o Prlme muscle : Dlaphragm ’0nnervated by

During normal Passive Process. phrenie (C, CG)
physiologlcd. GCi, G, is Inturn Innervated by resp.
process, Inspiratlon Centres In braln.
happens by
creating a negative When diaphragm is pulled down, ventricular diameter
of thorax is increased.
pressure around
the lungs, not by By using external intercostal muscles, we can be able
pushing air into to Lift the lateral wall out->Increases transverse
lungs. |diameter.
When negative
pressure normal Without even voluntary Input, dlaphragm contracts
and relaxes facilitating breathing making air getting
breathing fols, we
wll. be Intubating into lung, Insplration happens uhich is exactly why
the dlaphragm is called prime muscle of inspiration.
patient,connecting Accessory muscles of inspiration
the patient to 1. External intercostals
mechanical
2. Serratus anterior.
ventilator,machine 3. Scalene musces.
is going to push air ALL 3musdes are involved in fting up the
into ungscalled ribs.
as positive 4. Sternomastoid -involved in ifting sternum
pressure
ventilation.
upwards.
Expiration
Positive pressure ventilation occurs by Passive process
No need of active input
’Mechanical ventilator Can be read in 2 aspects
’Bag and mask ventilation. 1. Spontaneous subconscious expiration
(passive process)
inspiration 63b79aba4554da6d24c8ad33 When Iexpire, lcontrol my expiration so that
1. Negative pressure breathlng the air exit happens n a very gradual manner.
2. Active process This air coming out of my Larynx is being to set
(Neural 2 chemlcal mechanlsm) to get vibrated by vocal cords. The vibration,
the vocal cords sets 0n over the air molecuies
3. Muscdes of Insplration
GACTIVE SPACE

eGurukul 3.0/ 2022 188

 RESPIRATION

makes the air molecule to resonate wlth that Ventrice diameter decreased,so that the air in the
vibration as the air molecule comes to pharynx thorax is going to be pushed out.
oral activity, it is going to come out as speech. 3. Internal intercostal muscle
The prime resonant factor glven to the air
molecule is by vocal cords. This air molecule
comes to the vocal cord during expiration. Going to bring doun the rib coges.
Based on tthe speed Im talking, based on Ribs are pulled out by external intercostals
phonetics Im talking, if Im singing.my Ribs are pulled down by Internal intercostals
respiratory effort has to be different.
Based on my demand, the need to produce aword,
the need with which word has to be spell out-l PRESSURES INRESPIRATORY SYSTEM 20:54
control my expiration so that the air exist is
1. Transmural pressure
going to happen in atargeted manner, the
vibration sets in, speech comes out.
During special conditions like continucus
speaking, continuous singing, exercises where you Tramaa Resure
have to consciously breath out carbon dioxide
more -expiration becomes active process. Epend
Muscles of expiration:
1. Rectus abdominis(most important.)
ttt
Pitde Potside
When it squeezes abdominal cavity it is going to
exert aforce on the visceral orqans of abdomen. This
force exerted by rectus abdominis is supportedby
2. Externa. oblique abdominis
Internd. oblique abdominis
By this method, both these muscdes are going to Membrane is a part of hollow viscous.
squeeze or push abdominadl organs up If this hollow viscous need to expand
63b79aba4554da6d24C8ad33
Elevates the diaphragm Pressure inside Pressure outside
Viscous Viscous
Toinflate, the pressure inside viscera should be
more and Less pressure outside viscous so that

ACTIVE SPACE

eGurukul 3.0/2022 189

 RESPIRATION
the structure gets expanded from region of Low
pressure to aregion of high pressure.
So, any pressure which is used to inflate in the
transmura. pressure (word mural stad for
tissue)
Pressure across the organ or hollow viscous
This pressure is facilitating expansion of
viscous.
Calculated using pressure inside viscous
pressure outside
And this value should be more positive.
o Trans ventricular pressure =Pressure inside
Ventricle
Pressure outside ventrice
Blood vessel Transvascular pressure
o Stomach -+Transgastric pressure
o Bladder Trans ventricular pressure
Inspiration of lungs
Happens becuse of the gradient transpulmonary
pressure.
Here the tissue is lung, alveoli.
Transpu.monary pressure is the pressure acting
inside the dveoli and outside the alveoli.
Traspuimonay Ressue
63b79aba4554d6a~a&8ad33
lahapeal Re
Presure
GACTIVE SPACE
eGurukul 3.0/ 2022
Intra alveolar presure - Intra pleural pressure
Transpulmonary Pressure
If insplration has to take place, ue need positive
pressure in the dlveoll less negative pressure.
Intrapleural pressure 5cm H,0
Intra dlveolar pressure ’lcm H0
Alveoli are kept in expanded manner.
Alveoliis astructure which is naturdiy designed
to collapse.
In order to pull the structure going to collapsing
stage, needa much much negative pressure
outside that is getting contributed by intrapleura.
pressure which is Scm H20.
If the subject needs to inspire,
Intra alveoLar pressure becomes - cm H¿0
Intra pleural pressure becomes - tcm H,0
Respiratory muscdes -diaphragm, external
intercostals scaleini, serratous arterior,
sternomastoid, dll.these muscles comes into play,
the ribs are pulled outwards and upwards, sternum
is pulled outwards and upuards, Diaphragm is
pushed downwards these by vertical diameter
increases, transverse diameter increases, antero
posterior diameter increases, when there is going
A,the sides of pleural
CavITY, Intrapleural pressure becomes more
negative (from -5 to - cm H,0)
When the intrapleural pressure is going to be
more negative, naturally from high pressure
region, alveoli will expand.
190
 RESPIRATION

Once the alveoli expands pressure inside alveoli

drops from 1cm H,0 to -1 cm H,0
Air from atrmosphere is going to go from ahigh
pressure to Lower pressure of intra alveolar
pressure.
Expiration
While expiration takes place, because of
compression of chest wall, compression of organs
over diaphragm, the diaphragm is pushed up, all
diameters will reduce.
Intrapleural pressure comes to -5cm H,0.
Intraalveolar pressure comes to +1 cm H,0
Because high pressure in dlvecli, air from high
pressure region of alveoli qets out back into
atmosphere.
O
mmHg means equivalent to atmospheric pressure
When asubject is not breathing, but he has
opened his glottis

Air from atmosphere enters into oral cavity

Pressure in respiratory is going to be equd. to

atmospheric pressure

O
mmHg
GACTIVE SPACE
917657904175

eGurukul 3.0/ 2022 191

 Offic1al Notes Partner

RESPIRATION

lulorerany Vertidatier - Ceryliace ard Sunlace

Tersier Part 1
Compliance :Easiness of expansion Alveoli:

Type 2 Preumocybes
Corresponds directly to thinness of wall
Type pneumozybe
InverselyA volume
relation to elasticity
Compliance - Apressure
Ifa structure is very thin, no elasticity or very
very less elastic with application of ImmHg
pressure itself,you can inflate the structure
massively. So for asmall change in pressure, Alveoli is immediately attached to pulmonary
volume change is going to be high. capillary.
2 classes of cells in alveoli.
Pulmonary compliance:
Change in volume AV
Change in pressure AP

Alung volume
Type 1 Type 2
ATranspulmonary Pressure
Alveolar pneunocyte Alveclar pneurmocyte
Type 1:very flat cells
Lines 95% of alveoli
Vabe
lnapaien Forms 95% of gas exchange membrane
Do not have reqenerative property
Secrete afluid named as alveolar fuid.
Iype 2: Big globular cells
TeaNSPwNAN RESSURG
63b79aba4554da6d24c8ad33ines 5% of qas exchange membrane
For the same transpulmonary pressure, the
volume of air during inspiration is different from Tremendous regenerative property (stem
expiration. cells)
The difference between inspiration and expiration
is called hysteresis.
 RESPIRATION
Darmage to type Ipneumocytes
Gas exchange compromised
Type 2pneumocyte from the point of attachment Jt
comes down to the place where type 1pneumocyte was
originally present.
Convert themselves to stem cells and multiply.
When they multiply and divide, they turn
themselves to type 1pneumocytes.
Type 2 pneumocytes secretes surfactants.
SURFACTANTS 16:30
Synthesis: starts from 24-26 weeks of gestation.
Fully functional by 32-34 weeks of gestation
Composition : predominantty alipid molecule
1. Dipalmitoyl phosphotidyl choline (lecithin)
2. Sphingomyelin
3. Surfactant protein A
4. Surfactant protein B
" Functional component of surfactant is measured
by ratio between lecithin and sphingomyelin
lecithin:Sphinomyelin ratio
>2 ’Normal Value
Surfactant is effective in its.function
Surface tension
53679aba454dg6c4adg
Breaker with water molecules arranged layer by
layer.
One water molecule will be attracted equdlly by
all the sides.
The net force Is going to be equa.
So, the molecule is equally attracted by 360° that
particular molecule is going to hold its postion
conslstent.
If you consider molecule on superficial surface
dfference between molecule inside and
superficial surface is on the superficial surface
there is air there is qoing to be formation of air,
water interface -’air water interface molecule.
Again this molecule is attracted by sides and is
going to acquire position.
Every single molecule over superficial layer
wOuld collide with each other. This collision will
convert superficial Layer of molecules into a
membrane kind of consistency and going to act as
Surface.
Becquse of collision force, there is qoing to be
tenslon between them called as surface tension .
Presence of surface tension makes water
molecules toclub togetther.
Surface tension happens at aparticular site
where there is going to be air water interface.
Because of air-water interface ’ surface tenslon
comes in and because of surface tenslon water
molecule tries to club to each other and this leads
to formation of water droplets.
 RESPIRATION
when a baby is in uterus, the whole lung is going
to be filled with amniotic fuid.
> In uterine life ’whole alveolus is filled with
amniotic fluid.
ALong with amniotic fluid, there is
going to be some amount of alveolar
fuid (secreted by Type 1pneumocyte)
Oxygen demand of foetus is taken care by
placenta.
The moment the baby comes out of birth
canal and takes first breath,amniotic fuid
from lungs will. be spitted out.
For the first time, dlveoli is going to have
emptiness only alveolar fluid present.
Air
iterface
+Aheolar
Alveolar fluid gets collided with each other to
form a droplet of alveolar fluid.
Alveoli is a non bony structure
Content of the bag is ging to determine
diameter of bag
If the droplet is formed membrane also will.
take the size of droplet and the whole alveoli will
go for collapse-> Atelectasis-’ collapse of lung.
In the same alveolus, whenever alveolar fluid is
present, we dlso have lipidiceous material called
surfactant.
Surfactant is placed between the water molecule.
Surfactant is alipid and you have a water
molecule beside.
If you add drop of oil to water, water gets
scattered awoy, exactty uhat is going to happen in
alveoli.
Because of the presence of surfactants in the
alveoli, the intermolecular attractive force is cut
.So, the presence of surfactant is going to
reduce or abolish attractive force between water
molecules.
When surfactants are absent.
Delivery happens before complete maturation
(preterm labour) ’Infant respiratory
distress syndrome.
917657904175 Neonatal
Administer gucocorticoids to mother ateast t days
before delivery
Enhances foetal lung maturity
1. TNo of type l pneumocytes
2. 1Secretary vesicles which are filled with
surfactant.
Inside type Ilpneumocytes
> These secretary vesicles are called Lamellar
bodies.
Rx: Administration of intra nasal. surfactant.
 Official Notes Partner:

RESPIRATION

Pulreray lertilatier -Cenyliarce ard Sunlace

Teryier Part 2
Laplace law: Volume ttVolume
Collapsing pressure inside
ttSurface tension JUSurface tension
2xSurface tension
an dvedli a
Radius of the alveoli
ttCollapsing pressure tCompliance
When alveolar volume increased
lin complGt79 aba4554da6d24c8ad33

Trigger for li pneurnocytes In order to preventcollapse,you need to apply

greater transpulmonary pressure.
Hagnitude of transpulrnonary pressure to keep
Secrete more surfactants the alvedliopen is going to be very high.
" Smaller alveoli difficult to expand
An alveoli with aopen position has got better
ISurface tension compliance than with closed position.

End of Expiration
End of Inspiration
Volvne
Fuids are placed
dosed together Alveolar fuid are widely located,
placed in adistant manner
leading to very
high inter This distance itself is going to reduce RV
moleaular the attractive force of alveolar fluid.
attractive force.
This wide Location od alveolar Transpumonay Pressue
fuid is going to have impact witth " When an alveollor lunq is in residual volume,
interalveolar fuid, attraction there is qoing to be increase surfoce tension
forces coming down. This itself becouse of less size.
will reduce surface tension In order to combat surface tension, there is more
conferring stability of alveoli. transpulmonary pressure need and there is going
Bigger alveoli are more stable to be decreased compliance.
because of Less surfactant.
 RESPIRATION

RVcharacterized by 1tSurface tension 2. Radius of alveoli.

3. Laplace aw.
LCompliance. 4. Transpulmonary pressures.
Compliance is change in volume with change in > If the ung is filled with air, there is going to be
pressure. striking difference between inspiration and
When the dlveoli reaches the maximum volume, it expiration.
cannot be inflated any further because if we Instead of air, If we will the lung with saline, the
apply too much transpulmonary pressure, dlveoli difference between inspiratory curve and
may get ruptured but not going for expansion. expiratory curve is not very much.
At total ungcapacity, because alveoli has
reachedmaximum size-»this alveoli cannot saline
expand anymore. filled
Even though there is very much reduced surface lung Ar fled
tension, because of alveolar limit has reached, lung
there is going to be reduced compliance in lung
which is completely filled with air.
> During expiratory phase, uhen there is still.
availability of expansion-lungs will show
maximum compliance. Saline filled lung:
Cause for hysteresis 1. No greater transpulmonary pressure
required.
Ina lung that is cbout to go for inspiration, when 2. The difference between inspiration and
asubject expires, lung will be in residual volumes, expiration is much less.
so there isqoing to be too much of surface Saline lungs can be to fetal
tension.So, when this subject is going to take up lung where the whole lung wil. be filled with
his breath ,the need of transpulmonary pressure amniotic fuid also caled foetal Lung.
is very high because surface tension is going to
be very hiqh. At the same time, when he has
Curve is going to be different.
reached maximum position, inspiration is going to
be very easy, so surfoce tension is less. Because Only when there isalr fluid interphase, there
of this reason, the aurve differs. going to be surface tension.Becauseof surface
Reason for hysteresis: tension, there is going to be hysteresis.
917657904175 Saline/Amniotic fuid filled lung
1. Surfoce tension differs between inspiration o No air fluid interfoce.
and expiration. o No surface tension
 RESPIRATION

o No hysteresis
Changes in compliance:
Increased: Decreased:
1. Emphysema 1. Fibrosls
2. Old age 2. Amyloidosis
3. Sarcoidosis
4. Asbestosis
5. Silicosis
6. Chest wall disorders
(Scoliosis, kyphosis,
kyphoscoliosis)
. Pleural effusion.

When there is accumulation of fuid in pleural

space, the expansion of alveoli is going to be
difficult.
2L
> Norml value of compliance
1mm Hg

917657904175