Anatomy

MedEX Lung Volumes

Anaesthesiology FRC,

April 2022 CC,

Oxygen Cascade,
Preparatory Class Gas Transport,

Hypoxemia &

Respiratory
Hypoxia

Physiology I
Anatomy
• Respiratory Tract

• Innervation

• Muscles involved
Respiratory tract
• Start from Nose

• End at Alveoli
Nose
• Humidification

• Filtration

• Olfaction and sensory

• Speech

• Cosmetic
 Pharynx
• Can be divided into nasopharynx, oropharynx, laryngopharynx

• Fibromuscular tube, 12cm in length

• Landmark
• Communicate with nose and mouth anteriorly
• Communicate with oesophagus inferiorly

• Function
• Swallowing
• Separation of digestive and respiratory tract
• Phonation
• Immune function
Larynx
• Divide the airways into upper and lower

• Divided by vocal folds into upper and lower half

• Function
• Respiration
• Swallowing
• Phonation
• Cough reflex
Total 23 generation
7 generation of
respiratory zone

1 football team
consist of 23 players
Minimum 7 players
needed.
Trachea
• Start from Level of C6, cricoid cartilage, ends at sternal angle

• May move down by 5cm during full inspiration

• Fibrocartilaginous tube, C shape, posterior by a sheet of muscle

• 10cm long
Acinus
• Functional unit of lung.

• Consist of
• Respiratory bronchioles
• Alveolar ducts
• Alveolar sacs
• Alveoli
Innervation
• Recurrent laryngeal nerve
• Sensory innervation for larynx below vocal cord
• All muscle of larynx except cricothyroid

• Superior laryngeal nerve

• Sensory innervation for larynx above vocal cord
• Cricothyroid muscle
Lung volumes
• Volumes

• Capacity
FRC
• Volume of which remains in the lungs at the end of normal expiration

• ERV + RV

• Balance point between tendency of chest wall to spring outwards and tendency of the
lung to collapse inwards

• 30ml/kg
Measurement of FRC
• GAS dilution methods
• Nitrogen washout method
• Helium washin method

• Body plethysmography
Function
• Oxygen store

• Buffer to maintain a steady arterial pO2

• Prevent atelectasis

• Minimize work of breathing

• Minimize pulmonary vascular resistance

• Minimize V/Q Mismatch

• Keeps airways resistance low

Factors affecting
• 5 major factors
• Height
• Weight
• Position
• Disease
• Muscle relaxation
Consequences of decreased FRC
• Decrease lung compliance
• Increase airway resistance
• Increased work of breathing
• Decrease TV, Increased RR
• Decrease Oxygen reserve
• Increased atelectasis
• Increased shunt
• Increased PVR
• Increase RV afterload
Closing capacity
• Lung volume at which the small airways in the lung first start to close.

• Small airways tend to 1st collapse at the bases of the lung, most squashed.

• CC = RV + CV
Measurement
Factors affecting
• Expiratory airflow

• Expiratory effort

• Small airways disease

• Increased pulmonary blood volume

• Decrease pulmonary surfactant

• Parenchymal lung disease

• Age
Clinical significance
• Denitrogenation of FRC

• Atelectasis

• Age-related decrease in Oxygenation

• Lung injury
Oxygen cascade
• an ordered journey from the atmosphere to the mitochondria

• Stepwise decreases in pO2

Alveolar Gas Equation
Critical oxygen deficit: "Pasteur
point"

• Critical threshold for oxygen tension beyond which aerobic metabolism cannot be
continued

• 1mmHg
Oxygen Transport
• Oxygen consumption: 250ml/min

• Oxygen flux
• Amount of oxygen delivered to the peripheral tissues per minute
• 1000ml/min in healthy adult

• Carried in
• Chemical oxygen
• Dissolved oxygen
Oxygen Flux
Oxygen storage in body
Oxygen Dissociation Curve
(ODC)
Hypoxia & Hypoxaemia
• Hypoxaemia => abnormally low concentration of oxygen in arterial blood

• Hypoxia => failure of tissue oxygenation

• Types of Hypoxia
• Hypoxaemic Hypoxia (Problem with supply)
• Anaemic Hypoxia (Problem with trucks)
• Ischaemic Hypoxia (Problem with highway)
• Histotoxic Hypoxia (Problem with end user)
Postoperative hypoxemia
• Decreased alveolar oxygen

• Decreased perfusion of gas exchange surfaces

• Decreased mixed venous oxygen content