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2M: CONCEPT OF OXYGENATION
Oxygenation
● process of supplying oxygen to the
body's cells
● Used for:
○ Ventilation - to achieve
these functions muscles and
structures of the thorax
create the mechanical
movement of air into and out
of the lungs
○ Respiration - ventilation gas
exchange occurs at the
alveolar level where blood is
oxygenated and carbon
dioxide is removed
● Functions:
○ is to provide the body with a
constant supply of oxygen
and to remove carbon
dioxide
How do the respiratory, circulatory and
hematologic systems work together?
● performs a number of functions
including metabolism of endogenous
and foreign agents defense against
disease and chemical injury in most
especially gas exchange between
oxygen and carbon dioxide
● Cardiac Output
○ the amount of blood that the
heart pumps in one minute
○ in order for oxygenated blood
to move from the alveoli in
the lungs, to the various
organs and tissues of the
body the heart must
adequately pump blood
through the systemic arteries
● Perfusion
○ the passage of blood
through arteries to an organ
or tissue
Globin
● Protein molecules that bounds with
iron in heme to form hemoglobin or
myoglobin
● heme-containing proteins involved in
binding and or transporting oxygen
● 4 GLOBIN CHAINS
○ alpha 1 and 2 and beta 1 and
2 comprising each
hemoglobin molecule
consists of two identical pairs
of unlike polypeptide chains
with 141-146 amino acids
Heme
● composed of a ring-like organic
compound known as a parfrin to
which an iron atom is attached
● plays multiple roles in cellular
processes
● the strong affinity of heme toward
oxygen makes it possible for
hemoglobin and myoglobin, two
heme-containing proteins to function
as major oxygen transporters
● also participates in respiration,
sensing of diatomic gasses, drug
detoxification, signal transduction,
and regulation of transcription,
translation, microrna nucleic acid
processing, mitochondrial protein
import, protein stability, and
differentiation
● 1 O2 molecule = 1 group of heme
● Able to bind to O2 loosely &
reversibly
● Iron is present, non protein
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Oxyhemoglobin ○ Internal Respiration

● the oxygen-loaded form of ■ Exchange of gasses
hemoglobin and is bright red between the systemic
● O2 + Hgb = HbO2 capillaries & tissue
● Dissociates easily when the O2 cells
concentration is low
Hemoglobin There are two types of Respiration:
● the predominant protein in red blood
External Respiration
cells
● is a protein molecule that binds to - Exchange of gases between the
oxygen alveoli & blood
● forms an unstable reversible bond - O2 + Hb = HbO2 (loading of O2)
with oxygen
HCO3 + H = H2CO3 → CO2 + H2O
(unloading of CO2)

Internal Respiration

- Exchange of gases between the

systemic capillaries & tissue cells
- CO2 + H2O = H2CO3 → H + HCO3

● In external respiration, there are two

stages involved which are ventilation
breathing and gas exchange which
occurs in the alveoli and blood.
● Internal respiration involves two
Respiration processes, first is the exchange of
● whole process of gas exchange gases between the bloodstream and
between the atmospheric gas and the tissues. The second process is
the blood and between the blood cellular respiration from which the
and cells of the body cell utilizes oxygen to perform basic
● “PERI” metabolic function.
○ Pulmonary Ventilation
■ Flow of air in and out How respiration occurs both in the
of the lungs cellular level and through the alveoli
○ External Respiration
■ Exchange of gasses
between the alveoli
and blood
○ Respiratory Gas Transport
■ RBC transport
system/ “RBC
Express”

Basic Principles of Gas Exchange
Oxygen is carried in the blood in 2
Forms:
Carbon Dioxide is carried in the blood in
2 Forms:
● Gas exchange during respiration
occurs primarily through diffusion.
○ Diffusion is a process in
which transport is driven by a
concentration gradient. Gas
molecules move from a
region of high concentration
to a region of low
concentration.
● Blood that is low in oxygen
concentration and high in carbon
dioxide concentration undergoes
gas exchange with air in the lungs.
The air in the lungs has a higher
concentration of oxygen than that of
oxygen depleted blood in a lower
concentration of carbon dioxide. This
concentration gradient allows for gas
exchange during respiration.
● Partial pressure is a measure of the
concentration of the individual
components in a mixture of gases.
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● The total pressure exerted with the
mixture is the sum of the partial
pressures of the components in the
mixture.
● The rate of diffusion of a gas is
proportional to its partial pressure
within the total gas mixture.
● Dissolved O2 in plasma
● Combine with Hb or Hgb in RBCs =
O2 saturation
● Bicarbonate (HCO3) - CO2 in
plasma
● CO2 in Hb at a different site than O2
- Oxygen saturation is an essential
element of patient care. Oxygen is
tightly regulated within the body
because hypoxemia can lead to
many acute adverse effects on
individual’s organ systems. These
include the brain, heart and kidneys.
- Oxygen saturation is a measure of
how much hemoglobin is currently
bound to oxygen compared to how
much hemoglobin remains unbound.
- At a molecular level, hemoglobin
consists of 4 globular protein
sub-units. Each sub-unit is
associated with hemoglobin. Each
molecule of hemoglobin
subsequently has 4 heme-binding
sites readily available to bind
oxygen. Therefore, during the
transport of oxygen in the blood,
hemoglobin is capable of carrying of
up to 4 oxygen molecules. Due to
the critical nature of tissue-oxygen
consumption in the body, it is

essential to be able to monitor
current oxygen saturation.
- A pulse oximeter can measure
oxygen saturation. It is a check the oxygen saturation level of
non-invasive device placed over a
person’s finger. It measures
light-wavelengths to determine the
ratio of the current level if
oxygenated hemoglobin to
deoxygenated hemoglobin. The use
of pulse oximetry has become a
standard of care in medicine. It is
often regarded as a fifth vital sign.
As such, medical practitioners must
be familiar with the functions and
limitations of pulse oximetry. They
should also have a basic knowledge
of oxygen saturation.
How to Use a Pulse Oximeter
Nursing Application
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- During the pandemic, pulse oximeter
was a vital device to have. This is to
patients suspected and diagnosed
with COVID-19.
What is the normal level of SpO2 during
anesthesia?
● Normal SpO2 is 96% or above.
● During anesthesia, this should be
maintained.
● This means we need to be
concerned with SpO2 readings of
below 95%
Respiratory Mechanics
Diffusion
● Higher - lower concentration
● Little or no energy required
- The structure of the lung maximizes
its surface area to increase gas
diffusion, because of the enormous
number of alveoli, approximately 3
hundred million in each human lung.
The surface area of the lung is very
large with a measurement of 75
square meters. Having such a large
surface area increases the amount
of gas that can be diffused into and
out of the lungs.
Perfusion
● Latin = “perfundere” - to pour over
● Passage of fluid through a specific
organ or an area of the body
- Is the body process of supplying
oxygenated blood to the cells and is
reliant to adequate cardiac output in
order to be optimal.
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Pulmonary / Lung Compliance (C)

● Measure of the ease of expansion of the lungs and thorax
● Ability of the lungs and pleural cavity to change in volume based on pressure changes.
- Lung compliance or pulmonary compliance is the measure of the lung expandability
which is important in ideal respiratory system function. It refers to the ability of the lungs
to stretch and expand.
- Factors affecting lung compliance include elasticity from the elastin in connective tissue
and surface tension which is decreased by surfactant production.
- Lung compliance participates in the lung-chest wall system by opposing the outward pull
of chest wall compliance.
Lung Elasticity (LE)
● Essential for lung distention during inspiration and lung recoil during expiration
● Represents the mechanical properties of the lungs
- The net compliance or/of the lung-chest wall system allows the lungs to achieve
appropriate functional residual capacity which is the volume remaining after passive
expiration.

Importance of compliance
(Lung compliance is inversely proportional;
to elastance this elastic resistance is both true
to the elastic property of long tissue or
parenchyma and the surface elastic force; any
changes occurring to these forces can lead to
changes in compliance)
(Compliance determines 65% of the work of
breathing in; if the lungs has low compliance,
it requires more work from breathing muscles
to inflate the lungs in specific pathologies
continuous monitoring of the lungs.)
(Continence curve is useful to understand
the progression of the condition and to decide
on therapeutic settings needed for ventilator
management.)
IMPORTANT FACTORS:
● ELASTIN
-Highly stretchable CHON in pulmonary
interstitial connective tissue; like a “rubber
band”
-Highly resistant to further stretching once the
lung is stretched to large volume.
● SURFACE TENSION
-Physical property of H2O; powerful
contributor to the elastic recoil of the lung.
-Inward force created by films of molecules
that can reduce the surface area.
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● SURFACTANT
-Continuously produced by alveolar type II
epithelial cells/pneumocytes
● LUNG VOLUME
● AGE
(Some compliance can be calculated by
dividing volume by pressure; two important
factors of lung compliance are elastic fibers
and surface tension; more elastic fibers in the
tissue lead to ease in expandability and
therefore compliance.)
(Surface tension within the alveoli is
decreased by the production of surfactant to
prevent collapse.)
(Compliance is more easily achieved by
decreasing surface tension. Other factors
affecting pulmonary compliance, elastic
property of the lung tissue which results from
collagen and elastin fibers inside the lung
parenchyma.)
(Surface tension elastic force: one of the
important concepts affecting lung compliance
is the elastic property of the lung contributed
to by the surface tension of the alveolar
lining.)
(Surfactant is a surface active agent in the
fluid secreted by type-2 alveolar epithelial cells
lining the alveoli.)
(The smaller alveoli have a smaller surface
area which leads to high concentration of the
surfactants and eventually lower surface
tension.)
(Lung volume is equally related to compliance
- Age , these factors minimally influence
compliance.)

(Pulmonary compliance increases with age
are going to the structural changes in the
long-lasting fibers.)
(Lung surfactant is lipoprotein which
comprises 90 lipids and 10 proteins in the
tissues of the lungs that reduces surface
tension and permits more efficient gas
transport it helps maintain in the innate
component of the lungs immune system by
maintaining sterile and balanced immune
reactions in the distal airways.)
(Lung compliance changes can indicate and
there are issues with lungs.)
(A decreased compliance might show
restrictive lung diseases restrictive lung
diseases can result from mechanical issues
with peripheral hypoventilation including for
muscular effort or structural dysfunction
conditions like muscular dystrophy, polio,
myasthenia gravis and guillain-barre
syndrome can cause poor muscular effort
scoliosis or morbid obesity can also cause
structural limitations.)
(Increased compliance can indicate a state of
disease where there is degeneration of tissue
that causes the lungs to have to work harder
to expand such as in the case of
emphysema.)
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(With emphysema the tissue damage means
that it is easier to inhale as there is less
resistance but it's harder to exhale.)
What is the clinical significance?
● Certain pulmonary diseases can
influence changes in the lung
compliance the following are
pathologies that can increase or
decrease lung compliance.
● Emphysema are chronic obstructive
pulmonary diseases in both of these
conditions the elastic recall property of
the lung suffers damage due to a
genetic cause or extrinsic factor
because of or elastic recoil such
patients have high lung compliance.
● Their ovular sacs have a high residual
volume which inturn causes difficulty in
exhaling the excess air out of the lungs
and patients develop shortness of
breath.
● For patients with pulmonary fibrosis
certain environmental pollutants,
chemicals or infectious agents could
cause fibrosis of the lung tissue.
● Genetic diseases can also do so in
fibrosis long elastic are replaced by
collagens which are less elastic and
decrease the compliance of the lungs
such patients need higher work of
breathing to inflate more rigid lung
alveoli.
● In Newborn respiratory distress
syndrome, usually surfactant
secretion begins between the 6th and
7th months of gestation.

● Premature newborns have little or no
surfactant in the alveoli when they are
born and their lungs have a significant
a tendency to collapse as described
earlier surfactant helps in reducing
surface tension and thereby
increases compliance of the lung)
Increased lung compliance- “Difficulty
exhalation”
● Lung surfactant
● Lung volume: compliance is at its
highest at FRC
● Posture (supine, upright)
● Loss of lung connective tissue
associated with age
● Emphysema
Decreased static lung compliance-
“Stuff”
● Loss of surfactant (e.g. ARDS)
(Absence of the surfactant needs to
decrease the pulmonary compliance and this
condition is called Newborn Respiratory
Distress Syndrome. This is very fatal and
requires aggressive measures by continuous
pressure breathing)
● Decreased lung elasticity
- Pulmonary Fibrosis
- Pulmonary edema
● Decreased functional lung volume
- Pneumonectomy or lobectomy
- Pneumonia
- Atelectasis
- Small stature
● Alveolar overdistension
(Atelectasis or acute respiratory
syndrome- Is the collapse of a lung alveoli
and usually occurs independent parts of the
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lungs following preoperative anaesthesia
could be potentially one of the complications.)
(In the case of atelectasis, pulmonary
compliance decreases due to the decreased
volume of the lungs and requires higher
pressure to inflate the alveoli.
(Obtaining the compliance curve along with
the oximetry in arterial gas analysis is one
useful method in ICU monitoring of the
patient.)
POINTS TO REMEMBER:
● Each gas fights to reach its partial
pressure equilibrium between the
alveolar and capillaries, regardless by
diffusing into or diffusion out from the
capillaries.
● Partial pressure value can only be
measured when the gas is free in the
plasma.
Partial O2 CO2
Pressure Value
Alveolar Level 105mmHg 40mmHg
Capillary Level 40mmHg 46mm Hg
● Even though O2 has as high diffusing
capacity, it has a slower diffusing rate
compared to CO2
● The pulmonary artery that enters the
lung is already preloaded with O2.
● Normal amount of O2 entering the
blood per tidal volume is 500ml.
Mechanics of Lung Ventilation
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atmospheric pressure is the sum of all the

partial pressure of the atmospheric gas added
together at high altitude, the atmospheric
pressure decreases but concentration does
not change.)

(The partial pressure decrease which is due

to the reduction in atmospheric pressure.
When the air mixture reaches the lung it has
been humidified.)

(The pressure of the water vapor in the lung

does not change the pressure of the air but
it must be included in the partial pressure
equation. These pressures determine the gas
(Gas move freely with gas particles or exchange or the flow of gas in the system.)
constantly hitting the walls on their vessel by
producing gas pressure) (Oxygen and Carbon dioxide will flow
according to their pressure gradient from high
1. Nitrogen 78.62% to low. Therefore, understanding the pressure
of each gas will aid in understanding how
2. Oxygen 20.9% gasses move in our respiratory system.)
3. Water vapor 0.5%
(Gas exchanges in the body according to the
4. CO2 0.04% laws of diffusion there is always more.)

(Each gas component of that mixture exerts (More oxygen in the alveoli than there is in the
the pressure for individual gas and the mixture blood. Most of the conversion of carbon
is the partial content gas; approximately 21% dioxide Is bicarbonate which occurs inside
atmospheric gas is oxygen.) the rbcs Or red blood cells).

● Intrapulmonary Pressure- within the 2 Phases of Pulmonary Ventilation

alveoli; constantly rises & falls.
INSPIRATION= 1-1.5 seconds
● Intrapleural pressure- within pleural
space; always less than the ● Contraction & flattening of diaphragm →
intrapulmonary pressure. external intercostal mm.
● Contract → ↓ intrapleural pressure
- Functions: TO CONTRACT THE →stretching of the lungs, increase of
LUNGS AND PREVENT LUNG intrapulmonary volume → ↓
COLLAPSE intrapulmonary pressure slightly below
atmospheric pressure → air rushes into
(The partial pressure of oxygen is much the lungs → reach equal pressure
greater than carbon dioxide. PATM the (Intrapulmonary & atmospheric)
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LUNG CAPACITIES
EXPIRATION= 2-3 seconds; PASSIVE PROCESS

● 12-20 times/minute

LUNG VOLUME/CAPACITIES

There are physical factors the govern airflow in

and out of the lungs namely: air pressure
variance, resistance to airflow and lung
compliance Common phenomena which may alter
bronchial diameter which affects airway and
Lung function which reflects the mechanics of resistance include the ff:
ventilation is viewed in terms of: Lung volume ● Contraction of bronchial smooth
and Lung capacities - refer to the volume of air muscle
associated with different phases of the respiratory ● Has an asthma
cycle. ● Thickening of bronchial mucosa as in
chronic bronchitis
● LUNG VOLUMES are directly measured. ● Obstruction of the airway possibly
● LUNG CAPACITIES are inferred from lung caused by mucus
volumes. ● A tumor
● Average total lung capacity (adult ● A foreign body
male) = 6L ● Lost of lung elasticity as in emphysema
● Tidal breathing = resting breathing which is characterized by connective
tissue encircling the airways(??) by
keeping them open during both
FACTORS AFFECTING LUNG VOLUME inspiration and expiration
AND LUNG CAPACITY
1. Gender TAKE NOTE
2. Age
3. Weight
4. Health Status

LUNG VOLUMES
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centers is to control both the rate and depth of

respiration to retain normal level of oxygen
and carbon dioxide in the blood. The medulla
oblongata is the primary respiratory controller
of our breathing while the pons is the other
respiratory controller specifically in controlling
rate and speed of involuntary respiration.
Therefore take note of the ff. Key
terms:
● Respiratory control centers
● The medulla which sends signals to
the muscle in five?? And breathing
PULMONARY DYNAMICS ● And the pons of which controls the rate
of breathing
Respiratory Centers ● The chemoreceptors are receptors in
the medulla
● And the aortic and the carotid bodies
of the blood vessels that detect
changes in blood, pH and signals the
medulla to correct those changes

How the body response and maintains

homeostasis in terms of breathing

Respiration is mainly controlled by the

nervous system. The role of the regulatory
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FACTORS AFFECTING RESPIRATION

● Lung Compliance
○ Distensibility of lungs
● Lung Elasticity
○ Essential for lung distention
during inspiration and lung
recoil during expiration
● Liquid Film
○ Creates a surface tension; aids
in lung recoil during expiration

CONTROLS OF RESPIRATION

MUSCLES OF RESPIRATION (primary

muscles of inspiration and expiration)

We also include the accessory

respiratory muscles as well.
The Phrenic Nerve is a bilateral-mixed
nerve that originates in the neck and
descends in the thorax to reach the
diaphragm. It is the only source of motor
innervation to the diaphragm. This nerve plays
an important role in breathing. Once the
diaphragm has been innervated, it causes a
cyclic excitation, therefore stimulating
respiration

As a stimulus the level of hydrogen

ions and carbon dioxide trigger the
chemoreceptors to send an impulse of
increased or decreased level to the respiratory
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centers which then sends impulse through the

nerves which then cause rhythm of breathing
and resulting into a normal respiratory rate
and depth to maintain homeostasis.
During normal inspiration, as the lung
expands, it activates the stretch receptors
which are found in the alveoli causing the
inhibition of inspiration.
Hering-Breuer inflation reflex
(Ewald Hering and Josef Breuer)
● Reflex triggered to prevent
over-inflation of the lungs
● Pulmonary stretch receptors (smooth
muscle of the airways)
● The neural circuit that controls the
Hering-Breuer inflation reflex:
○ Central Nervous System
○ Both sensory and motor
components of the vagus nerve
○ May determine breathing rate
and depth in newborns and in
adults humans when tidal
volume is more than 1L.
Ex. exercising

(It is a reflux trigger to prevent over inflation of

NERVOUS RECEPTORS IN THE LUNGS
the lungs.)
AND RESPIRATORY TRACT

(this is a response to excessive stretching of

1. Deep, slowly adapting end-organs
the lungs during large inspirations by the
○ Responsible for the
pulmonary stretch receptors that are found in
Breuer-Hering Reflex
the smooth muscle of the airways).
2. Endings in and under the epithelium
○ Responsible for defensive
TAKE NOTE:
reflexes such as cough and
Hering-Breuer deflation reflex is a cause of
sneeze, and for the reflex
concern among the Anesthesiologists who
actions to inhaled irritants and
must maintain the right mix and volume of
to some respiratory disease
gases and surgery to provide patients with
processes
oxygen they need without damaging the lungs
3. Receptors with non-myelinated nerve
.)
fibers
○ These receptors may be similar
Hering-Breuer deflation reflex
in function to nociceptors
4. Specialized receptors such those for
● Shorten exhalation when the lungs is
taste and swallowing, and those
deflated
around joints and in skeletal muscle
● Initiated either by stimulation of stretch
○ Stimulation of any group of
receptors or stimulation of
receptors ma cause reflex
proprioceptors activated by lung
changes in breathing
deflation

● Impulses travel afferently via
vagus.
(Remember proprioceptors orders actress
which gives responds to the change in the
body position of a different parts of the body
so when there is a body of movement
proprioceptors are activated through the
muscles and joints therefore increasing
ventilation.)
● Viral receptors are mechanoreceptors
located in blood vessels near the heart
that provide the brain with information
pertaining to blood volume and
pressure by detecting the level of
stretch on vascular walls.
● In a situation where there is an
increase or decrease arterial blood
pressure the viral receptors are
activated in turn it causes a reflex hypo
or hyperventilation
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the
● The parasympathetic side which the
vagus nerve is heavily involved in
decreases alertness, blood pressure
and heart rate and it also helps with
calmness, relaxation and digestion.
● if the vagus nerve is stimulated it also
union return stimulates diaphragmatic
contraction and inspiration at the same
time causes bronchoconstriction
● The sum the sympathetic nervous
system also has an effect on
oxygenation it also stimulates an
increase rate and depth of respiration
at the same time causes
bronchodilation
Now, let us learn the different Protective
Mechanisms of respiration:
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- A Sneeze or a stir mutation is expulsion of

air from the lungs through the nose and mouth
most commonly caused by irritation of the
nasal mucosa cough and bronchial
constriction or airway reflexes that protect the
lung from inspired noxious agents.

These are the composition of inspired air:

1.Bone Marrow (Macrophages)

- known as monocytes it maintains
homeostasis by clearing inhaled particles
bacteria and removing apoptotic cells from the
local pulmonary environment.

2. Cilia
-bronchus in the lungs are line with the hair
like projections called cilia, that moves
microbes and breeze up and out of the TAKE NOTE:
airways scattered throughout the cilia that are
gold blood cells that secrete mucus which Partial Pressure of Gas= Gas Concentration
helps protects the lining of the bronchus and Total Pressure= Sum of Partial Pressure
trap microorganisms. (DALTON’S LAW)

3. Mucociliary escalator ● PaO2= clinical measure of O2 status

- is inside of the conducting airways made up ● PaCo2- clinica measure of ventilation
of mucus and cilia which moves the mucus up status
and out of the lungs where it can be expelled
by coughing or swallowing.Together these
components form a gel that drives particles
that enter the airway.

4. Cough reflex
- The cough reflex occurs when stimulation of
cough receptors and respiratory tract by dust
or other foreign particles produces a cough
which causes rapidly moving air which usually
removes the foreign material before it reaches
the lungs. 2 TYPES OF V-P MISMATCH

5. Sneeze Reflex ● SHUNTING- Portion of cardiac output

- Sneezing is a protective reflex and is that does not exchange with alveolar
sometimes a sign of various medical air
conditions.
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● DEAD SPACE- Portion of Ventilation

that does not exchange with an intact
capillary (wasted ventilation)

BLOOD DYNAMICS

(Concept of oxygenation is never complete

without knowing the blood dynamics
resources)

ERYTHROPOIESIS
● Greek “erythro” = RBC & “poiesis”= to
make
● Decreased O2= secrete erythropoietin
● Essential for the maturation of RBCs:
Vitamin
● B12 (cobalamin) and Vitamin B9 (Folic
Acid)

TAKE NOTE:
● The bone marrow of essentially all the
bones produces RBCs until a person is
around 5 years old.

● The tibia and femur cease to be

important sites of hematopoiesis by
about age 25.

● The Vertebrae,sternum,pelvis, ribs,

and cranial bones continue to produce
red blood cells throughout life.