112 3M: CONCEPT OF 91-94 Mild Hypoxemia*

OXYGENATION 86-90 Moderate

Hypoxemia*

THE RESPIRATORY SYSTEM <85 Severe HYpoxemia*

*Hypoxemia is defined as decreased partial

GLOBIN
pressure in blood and oxygen available to the
- 4 globulin protein molecules body or an individual tissue or organ
HEME
- The pigmented ironcontaining
nonprotein part of the Hgb molecule RESPIRATORY MECHANICS
OXYHEMOGLOBIN
- O2 + Hgb = HbO2 • Dissociates easily DIFFUSION
when the O2 concentration is low ● Higher –lower • Little or no energy
required
PERFUSION
EXTERNAL INTERNAL ● Latin= “perfundere”- to pour over •
RESPIRATION RESPIRATION Passage of fluid through a specific
organ or an area of the body
- Exchange of - Exchange of
gases gases PULMONARY COMPLIANCE (C)
between the between the ● Measure of the ease of expansion of the
alveoli & systemic lungs and thorax
blood capillaries &
tissue cells 2 Important factors:
- O2 + Hb= 1. ELASTIN
HbO2 - CO2 + H20=
(loading of H2CO3→ H+ - Highly stretchable
O2) HCO3 CHON in pulmonary
interstitial connective
- HCO3 + H= tissue; like a “rubber
H2CO3 → band”
CO2 + H2O - powerfully recoil the
(unloading of
lung and only stretch
CO2)
when a force is applied
- highly resistant to
PHYSIOLOGY OF GAS EXCHANGE further stretching once
the lung is stretched to
OXYGEN IS CARRIED IN THE BLOOD IN 2 large volumes
FORMS: 2. SURFACE TENSION
1. Dissolved O2 in plasma - physical property of
2. Combine with Hb or Hgb in RBCs= O2 H2O; powerful
saturation contributor to the elastic
recoil of the lung
CARBON DIOXIDE IS CARRIED IN THE
BLOOD IN 2 FORMS: COMPLIANCE=ΔV/ΔP (change in volume
1. BICARBONATE (HCO3)- CO2 in over change in pleural pressure)
plasma
2. CO2 in Hb at a different site than O2 EXAMPLES OF ©
Increased lung compliance
PULSE OXIMETERs ● Lung surfactant
SPO2 Reading (%) Interpretation ● Lung volume: compliance is at its
highest at FRC
95-100 Normal ● Posture (supine, upright)
● Loss of lung connective tissue
associated with age
 ● Emphysema ● INTRAPLEURAL PRESSURE- within
pleural space; always less than the
Decreased static lung compliance intrapulmonary pressure
● Loss of surfactant (e.g. ARDS) ○ Functions: TO CONTRACT
● Decreased lung elasticity THE LUNGS & PREVENT
○ Pulmonary fibrosis LUNG COLLAPSE
○ Pulmonary edema
● Decreased functional lung volume 2 PHASES OF PULMONARY VENTILATION
○ Pneumonectomy or lobectomy 1. INSPIRATION
○ Pneumonia - 1-1.5 seconds
○ Atelectasis - Contraction & flattening of
○ Small stature diaphragm→ external intercostal
● Alveolar overdistension mm. Contract→↓ intrapleural
pressure→ stretching of the
POINTS TO REMEMBER lungs, increase of
- Each gas fights to reach its partial intrapulmonary volume→ ↓
pressure equilibrium between the intrapulmonary pressure slightly
alveolar and capillaries, regardless by below atmospheric
diffusing into or diffusion out from the pressure→air rushes into the
capillaries. lungs→reach equal
- Partial pressure value can only be pressure(intrapulmonary &
measured when the gas is free in the atmospheric)
plasma
2. EXPIRATION
- 2-3 seconds; PASSIVE
PARTIAL O2 CO2
PRESSURE PROCESS
VALUE - 12-20 times/minute

ALVEOLAR ~ 105mmHg ~ 40mmHg LUNG VOLUME/CAPACITIES

LEVEL ● Lung volumes and lung capacities refer
to the volume of air associated with
CAPILLARY ~ 40mmHg ~ 46mmHg
LEVEL different phases of the respiratory cycle.
● LUNG VOLUMES are directly
measured.
● Even though O2 has a high diffusing ● LUNG CAPACITIES are inferred from
capacity, it has a slower diffusing rate lung volumes.
compared to CO2. ● Average total lung capacity (adult male)
● The pulmonary artery that enters the = 6L
lung is already preloaded with O2. ● Tidal breathing= resting breathing
● Normal amount of O2 entering the blood
per tidal volume is ~500ml. Factors Affecting LV & LC
● Gender
GAS EXCHANGES IN THE BODY ACCDG. TO ● Age
LAWS OF DIFFUSION ● Weight
● There is always more O2 in the alveoli ● Health Status
than there is in the blood.
● Most of the conversion of CO2→ HCO3 LUNG VOLUMES
occurs inside the RBCs.
LUNG SYMBOL NORMAL
MECHANICS OF LUNG VENTILATION VOLUME VALUE
● INTRAPULMONARY PRESSURE- TIDAL VT or TV 500 mL
within the alveoli; constantly rises & falls VOLUME

INSPIRATOR IRV 3100 mL

Y RESERVE
VOLUME

EXPIRATOR ERV 1200 mL

Y RESERVE
VOLUME

RESIDUAL RV 1200 mL
VOLUME

LUNG CAPACITIES

LUNG SYMBOL NORMAL

CAPACITY VALUE

VITAL VC 4800 mL
CAPACITY

INSPIRATOR IC 3600 mL
Y CAPACITY

FUNCTIONA FRC 2400 mL

L RESIDUAL
CAPACITY

TOTAL TLC 6000 mL

LUNG
CAPACITY

LUNG CAPACITY COMPONENTS

TLC TV+IRV+ERV+RV

VC TV+IRV+ERV MUSCLES OF RESPIRATION

IC TV+IRV
FACTORS AFFECTING RESPIRATION
FRC ERV+RV ● RESPIRATORY CENTERS: medulla
oblongata & pons
● CHEMORECEPTORS (Aortic &
PULMONARY DYNAMICS
Carotid Bodies)
○ respond to changes in arterial
blood
● RESPIRATORY PASSAGEWAY
RESISTANCE
○ Friction of gases
● 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
 ○ both sensory and motor
CONTROLS OF RESPIRATION components of the vagus nerve
1. ● may determine breathing rate and depth
PHRENIC NERVE in newborns and in adult humans when
DIAPHRAGM tidal volume is more than 1 L
CYCLIC EXCITATION ○ Ex. exercising
RESPIRATION
Hering–Breuer deflation reflex
2. ● shorten exhalation when the lung is
CO2+H20= H2CO3 deflated
CHEMORECEPTORS ● initiated either by stimulation of stretch
RESPIRATORY CENTERS receptors or stimulation of
RHYTHM OF BREATHING proprioceptors activated by lung
RATE & DEPTH deflation
● impulses travel afferently via the vagus
3.
INSPIRATION NOTE:
LUNG EXPANSION - The HERING-BREUER REFLEX cause
ACTIVATES STRETCH RECEPTORS IN for concern among anesthesiologists
ALVEOLI who must maintain the right mix and
INSPIRATION INHIBITED volume of gases in surgery to provide
patients with the oxygen they need
Nervous receptors in the lungs and without damaging the lungs.
respiratory tract
1. Deep, slowly adapting end organs 4.
- Responsible for the BreuerHering reflex. BODY MOVEMENT
PROPRIOCEPTORS ACTIVATED (MM. &
2. Endings in and under the epithelium JOINTS)
- Responsible for defensive reflexes such ↑ VENTILATION
as cough and sneeze, and for the reflex
actions to inhaled irritants and to some 5.
respiratory disease processes. INCREASED/ DECREASED ARTERIAL BP
BARORECEPTORS ACTIVATION (AORTIC &
3. Receptors with non-myelinated nerve CAROTID BODIES)
fibres REFLEX HYPO/ HYPERVENTILATION
- These receptors may be similar in
function to ' nociceptors‘.

4. Specialized receptors such as those

for taste and swallowing, and those
around joints and in skeletal muscle
- Stimulation of any group of receptors
may cause reflex changes in breathing.

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:
7.
○ central nervous system
SNS
↑ RATE & DEPTH OF RESPIRATION & BLOOD DYNAMICS
BRONCHODILATION
ERYTHROPOIESIS
PROTECTIVE MECHANISMS OF ● Greek “erythro" = RBC & "poiesis“- to
RESPIRATION make
● Bone marrow (macrophage) ● decreased O2= secrete erythropoietin
● Cilia ● Essential for the maturation of RBCs:
● Mucociliary escalator Vitamin B12 (cobalamin) and Vitamin B9
● Cough Reflex (Folic acid)
● Sneeze reflex
● Reflexive bronchoconstriction TAKE NOTE!
● The bone marrow of essentially all the
COMPOSITION OF INSPIRED AIR bones produces RBCs until a person is
● NITROGEN (N) around 5 years old.
● OXYGEN (O2) ● The tibia and femur cease to be
● CARBON DIOXIDE (CO2) important sites of hematopoiesis by
● WATER VAPOR about age 25.
● HELIUM (He) ● The vertebrae, sternum, pelvis and ribs,
● ARGON (Ar) and cranial bones continue to produce
red blood cells throughout life.

TAKE NOTE!
● PARTIAL PRESSURE OF GAS = GAS
CONCENTRATION
● TOTAL PRESSURE = SUM OF
PARTIAL PRESSURES (DALTON’S
LAW)
● PaO2- clinical measure of O2 status
● PaCo2- clinical measure of ventilation
status
V-P BALANCE & IMBALANCE
● NORMAL RATIO (1:1)
● LOW V-P RATIO (P > V)
○ Ex. Pneumonia, atelectasis,
tumor, mucus plug
● HIGH V-P RATIO (V > P)
○ Ex. Pulmonary emboli,
pulmonary infarction,
cardiogenic shock
● SILENT UNIT (NO V-P)
○ Ex. Pneumothorax, Severe
acute respiratory distress
syndrome

2 TYPES OF V-P MISMATCH

1. Shunting
- Portion of cardiac output that
does not exchange w/ alveolar
air
2. Dead Space
- Portion of ventilation that does
not exchange w/ and intact
capillary (wasted ventilation)