SI units and simple respiratory and

cardiac mechanics
Paul Marval BMedSci BM BS FRCA

Key points Fundamental and derived Table 1 Fundamental SI units

SI units Quantity Name of unit Symbol

SI units were adopted in
medicine in 1977 to The Système International d’Unités (SI) was Length Metre m
harmonize the exchange of Mass Kilogram kg
the culmination of more than a century of Time Second s
scientific information. international effort to develop a universally Electric current Ampere A
Seven base units are used to acceptable system of units of measurement. Thermodynamic temperature Kelvin K
Luminous intensity Candela cd
form a large number of It was developed and subsequently adopted Amount of substance Mole mol
derived units, some with by the Conférence Générale des Poids et
special names. Mesures (CGPM) in 1954 to harmonize
Prefixed units are not SI units the increasing expansion of world trade and
(except kg). exchange of scientific information. The Table 2 Examples of derived units

Work, force and power have
precise definitions.
Cardiac and respiratory work
may be calculated from
pressure/volume graphs.
Paul Marval BMedSci BM BS FRCA
Consultant Anaesthetist
Department of Anaesthetics
Derbyshire Royal Infirmary
London Road
Derby
DE1 2QY
UK
Tel: 01332 347141
Fax: 01332 254605
E-mail: paul.marval@nhs.net
(for correspondence)
Thirtieth World Health Assembly endorsed
the use in medicine of SI units in May 1977.1
The SI comprises three types of unit:
fundamental, derived and supplementary
units. There are two supplementary units:
the unit of plane angle, the radian (symbol:
rad), and the unit of solid angle, the steradian
(symbol: sr). They can be used to form
derived units; however, these are not relevant
to general medical practice and will not be
discussed further in this review.
Fundamental units
Seven units have been selected as the basic or
fundamental units on which the system is
based (Table 1). These units are defined very
precisely and over time require further pre-
cision with the progress of science. Their
definitions are given in Appendix 1.1
Derived units
SI derived units are formed by multiplying
the base unit by itself, or combining two or
more base units by simple multiplication or
division. There are a large number of units
within this group; some examples are given in
Table 2.
A number of derived units have been allo-
cated special names, the purpose of which is
to abbreviate potentially inconvenient unit
symbols. An example of this is the unit of
force. This is defined as the force that gives
a mass of 1 kg an acceleration of 1 m s
2
(the speed of the mass increases each second
by 1 m s
1). The derivation of this unit is
Quantity Name of derived unit Symbol for unit
Area Square metre m2
Volume Cubic metre m3
Speed Metre per second m·s
1
Acceleration Metre per second square m·s
2
therefore kg·m·s
2; it is otherwise named
newton (symbol: N).
A further example of particular relevance
is the unit of pressure. Pressure is the action
of force on an area or newton per square
metre and has been given the special name
pascal (symbol: Pa). However, the derivation
of this unit is force (kg·m·s
2) divided by
area (m2) or kg·m·s
2·m
2, which reduces to
kg·m
1·s
2. Eighteen SI derived units have
been given special names. Those of relevance
to anaesthesia are shown in Table 3. From
the two examples and Table 3, it becomes
apparent that, despite the development of
a diverse collection of derived units and
symbols, all are a function of the seven
fundamental units.
SI prefixes
Often it is inappropriate to use the SI unit in
its standard format as this is inconveniently
too large or too small; for example, the use of
metre to describe large distances. To over-
come this difficulty, a series of SI prefixes
(Table 4) are used to form decimal multiples
and submultiples of the SI unit. However, the
prefixed units formed should not be called
SI units. The exception is the unit of mass
where kilogram is the SI unit (not gram).

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 SI units and simple respiratory and cardiac mechanics

Table 3 Specially named SI units of relevance to anaesthesia

Quantity Name of Symbol Derivation

derived unit for unit of unit

Frequency Hertz Hz s
1

Force Newton N kg·m·s
2
Pressure Pascal Pa N·m
2
Work; energy; quantity of heat Joule J N·m
Power; radiant flux Watt W J·s
1
Electric charge; quantity of electricity Coulomb C A·s
Electric potential; potential difference Volt V W·A
1
Capacitance Farad F C·V
1
(Electric) Resistance Ohm V V·A
1
Magnetic flux Weber Wb V·s
Magnetic flux density Tesla T Wb·m
2
Inductance Henry H Wb·A
1

Celsius temperature Degree Celsius C K

Table 4 Common SI unit prefixes

Factor Prefix Symbol Factor Prefix Symbol

for prefix for prefix

109 Giga G 10
1 Deci d

106 Mega M 10
2 Centi c
103 Kilo k 10
3 Milli m
102 Hecto h 10
6 Micro m
101 Deca da 10
9 Nano n

Non-SI units
A few non-SI units have also been adopted as they are so widely
used. Of relevance to medical practice is the unit of volume, for
which the ‘cubic decimetre’ has been given the ‘special name’ of
litre, and time, for which the SI unit of second is replaced by
minute, hour and day.1
Simple mechanics
The SI derived units of force, work and power are familiar and
commonly used everyday terms. Within the scientific community
however, these terms require precise usage and have limited
meanings. Within anaesthesia and intensive care, they are often
applied to the cardiovascular and respiratory systems where the
terms cardiac work and work of breathing are often referred to.
The precise meaning of these derived units in this situation is
illustrated below.
The unit of force is defined above.
Force ¼ m · a
¼N
The unit of work is defined as the product of the force
exerted and distance (d) moved in the direction of the force and
is named joule (J).
Force ¼ f · d
¼J
The unit of power is defined as the work done per unit time
(s) and is named watt (W).
Power ¼ J s
1
¼W
Fig. 1 Left ventricular pressure and volume loop for a single
cardiac cycle.
Within the physiological context, mechanical or external
work is only performed if displacement of fluid or gas occurs;
therefore, when applied to muscle contraction, this requires
shortening or lengthening of that muscle. This can be described
as positive work if the muscle shortens or negative work when
the muscle lengthens as a result of a larger, opposite applied
force. Contraction without a change in length (isometric con-
traction) does not constitute external work. As work performed
is force times distance (N · m), this has the same dimensions as
pressure times volume (N/m2 · m3¼N · m); the latter can be
used to calculate the work of breathing or cardiac work.
Cardiac work
The change in volume and pressure of the ventricle can be used
to calculate cardiac work for a single cardiac cycle. Figure 1
illustrates these changes in the left ventricle and, as work ¼
change in pressure (DP) · change in volume (DV), the area
contained within the P
V loop represents the external work
necessary to expel the stroke volume, that is, stroke work.2 The
area below this loop during diastolic filling represents the work
performed by the right ventricle and left atrium to fill the left
ventricle (internal work).
Any increase in mean arterial pressure, with cardiac output
maintained, will therefore result in additional energy require-
ments and oxygen demand. Similarly, a high cardiac output
resulting from, for example, thyrotoxicosis and anaemia will

Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 5 2006 189
SI units and simple respiratory and cardiac mechanics
A D
Expiration
E
B Volume (ml)
F Metre
Inspiration
C
Pressure (cm H2O)
Fig. 2 Respiratory Pressure-volume loop illustrating work of breathing.
also increase cardiac work. Prolonged myocardial exposure to
these conditions may subsequently lead to heart failure.
Cardiac work done:
Work ¼ DP · DV
¼ ð14:6 · 103 ÞPa · ð70 · 10
6 Þm3
¼ 1022 · 10
3
¼ 1:022 J
(note the conversion of mm Hg to Pascal, an SI unit).
Work of breathing
During inspiration, movement of gas (the work of breathing) is
usually achieved by diaphragmatic and intercostal muscle
contraction. This overcomes lung and chest wall compliance
(elastic forces), the viscous resistance of movement of gases
down airways, together with the inertia created by both gases
and tissues, which is usually very small. During inspiration,
muscle contraction generates a reduction in pressure within
intrapleural space, which is transferred to the alveolus, and gas
movement takes place. This is demonstrated in the pressure/
volume loop in Fig. 2. The work expended in overcoming
airway resistance and compliance during the inspiratory phase is
given by the areas AFCBA and ABCDA, respectively.3 An
increase in airway resistance would cause a greater bowing of
the line AFC, while a reduced compliance reduces the slope of
line ABC.
During expiration, the area ABCEA is the work required to
overcome airway resistance and is usually contained within the
area ABCDA. Therefore, expiration is passive using the stored
elastic energy within the lung and chest tissues. The difference
between areas ABCEA and ABCDA is the energy dissipated as
heat.
190 Continuing Education in Anaesthesia, Critical Care & Pain | Volume 6 Number 5 2006
Conclusion
SI units and simple mechanics are defined precisely despite being
terms often used loosely in everyday language. Appreciation of
these definitions and derivations is important in medical
practice, particularly in describing work, as this improves
understanding of how oxygen demand changes under different
physiological conditions.
Appendix 1: Definition of SI units
The metre is the basic unit of length. It is the distance light
travels, in a vacuum, in 1/299792458th of a second.
Kilogram
The kilogram is the basic unit of mass. It is the mass of an
international prototype in the form of a platinum-iridium
cylinder kept at Sevres in France. It is now the only basic unit
still defined in terms of a material object, and also the only one
with a prefix[kilo] already in place.
Second
The second is the basic unit of time. It is the length of time taken
for 9192631770 periods of vibration of the caesium-133 atom to
occur.
Ampere
The ampere is the basic unit of electric current. It is that current
which produces a specified force between two parallel wires
which are 1 metre apart in a vacuum. It is named after the
French physicist Andre Ampere (1775–1836).
Kelvin
The kelvin is the basic unit of temperature. It is 1/273.16th of the
thermodynamic temperature of the triple point of water. It is
named after the Scottish mathematician and physicist William
Thomson 1st Lord Kelvin (1824-1907).
Mole
The mole is the basic unit of substance. It is the amount of
substance that contains as many elementary units as there are
atoms in 0.012 kg of carbon-12.
Candela
The candela is the basic unit of luminous intensity. It is the
intensity of a source of light of a specified frequency, which gives
a specified amount of power in a given direction.
 SI units and simple respiratory and cardiac mechanics

Key References
1. Système international d’unités. English. SI: The International System of
Units—approved translation of the International Bureau of Weights and
Measures publication. Bell RJ, editor. Le Système International d’Unités (SI).
6th Edn. London, UK: HMSO, 1993.
2. Davis PD, Parbrook GD, Kenny GNC. Basic Physics and Measurement
in Anaesthesia, 4th Edn. Oxford: Butterworth-Heinemann, 1995.
3. Widdicombe J, Davies A. Respiratory Physiology, 2nd Edn. London: Edward
Arnold, 1991.
Please see multiple choice questions 12–15.

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