MECHANICS OF VENTILATION

AND CONTROL OF BREATHING

Moderated by – Dr. Anjali Mehta

Presented by-Dr. Sonal Sharma

 Goals of Respiration
Primary Goals Of The Respiration System
• Distribute air & blood flow for gas exchange
• Provide oxygen to cells in body tissues
• Remove carbon dioxide from body
• Maintain constant homeostasis for metabolic
needs
 Functions of Respiration

Respiration divided into four functional events:

1.Mechanics of pulmonary ventilation

2.Diffusion of O2 & CO2 between alveoli and blood
3.Transport of O2 & CO2 to and from tissues
4.Regulation of ventilation & respiration
 Pulmonary Ventilation

• Mechanical process causing gas flow into and out of the lungs
according to volume changes in the thoracic cavity. (A.K.A.
“Breathing”)
• Consists of two phases:
– Inspiration: period of time when air flows into the lungs
– Expiration: period of time when gases exit the lungs .
• Important physics rule to remember for breathing mechanics:
– Volume changes lead to pressure changes
-Pressure changes lead to flow of gases to equalize pressure
• Boyle’s Law: (when temp constant) P1V1 = P2V2
– At a constant temperature, pressure varies inversely with volume
 The Breathing Cycle
• Airflow requires a pressure gradient
• Air flow from higher to lower pressures
• During inspiration alveolar pressure is sub-
atmospheric allowing airflow into lungs
• Higher pressure in alveoli during expiration
than atmosphere allows airflow out of lung
• Changes in alveolar pressure are generated by
changes in pleural pressure
 Inspiration
Active Phase Of Breathing Cycle
• Motor impulses from brainstem activate muscle contraction
• Phrenic nerve (C 3,4,5) transmits motor stimulation to diaphragm
• Intercostal nerves (T 1-11) send signals to the external intercostal
muscles
• Thoracic cavity expands to lower pressure in pleural space
surrounding the lungs
• Pressure in alveolar ducts & alveoli decreases
• Fresh air flows through conducting airways into terminal air spaces
until pressures are equalized
• Lungs expand passively as pleural pressure falls
• The act of inhaling is negative-pressure ventilation
 Muscles of Inspiration: Diaphragm
Most Important Muscle Of Inspiration
• Responsible for 75% of inspiratory effort
• Thin dome-shaped muscle attached to the lower ribs, xiphoid process,
lumbar vertebra
• Innervated by Phrenic nerve (Cervical segments 3,4,5)
• During contraction of diaphragm
– Abdominal contents forced downward & forward causing increase in vertical
dimension of chest cavity
– Rib margins are lifted & moved outward causing increase in the transverse
diameter of thorax
– Diaphragm moves down 1cm during normal inspiration
– During forced inspiration diaphragm can move down 10cm
• Paradoxical movement of diaphragm when paralyzed
– Upward movement with inspiratory drop of intrathoracic pressure
– Occurs when the diaphragm muscle is denervated
Movement of Thorax During
Breathing Cycle
Movement of Diaphragm
 Muscles of Inspiration
External Intercostal Muscles
• The external intercostal muscles connect to adjacent ribs
• Responsible for 25% of inspiratory effort
• Motor neurons to the intercostal muscles originate in the respiratory
centers of the brainstem and travel down the spinal cord. The motor
nerves leave the spinal cord via the intercostal nerves. These originate
from the ventral rami of T1 to T11, they then pass to the chest wall
under each rib along with the intercostal veins and arteries.
• Contraction of EIM pulls ribs upward & forward
– Thorax diameters increase in both lateral & anteroposterior directions
– Ribs move outward in “bucket-handle” fashion
– Intercostals nerves from spinal cord roots innervate EIMs
• Paralysis of EIM does not seriously alter inspiration because
diaphragm is so effective but sensation of inhalation is decreased
 Muscles of Inspiration
Accessory Muscles
These muscles assist with forced inspiration
during periods of stress or exercise

Scalene Muscle
• Attach cervical spine to apical rib
• Elevate the first two ribs during forced inspiration
Sternocleidomastoid Muscle
• Attach base of skull (mastoid process) to top of
sternum and clavicle medially
• Raise the sternum during forced inspiration
 Expiration
The Passive Phase Of Breathing Cycle

• Chest muscles & diaphragm relax contraction

• Elastic recoil of thorax & lungs return to equilibrium
• Pleural & alveolar pressures rise
• Gas flows passively out of the lung
• Expiration - active during hyperventilation & exercise
 Muscles of Active Expiration
Active expiration requires abdominal & internal intercostals
muscle contraction

• Rectus abdominus/abdominal oblique muscles

– Contraction raises intra-abdominal pressure to move diaphragm upward
– Intra-thoracic pressure raises and forces air out from lung
• Internal intercostals muscles
– Assist expiration by pulling ribs downward & inward
– Decrease the thoracic volume
– Stiffen intercostals spaces to prevent outward bulging during straining

These muscles also contract forcefully during coughing, vomiting, &

defecation
Inspiration
Expiration
 Various pressure in the lungs

Pleural pressure – is the pressure of fluid in the narrow

space between the visceral and parietal pleura, normally
slightly negative pressure( due to constant suction of
fluid into lymphatic channels)

•Normally at rest suction creates a negative pressure at beginning of

inspiration (-5cmH20)
•This suction holds the lungs open at rest
•Pressure becomes more negative during inspiration moving to
-7.5cmH20 allowing for negative pressure respiration
•If pleural pressure becomes positive the lung will collapse:
Pneumothorax, Hemothorax, Chylothorax
 Alveolar pressure
• Alveolar pressure: – is the pressure difference between
inside the lung alveoli and atmosphere.(zero for reference)
• Air flows into the alveoli when the atm pressure is greater than
the alveolar pressure
• Alveolar pressure is normally atmospheric at end expiration
and end inspiration
During inspiration:  –1cm of H2O (this slight negative
pressure is enough to move about 0.5 liter of air into the
lungs in the first 2 second of inspiration)

• During expiration: it rises to about +1cm of H2O (this forces

0.5 liter of inspired air out of the lungs during the 2 to 3
seconds of expiration
 Transpulmonary Pressure
• The pressure difference across the alveolar
wall i.e. between the alveolar pressure &
pleural pressure
thus
Ptranspul.= Palveoli- Ppleural
+ve Ptranspul.= alveoli is inflating
-ve Ptranspul.= alveoli is deflating
Pressures during breathing cycle
Pressure Changes During Normal
Breathing
 Pulmonary volumes and capacities
• Pulmonary volumes (by using spirometer):

1) Tidal volume – is the volume of air inspired or expired with each normal
breath = 500ml in young adult man.

2) Inspiratory reserve volume – is the extra volume of air that can be

inspired over and beyond the normal tidal volume = 3000ml.

3) Expiratory reserve volume – is the extra amount of air that can be

expired by forceful expiration after the end of a normal tidal expiration ~
1100ml.

4) Residual volume – is the extra volume of air that still remain in the lungs
after the most forceful expiration ~ 1200ml.
 pulmonary capacities
Comprises more than one volume:

1) Inspiratory capacity – is the volume of air inspired by a maximal inspiratory effort

after normal expiration = 3500ml = IRV +TV

2) The functional residual capacity – is the volume of air remaining in the lungs after
normal expiration = 2300ml = ERV+ RV

3) The vital capacity – is the volume of air expired by a maximal expiratory effort
after maximal inspiration ~ 4600ml = IRV+TV+ERV

4) Total lung capacity – is the maximum volume of air that can be accommodated in
the lungs ~ 5800ml = VC +RV

5) Minute respiratory volume – is the volume of air breathed in or out of the lungs
each minute = respiratory rate x tidal volume = 12 X 500ml = 6000ml/min.

All lung volume and capacity are about 20 to 25% less in women than in men and are
greater in athletic persons than in small and asthenic persons.
Pulmonary Volumes & Capacities
Spirometer
 Spirometry
• REMEMBER: Spirometry cannot measure Residual
Volume (RV) thus Functional Residual Capacity
(FRC) and Total Lung Capacity (TLC) cannot be
determined using spirometry alone.

• FRC and TLC can be determined by 1) Helium

dilution, 2) Nitrogen washout, or 3) body
plethysmography
Flow-Volume Loop
Flow-Volume curve: expiration effort
Abnormal Flow Volume Loops
 MECHANICS OF VENTILATION

• Forces or factors which cause air to move in and out of the

lungs.
• Proexpansion factors-factors which help the lungs to expand-
muscles of respiration.
• Antiexpansion factors- factors which impede changes in
volume of lungs. 1. elastic resistance
• 2.non elastic resistance
• a) airway resistance
• b) tissue resistance
• Work of breathing
 Elastic resistance
Elastic recoil is the tendency of an elastic structure to oppose stretching.
Both lungs and chest has elastic properties

The lungs naturally have a tendency to collapse because of elastic recoil.

They are held open by the negative pleural pressure (established by lymphatic
pumping of fluid).
•The chest wall naturally expands, but is also held by the negative pleural
pressure.
•Chest recoil is due to chest wall muscle tone.

•Elastic recoil of the lungs is due to the high content of elastin fibres& more
importantly the surface tension forces acting at the air fluid interface in alveoli
 Surface Tension
Water molecules at the interface with air are attracted to each other. This creates
surface tension forces which cause the water surface to contract.

Similarly gas fluid interface lining the alveoli produces surface tension forces

These forces reduce area of interface and favor alveolar collapse.

•the pressure caused by surface tension can be calculated from laplace formula
o P = 2T/r
 P = collapsing pressure
 T = surface tension
 r = radius of the alveolus
Thus collapse is more likely when surface tension increases or alveolar
size decreases.
 Surfactant
is a substance produce by type II alveolar epithelial cells (~ 10% of the
surface area of the alveoli)
reduce the surface tension of the fluid in the inner surface of the alveoli
it is a mixture of phospholipids, proteins, and ions,
the most important component is phospholipid dipalmitoyl
phosphatidylcholine which is responsible for reducing the surface tension
(formed of 2 parts, hydrophilic part dissolves in the water lining the alveoli
and hydrophobic part directed toward the air)
the alveolar collapse pressure in an average-sized alveolus with radius of
about 100µm and lined with surfactant, is about 4cm of H2O, but if it is lined
with pure water is about 18cm of H2O
 Surfactant

Table 35–2 Approximate Composition of Surfactant.

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