Pressure changes during respiratory cycle

The pleural sac

It is a thin closed serous sac which invests the lung except at the hilum. visceral pleura: The layer which is attached to the outer surface of the lung. parietal pleura: The layer which is attached to the chest wall, mediastinum and diaphragm .

In between, there is a potential space filled with a thin film

of serous fluid with mucoid characteristics (pleural fluid).

Functions of pleural fluid:

1-Lubricant. 2-Adheres the 2 layers of pleura.

Normally, no air exists in pleural space but rupture of the lung by a penetrating wound can cause air, fluid, blood or pus to enter.
If water is collected
If pus is collected If blood is collected

hydrothorax.
pyothorax. haemothorax.

If air is collected

pneumothorax.

Pneumothorax

Pleura and negative pressure

Intra-pleural pressure (IPP)

Intra-pleural pressure (IPP):

Definition: It is the pressure between the two layers of the pleura. It is always a negative pressure i.e subatmospheric.

Intra-pleural pressure (IPP)

Normal values: (During normal quiet breathing)
At the beginning of inspiration(-5 cm H2O ) . At the end of inspiration(-7.5 cm H2O ) .

At the beginning of expiration(-7.5 cm H2O ) .

At the end of expiration(-5 cm H2O ) .

Intra-pleural pressure (IPP)

Causes of the negative IPP

1-Lack of air in the pleural cavity

2- Recoil forces of the lung

3-Elastic properties of the chest wall

Recoil forces of the lungs

1-Elastic recoil force(1/3 of the recoil forces).

2-Surface tension of the fluid lining

the alveoli(2/3 of the recoil forces) .

Causes of the negative IPP

Significance of negative IPP:

1-It maintains the lung inflated and prevents its collapse. 2-It helps expansion of the lung during inspiration. 3-It helps venous return. 4-It helps lymphatic drainage through thoracic duct.

Alveolar pressure
(intrapulmonary pressure)

Alveolar pressure (intrapulmonary pressure): It is the pressure of air inside the lung alveoli. When the glottis is opened and no air is flowing into or out of the lungs, the pressure in all parts of the respiratory tree till the alveoli is equal to atmospheric pressure which is considered to be zero cm H2O

Pressure changes & Airflow

During inspiration:
increased thoracic volume decreases Palv

Palv

<

Patm

Air flows into alveoli

Pressure changes & Airflow

End of inspiration: Patm = Palv No air flow

Pressure changes & Airflow

During expiration: Decreased thoracic volume = increased pressure inside alveoli Palv > Patm Air flows out of lungs

Pressure changes & Airflow

At end of expiration: Patm = Palv No air flow

Changes in Intra-Alveolar Pressure During Respiration

Transpulmonary pressure:
It is the pressure difference between alveolar pressure and the pleural pressure.

(I Alv P - IPP)

Transpulmonary pressure

Compliance

Compliance is a measure for distensability of elastic tissue.

It is expressed as the change in lung volume per unit change in distending pressure.
Compliance =V/P =ml/cmH2O

Compliance of the lungs (CL):

It measures the change in lung volume against the change in distending pressure. It equals 200 ml/cm H2O pressure .
i.e. the increase in transpulmonary pressure by 1 cm H2O, increases the lung volume 200 ml. (when they are outside the thorax).

Pulmonary compliance(Total compliance): Compliance of the lungs and chest wall combined together .
It is much less because lung expansibility in the chest is limited by the rigid thoracic cage.

It is normally about 130 ml/cm H2O

Factors affecting lung compliance:

The initial lung volume. Presence of elastic fibers . Surface tension of alveolar fluid .

Causes of decreased lung compliance:

Diseases that cause stiffness of the lung as pulmonary fibrosis, congestion and oedema. Collection of air or fluid ( water,blood or pus) in the intra-pleural space.

Deformities of vertebral column e.g. kyphosis (antro-posterior bending) and scoliosis (lateral bending).

Scoliosis

Skeletal muscle disease as poliomyelitis .

Arthritis of the joints of the thoracic cage or vertebral column.

Causes of increased compliance:

Old age.
Emphysema.

Emphysema

Emphysema

Cigarette Smoking

Smoking
Increases pulmonary alveolar macrophages Release of a chemical substance attracts leukocytes to the lungs. The leukocytes in turn release proteases as elastase, which attacks the elastic tissue in the lungs. Plasma protein 1 -antitrypsin that inactivates elastase, is inhibited.

Chronic bronchitis
Irritation of bronchi and bronchioles. Excessive mucous secretion . Decreased ciliary movements. Mucous cannot pass out leading to airway obstruction . Over inflation of air spaces distal to the terminal bronchioles.

Chronic bronchitis

HANK OU