Pulmonary Physiology

Concepts:
1. Lung volumes/capacities
2. Ventilation and dead space
3. Lung and chest wall pressures
4. Lung compliance
5. Airflow resistance
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Lung volumes and Capacities

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Normal breathing provides tidal volume-- 500mls functional residual capacity

FVC:maximal amount of air that you can expire--- but it still leaves behind residual volume

Tlc= everything combined

FRC+ forces equal at this time

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TLC- =rv+erv+irv+tv

(VOLUMES TO REMEMBER >>>>REIT=FVI

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Ventilation
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Lung and chest wall pressures

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Pleural pressure always negative due to cchest wall pushing out and no counterbalance by the
alveoli

Alveoli pressure and pressure in the entire respiratory tree is o at rest

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Lung Compliance
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Resistance to AIrflow

Indication for NIV

- Reversible,Type 2 respiratory failure eg in COPD

CPAP

-alveoli stay open

- allow longer time for gaseous exchange of oxygen

And also prevent lung collapse

Usually at about 5 (EPAP)

In BiPaP

-helps with CO2 due to inflation (increase in IPAP)

In chronic resp acidosis and osa start at high ipap/epap eg 18/10 or 18/12

In less resistant patients can start at 10/5

With NIV

- Increase intrathoracic pressure compressing ivc decreased VR -- helps in heart failure
- Also decreases afterload
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- Bad in patients who are volume depleted .

Who it benefits:

Acute hypercapnic rf in COPD—improves compliance, decrease work of breathing, feel less dyspneic.
Reduces need for intubation. Importance: hard to get patient with COPD off ventilator.

- Patient selection:
- Ph 7.25-7.29 best

Can use to wean off intubation