LUNG COMPLIANCE

10. Lung compliance

Define lung compliance. Compliance is the measure of distensibility – the ease at which something
can be stretched. Lung compliance (CL) is defined as the change in lung
volume (ΔV) per unit change in transpulmonary pressure (ΔP).

CL = ΔV/ΔP

> Specific compliance is compliance divided by FRC, thereby

compensating for differing body sizes.
> Elastance is the reciprocal of compliance.
Draw a pressure–volume curve Saline
of the lung.
Air
Lung Volumes (mL)

ARDS

Transpulmonary Pressure (cm H2O)

Fig. 10.1  Lung compliance

> Lung compliance is best described using pressure–volume curves

of the lungs under static conditions (i.e. when there is no gas flow
and the respiratory muscles are relaxed). Under these conditions the
transpulmonary pressure reflects in magnitude the elastic recoil pressure
of the lungs. The slope of the pressure–volume curve equates to lung
compliance. Normal lung compliance is 200 mL/cm H2O.
> In neonatal respiratory distress syndrome, lung compliance is greatly
reduced due to insufficient surfactant.
> Conversely, in hypothetical saline-filled lungs, compliance is greatly
increased as the lack of an air–fluid interface means that no surface
tension exists.

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 01 PHYSIOLOGY
What do you understand by the
term hysteresis?
What is the difference between
static and dynamic compliance?
How can static and dynamic
compliance be measured?
What factors affect lung
compliance?
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Hysteresis is an important phenomenon seen in P-V curves; it represents
‘unrecoverable’ energy because the lungs do not act as a perfect elastic
system (i.e. a system in which any energy that is put in is immediately
returned). At any given lung volume, the pressure required to inflate the lung
is greater than that required for deflation.
Static compliance is the lung compliance obtained during ‘static’
conditions when there is no gas flow activity within the lungs. Static
compliance monitors only elastic resistance (i.e. the resistance offered by the
alveoli being stretched and the interstitium and chest wall being moved). The
static compliance curve can be used to select the ideal level of PEEP during
mechanical ventilation.
Dynamic compliance is the lung compliance obtained under ‘dynamic’
conditions when gas flow activity is present during rhythmic breathing.
Dynamic compliance monitors both elastic resistance and airway resistance
(which depends on gas viscosity and density, length and radius of lumen,
gas flow rate and flow pattern).
Static compliance: This is obtained under ‘static’ conditions when there
is no gas flow (e.g. during an inspiratory pause). The subject breathes into
a spirometer to measure lung volumes and an oesophageal pressure probe
is used to estimate intrapleural pressures. The volumes and pressures
measured are then plotted to produce a pressure–volume curve. The
compliance is then calculated from the gradient of the curve (usually
measured near FRC). The term ‘static’ is somewhat misleading because
measurements have to be interrupted to allow the subject to breath and
therefore the system never truly reaches static conditions (it is, therefore,
sometimes called ‘quasi-static’ compliance).
Dynamic compliance: This is obtained under ‘dynamic’ conditions when
there is gas flow (i.e. during rhythmic breathing). Again the subject breathes
into a spirometer to measure lung volumes and an oesophageal probe is
used to estimate intrapleural pressures. The term ‘dynamic compliance’ is
also somewhat confusing as the compliance is typically calculated during
a tidal breath at the points of zero flow on the P-V loop (end-inspiration or
end-expiration).
> Lung volume – the slope of the P-V loop is not constant. It is steepest
around FRC but then reduces at both low and high lung volumes (note
that FRC is affected by many factors including age, body posture and
body size, which will all in turn affect lung compliance).
> Lung elasticity – this is due to the elastin and collagen present in
lung tissue. With ageing there is a gradual loss of elastic tissue and
this increases compliance of the lungs. In emphysema, loss of elastin
from lung tissue increases lung compliance. Compliance is reduced in
pulmonary fibrosis due to increased collagen deposition in lung tissue
and pulmonary congestion (e.g. oedema).
> Surface tension – this is the most important determinant of lung
compliance. The water in alveolar fluid has a high surface tension and
provides a force that tries to collapse the alveolus. Lung surfactant
breaks up the surface tension of the fluid, increasing lung compliance
and making the alveolus less likely to collapse. The effects of lack of
pulmonary surfactant are clearly evident in conditions such as neonatal
respiratory distress syndrome.
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 LUNG COMPLIANCE
How can you calculate the work Mechanical work of breathing = Force × Distance
of breathing? = Pressure × Volume

Thus, the work of breathing = c

 umulative product of pressure × volume of air
moved over time
= ΔP × ΔV/Δt
> During quiet breathing, most of the work performed is required to
overcome elastic resistance (~65%). This inflates the lung and provides
a store of elastic energy that gets released during expiration and is
therefore viewed as ‘useful’ work. However, overcoming non-elastic
resistance (e.g. airway resistance and viscosity, ~35%) results in energy
being dissipated as heat and is viewed as ‘wasted’ work.
> The normal metabolic cost of breathing is approximately 0.5–1.0 mL
O2/L /min but this may increase to 2–4 mL O2/L/min with hyperventilation.
Work increases with increasing tidal volume, increasing respiratory flow
and increasing airway resistance (e.g. COPD).

B
C

E
Volume (L)

F
G

D
A

Intrapleural Pressure (cm H2O)

Fig. 10.2  Lung pressure-volume loop to show the work of breathing

> Inspiration: Work required to overcome the elastic recoil of the chest
wall and lungs, airway resistance and viscosity (area AGBCD).
> Expiration: Expiratory work returned (area BEADC). This is passive
under resting conditions and active during stress conditions.
> Wasted work: Area contained within the loop represents total wasted
energy due to tissue and airway losses.

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