UNIVERSIDAD DE ZAMBOANGA

School of Allied Medicine

Department of Respiratory Therapy

PHYSIOLOGY OF
RESPIRATION
VENTILATION AND GAS EXCHANGE
MANAGEMENT
WHAT IS PHYSIOLOGY?
► the branch of biology that deals with the normal functions of living organisms and their parts.
► the way in which a living organism or bodily part functions.
► Physiology (/ˌfɪziˈɒlədʒi/; from Ancient Greek φύσις (physis), meaning 'nature, origin', and -λογία (-logia),
meaning 'study of'[1]) is the scientific study of functions and mechanisms in a living system
 WHAT IS RESPIRATION?
► the act of respiring; inhalation and exhalation of air; breathing.
1. the sum total of the physical and chemical processes in an organism by which oxygen is conveyed to
tissues and cells, and the oxidation products, carbon dioxide and water, are given off.
2. an analogous chemical process, as in muscle cells or in anaerobic bacteria, occurring in the absence of
oxygen.
PHYSIOLOGY OF RESPIRATION
Defining respiration
Respiration is the biologic process of oxygen and carbon
dioxide exchanging across the permeable membranes. The
single-celled animal directly acquires oxygen from the environment
and directly expels carbon dioxide metabolite. The entire process
requires nothing more than simple diffusion across cell membrane.
In humans O2 and CO2 diffusion (respiration) involves a number of
elements separating the environment from the cell.
The respiratory obstacle course requires
complex cardiovascular and pulmonary
systems capable of maintaining internal
stability through physiologic systems of
coordinated feedback responses, a process
referred to as respiratory homeostasis. The
relationship of the volumes of carbon dioxide
and oxygen exchanged per minute by the lung
(external respiration) is referred to as
respiratory exchange ratio (RR),
whereas the same relationship
at the tissue level (internal respiration) is referred to as the respiratory quotient (RQ).
Respiratory homeostasis requires that RR and RQ to be equal.
A change of any respiratory homeostatic factor must result in one of the following three
alternatives.
1. The arterial blood gas values change.
2. The cardiovascular and pulmonary systems increase work to maintain the homeostatic
balance; therefore, the blood gas values remain relatively unchanged.
3. Various combinations of the previous two may occur.
The degree of abnormality in arterial blood gas values is determined by
the balance between the severity of disease and the degree of
compensation by cardiopulmonary system. Normal arterial blood gases
do not mean there is an absence of disease because the homeostatic
system can compensate. However, abnormal arterial blood gas values
reflect uncompensated disease that may be life threatening.
 EXTERNAL RESPIRATION
• Gas exchange between the environment and the pulmonary
capillary blood is referred to as external respiration. The most
efficient gas exchange would occur if there is existed a perfect match
between all lung ventilation and all pulmonary capillary blood flow.
 Regional differences in ventilation
• In a healthy person standing erect, intrapleural pressure is more
subatmospheric at the apex than at the base. The most probable
reason for this is that the lung is “suspended” from the hilum, and the
weight of the lung requires a larger pressure for support below the
hilum than above
Thus pressure near the base is greater, and thereby
the intrapleural negativity is less. Approximately
40% of the total lung capacity remain in the lung at
the end of exhalation the distribution of this lung
volume will primarily be a function of the regional
pressure (transpulmonary pressure [TTP])
gradients across the lung,
which are greater at the apex than the base. When
inspiration creates more subatmospheric pressure
in the pleural space, the change in TTP at the base
will be far greater than the change in TPP at the
apex. Thus, relatively more the inspired tidal
volume will tend to distribute to the basilar alveoli.
Regional differences in ventilation refer to volume
changes in relation to resting volume. Compared
with the apex, the base of the lung has a smaller
resting volume and undergoes a larger volume
changes per unit of the lung; therefore, basilar
ventilation is greater. This is the true dependent
lung in any body position.
Regional differences in perfusion
The normal distribution of blood flow
throughout the pulmonary vasculature is dependent
primarily on gravity and cardiac output. In a
healthy person standing erect, there is a distance of
approximately 30 cm from the apex to the base of
the lung.
Assuming the pulmonary artery enters the lung
halfway between top and bottom, the pulmonary
artery pressure would have to be great enough to
overcome a gravitational force of 15cmH2o water
supply flow to the apex: a similar gradient would
be aiding flow to the base
This gravitational flow effect on blood flow results
in pulmonary artery pressure at the lung base of
greater magnitude than the pulmonary artery
pressure at the apex. Thus blood will preferentially
flow through the gravity dependent areas of the
lungs.
 LUNG ZONES
Zone 1 is the least gravity dependent area of the lung
and has alveolar pressures higher than pulmonary
arterial pressures, resulting the virtual absence of blood
flow. It should be noted that the total absence of
pulmonary blood flow to these areas does not exist to
any significant extent in the normally perfused lung.
However, if pulmonary artery pressure is
significantly decreased (hypotension) or alveolar
pressures significantly increased (positive airway
pressure therapy) the absence of perfusion to the
least gravity-dependent areas of the lung can
become significant.
Zone 2 is an area of complex and varying
intermittent blood flow. The extent of blood flow
in zone 2 depends primarily on the relationship of
pulmonary artery pressure to alveolar pressure.
Under normal circumstances this is determined far
more by the cardiac cycle and by the ventilator
cycle.
The amount of blood ejected by the right ventricle
per minute (cardiac output) is a major determinant
of blood flow through the pulmonary vasculature.
In general, the greater the cardiac output, the
greater the pulmonary artery pressure. Thus, in the
normal lung, as cardiac output increases, zones 2
and 3 extend upward; conversely, as the cardiac
output decreases zones 2 and 3 descends.
Zone 3 is the gravity dependent area of constant
blood flow (arterial pressure always greater than
alveolar pressure).
 VA/Q Relationship
Schematically, the gas exchange unit is
composed of an alveolus and its association
pulmonary capillary. This theoretical respiratory
unit can exist in one of four absolute relationships.
INTERNAL RESPIRATION
The primary purpose of respiration is to
provide oxygen to the cells; the secondary purpose
is to remove carbon dioxide from the cells. The O2
and CO2 exchange between systematic capillary
and blood cells is referred to as internal
respiration.
This process primarily depends on:
1. metabolism
2. regional perfusion
3. arterial blood gases
Although the pulmonary system is essential to
external respiration, the cardiovascular system is
essential to both external and internal respiration.
Perfusion that is inadequate to serve the oxygen
demands threatens internal respiration despite
adequate pulmonary function.
CELLULAR RESPIRATION
Many biochemical reactions essential for
sustaining life require considerable energy, in fact,
these energy demands have been referred to as
“thermodynamically improbable”. Molecular
oxygen must be available to the mitochondria so
that energy can be stored and released in the form
of high-energy phosphate bounds, the breakdown
of which is accompanied by a tremendous energy
released.
CELLULAR RESPIRATION
Many biochemical reactions essential for
sustaining life require considerable energy, in fact,
these energy demands have been referred to as
“thermodynamically improbable”. Molecular
oxygen must be available to the mitochondria so
that energy can be stored and released in the form
of high-energy phosphate bounds, the breakdown
of which is accompanied by a tremendous energy
released.
When oxygen is not available to the mitochondria,
the normal biochemical pathways for energy
production cannot be used. Under normal
circumstances, mitochondria can function
adequately when cellular oxygen tensions are less
than 5 mmHg, but we do not presently know the
critical intracellular oxygen tensions for various
vital organs systems under different conditions.
Tissue hypoxia
Tissue hypoxia exists when cellular oxygen
tensions are below the level required to meet
metabolic demands. Classically, tissue hypoxia is
subdivided into four etiologic categories:
1. hypoxemic hypoxia (secondary to inadequate
arterial oxygenation)
2. anemic hypoxia (secondary to inadequate
hemoglobin content)
3. circulatory hypoxia (secondary to inadequate
perfusion)
4. histotoxic hypoxia (secondary to an inability of
the cells to use oxygen
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