Learning Objectives:

-introduction

-what is the Central Respiratory Control

-Peripheral Respiratory Control

-Breathing Is Automatic and Not Autonomic

-Chemical control of breathing

Introduction:
Respiratory control and maturation are intricately
regulated by various systems, including the
central and peripheral nervous systems, as well as
feedback from lung tissues and airway muscles.

Our understanding of the normal development

and pathophysiology of respiratory control comes
from studies involving both humans and animals.
By comprehending the growth trajectory and
maturation process of each respiratory
component, along with the influence of postnatal
environmental factors, clinicians can gain insights
into the extent of respiratory control disturbances
in premature infants. This knowledge can guide
monitoring practices and help establish treatment
targets.
Central Respiratory Control:
Breathing control undergoes progressive
maturation in the pons and medulla regions of
the brain stem in human fetuses and neonates.
The pre-Butzinger complex, located near CO2-
sensitive areas in the brainstem, primarily
generates respiratory rhythm. Additionally,
respiratory pattern formation occurs in the
ventral respiratory column, further caudally, and
is capable of producing rhythmic breathing
without sensory feedback. This rhythmic activity
persists throughout life and is responsible for
"spontaneous" breathing efforts.

Peripheral Respiratory Control:

Peripheral organs play a crucial role in
synthesizing central nervous system signals and
providing feedback via pulmonary ducts and the
lower airway. Sensory receptors within the lungs
include fast-conducting myelinated fibers (SARS
and RARs) and slow-conducting non-myelinated
fibers (bronchopulmonary C-fibers), which
terminate in the nucleus tractus solitarius (NTS).
Projections from the NTS innervate phrenic motor
neurons in the medulla, pons, and spinal cord.
Activation or inhibition of SARS, RARS, and C-
fibers individually can influence cardiopulmonary
reflexes, which are discussed separately in this
section. Premature infants present unique
developmental features that pose clinical
management challenges in peripheral respiratory
control.

Breathing Is Automatic and Not Autonomic:

The control of breathing is an automatic process

that operates without conscious intervention
during sleep, anesthesia, or when a person is not
actively thinking about breathing. While
conscious factors can temporarily override or
modify automatic respiratory functions, the
automatic system ultimately ensures a return to
normal breathing. Although the control of
breathing is often associated with the autonomic
nervous system, it shares similarities with
systems governing voluntary motor functions like
walking.
Chemical Control of Breathing:
Minute ventilation, which determines the amount
of air exchanged during respiration, is regulated
through chemical control mechanisms. Changes in
minute ventilation occur over the span of a
minute or longer, and the breathing pattern
responsible for precise ventilation is influenced
by neural control. This neural control can cause
pattern changes within fractions of a second.

Asphyxia
In healthy individuals, changes in arterial Po2,
Pco2, or H+ typically occur simultaneously (unless
assessed by a respiratory physiologist). Engaging
in breath-holding or rebreathing from a plastic
bag triggers an accumulation of the stimulus to
breathe, leading to alterations in all three
variables.

Note:
Increased arterial Pco2 levels
(hypercapnia) stimulate
central and peripheral
chemoreceptors.
Chemical Dysregulation of Breathing:

Disruptions in the chemical control of breathing

may go unnoticed and can even result in life-
threatening events, particularly during sleep.
Standardized tests to evaluate in vivo chemical
control are still lacking, and interpreting the
results of such tests can be challenging. Non-
invasive monitoring of gas exchange and
polysomnography are essential for assessing the
severity of hypoventilation and its relationship to
the individual's level of alertness.