RESPIRATORY SYSTEM  It filters impurities and humidifies

 refers to organ system that moves air and warms the air as it inhaled.
into and out of the lungs, so that O2 and  It is composed of an external and
CO2 maybe exchange between the air internal portion. The external portion
and the blood. protrudes from the face and is
The respiratory system is composed of the upper supported by the nasal bones and
and lower respiratory tracts. Together, the two cartilage. The anterior nares
tracts are responsible for ventilation (movement (nostrils) are the external openings of
of air in and out of the airways). The upper
the nasal cavities.
respiratory tract known as the upper airways
 made up of bones and cartilage
warns and filters inspired air so that the lower
covered with skin.
respiratory tract (the lungs) can accomplish gas
exchange or diffusion. Gas exchange involves  inside the nostrils are hairs that helps to
delivering of oxygen to the tissues through the block the entry of dust called
bloodstream and expelling waste gases such as VIBRISSAE - The hair that lines the
carbon dioxide, during expiration. The vestibule and filter foreign object.
respiratory system depends on the  the two nasal cavities are within the
cardiovascular system for perfusion, or blood skull separated by nasal septum.
flow through the pulmonary system (Porth,  Each nasal cavity is divided into
2015) three passageways by the projection
of the turbinates from the lateral
DIVISIONS OF RESPIRATORY SYSTEM walls. The turbinate bones are also
called conchae.
1. UPPER RESPIRATORY TRACT/UPPER  NOSE acts to filter air that inhaled,
AIRWAYS serves as airway for respiration,
 Upper respiratory tract structures involves in speech, has olfactory
consist of the nose, paranasal receptors to sense to smell bad and
sinuses, pharynx, tonsils and good odors and dislodges materials
adenoids; larynx and trachea. via sneezing.
 Functions of Upper airways
 Transport of gases to the lower airways PARANASAL SINUSES
 Protection of the lower airways from
 These include the four of bony
foreign matter
cavities that are lined with nasal
 Warming, filtration and humidification
mucosa and ciliated pseudostratified
of inspired air.
NOSE columnar epithelium. These air
 The only externally visible part of the spaces are connected by a series of
respiratory system ducts that drain into nasal cavity.
 composed of mainly of hyaline cartilage  The sinuses are named by their
covered with skin. locations. Frontal, ethmoid,
 serves as a passageway for air to pass sphenoid, and maxillary
to and from the lungs  A prominent function of the sinuses
 Air enters and leave the respiratory is to serve as a resonating chamber in
system through the nose speech.
  the function is to lighten the skull and  The palatine tonsils - are located at the
provide resonance (more vibrating air) back of the throat.
for the voice One tonsil is located on the left side of
the throat and the other is located on the
 they help in phonation
right side. The tonsils play a role in
 These sinuses are common site of protecting the body against respiratory
infection. and gastrointestinal infections.
 Lingual tonsils are located on the
PHARYNX/ THROAT posterior surface of the tongue, which
 It is tube like structure that connects the also places them near the opening of the
nasal and oral cavities to the larynx. oral cavity into the pharynx.
Lymphocytes and macrophages in
 It is a passageway for air and food or
the tonsils provide protection against
common opening between the digestive harmful substances and pathogens that
and respiratory system. may enter the body through the nose or
mouth
3 PARTS OF PHARYNX
a. Nasopharynx- behind the nasal cavities, LARYNX/ VOICE BOX
passageway for air only.  an organ that connects the pharynx and
b. Oropharynx- located in the middle the trachea that contains the vocal cords
portion of the pharynx located behind for speech.
the mouth, and a passageway for both  Although the major function of larynx is
air and food. extends from uvula to vocalization, it also protects the lower
epiglottis airways from foreign substances and
facilitates coughing. It consists of the
c. Laryngopharynx- located in the lower
following:
portion of the pharynx that opens into
1. Epiglottis
the larynx and the esophagus that
 the upper most cartilage. A valve flap
serves a passageway for both air and
of cartilage that covers the opening to
food. extends from epiglottis to
the larynx during swallowing.
esophagus
 During swallowing, the larynx is
elevated, and the epiglottis closes to
TONSILS and ADENOIDS prevent the entry of saliva or food into
 are located in the roof of the the larynx.
nasopharynx. 2. Glottis
 The tonsils, the adenoids and other
 the opening between the vocal cords in
lymphoid tissue encircle the throat.
These structures are important links in the larynx.
the chain of lymph nodes guarding the 3. Thyroid cartilage
body from invasion of organisms  the largest of the cartilage structures;
entering the nose and the throat. part of it forms of the Adam’s apple
 Pharyngeal tonsil- commonly as that protrudes anteriorly. It can be felt
Adenoids aids in defending against in the front of the neck.
infections. The adenoids and tonsils
work by trapping germs coming in
through the mouth and nose
 4. Cricoid cartilage nodes guarding the body from invasion
 the only complete cartilaginous ring in of organisms entering the nose and the
the larynx (located below the thyroid throat.
cartilage)  Pulmonary protection in the alveoli
5. Arytenoid cartilage
 used in vocal cord movement with the
thyroid cartilage TRACHEA
 serves to maintain airway patency,  The trachea/ windpipe, is composed of
forms part of the larynx, and provides smooth muscle with C-shaped rings of
an attachment point for key muscles, cartilage at regular intervals.
ligaments, and cartilage, which function  It serves as the passage between the
in the opening and closing the vocal larynx and the right and left main stem
cords for sound production bronchi which enter the lungs through
an opening called the hilus.
6. Vocal cords
 The air passageway between the
 ligaments controlled by muscular
larynx and the primary bronchi
movements that produce sounds;  4-5 inches long and extend from the
located in the lumen of the larynx. larynx to the primary bronchi.
 are folds of tissue located in  The point at which it divides is called
the larynx (voicebox) that have CARINA A ridge at the base of the
three important functions: To protect trachea (windpipe) that separates the
the airway from choking on material openings of the right and left main
in the throat. To regulate the flow of bronchi (the large air passages that lead
air into our lungs.
from the trachea to the lungs)
The production of sounds used for
 Trachea and bronchi are line with cilia
speech.
and goblet cells
 The vocal folds produce
sound when they come together and  CELIA- hair like projections that sweep
then vibrate as air passes through out debris and excessive that sweeps out
them during exhalation of air from debris and excessive mucous in the
the lungs. This lungs
vibration produces the sound  GOBLET cells- secretes mucous
wave for your voice. (120ml/day) that entrap debris in the
respiratory tract.
B. LOWER RESPIRATORY TRACT
 consists of the lower portion of trachea, LUNGS
lungs, which contain the bronchial and  Are located on the either side of the
alveolar structures needed for gas heart and cavity and encircled and
exchange found in the chest cavity. protected by the rib cage.
Functions of Lower Airways  Occupy most of the thoracic cavity
 Clearance mechanism- cough,  Pair of organs in which the gas
macrophages, lymphatics exchange takes place between the air in
 Immunologic response- The tonsils, the the alveoli and the blood in the
adenoids and other lymphoid tissue
pulmonary capillaries.
encircle the throat. These structures are
important links in the chain of lymph
  Right lung has 3 lobes, Left lung has 2 BRONCHI
lobes because of the space limitation
imposed by the heart.  There are several divisions of the
 The right lung is broader, but shorter bronchi within each lobe of the lung.
due to the presence of liver on the right First are the lobar bronchi (three in
side of the abdomen. the right lung and two in the left
 The 2 lungs are separated by a space lung). Lobar bronchi divide into
called MEDIASTINUM. segmental bronchi (10 on the right
 Mediastinum-is in the middle of the and 8 on the left);
thorax, between the pleural sacs that  these structures facilitate effective
postural drainage in the patient.
contain the two lungs. It extends
 Segmental bronchi then divide into
from the sternum to the vertebral
subsegmental bronchi. These bronchi
column contains the heart, blood
are surrounded by connective tissue
vessels, lymph nodes, thymus gland,
that contains arteries, lymphatics and
nerve fibers and the esophagus.
nerves.
 Primary bronchi (Right and Left)-
PLEURAL MEMBRANES branches of trachea that enter the lungs.
 Are serous membranes that encloses the BRONCHIOLES
lungs  smaller branches of the air passageways
 The visceral pleura covers the lungs; within the lungs.
 the parietal pleura lines the thoracic
 contain submucosal glands which
cavity.
produce mucus that covers the inside
 The visceral and parietal pleura and the
small amount of pleural fluid between
lining of the airways. The bronchi
these two membranes serve to lubricate and bronchioles are also line which
the thorax and the lungs and permit cells that have surfaces covered with
smooth motion of the lungs within the cilia. These cilia create a constant
thoracic cavity during inspiration and whipping motion that propels mucus
expiration. and foreign substances away from
 Intrapleural pressure- is the pressure the lungs towards the larynx
within the pleural space. The IPP is  The bronchioles branch into terminal
normally less than the pressure within bronchioles, which do not have
the lungs. It is this negative pressure that mucus glands or cilia. Terminal
that keeps the lungs inflated. bronchioles becomes respiratory
 If the intrapleural space losses its bronchioles which are considered to
negative pressure (by exposure to be the transitional passageways
atmospheric pressure) the lung collapse,
between conducting airways and the
a condition as Pneumothorax.
gas exchange airways.
 The Pleural Space is also a potential
 The respiratory bronchioles then lead
space for accumulation of fluid. An
into alveolar ducts and sacs and then
abnormal accumulation of fluid in the
alveoli. Oxygen and carbon dioxide
pleural space is known as Pleural
exchange takes place in the alveoli.
Effusion.
ALVEOLI the lungs, the pleural space and the
 Made up of simple squamous epithelium mediastinum
 The lung is made up of about 300  provides protection for the lungs, heart
million alveoli, constituting a total and great vessels given by bony
surface area between 50 and 100m2 structures in the thoracic cavity
(Porth, 2015).  Thoracic cage is rigid and flexible that
 the air sacs and the functional units of allows for inhalation/inflation and
the lungs exhalation/deflation of the lungs.
 It is the end point of the respiratory tract  made up of 12 pairs of ribs bounded
where gas exchange takes place. anteriorly by the sternum and posteriorly
 Contains macrophages that perform a by the thoracic vertebrae.
phagocytic role. These cells move  The first seven ribs are attached to the
from alveolus to alveolus removing sternum, 8th, 9th, and 1oth ribs are attach
foreign substances and keeping the by cartilage to the ribs above them. The
alveoli sterile. 11th and 12th ribs are called “Floating ribs
 There are types of alveolar because they are not attached to another
cells/Pneumocytes. Type I and type structure.
II cells.
 Type 1 alveolar cells are flat RESPIRATORY MUSCLES
squamous epithelial cells and
account for 95% of the alveolar DIAPHRAGM
surface area and serve as a barrier  the dome shape muscle that separates
between the air and the alveolar the thoracic and abdominal cavities.
surface. Gas exchange takes place  the main respiratory muscle for
along these cells. inspiration, once it contracts it flattens
and moves downward.
 Type 2 alveolar cells account for
 other accessory muscles for inspiration:
only 5% of this area but are
sternocleidomastoid, trapezius and
responsible for producing surfactant.
pectoralis muscle. They are used during
 Pulmonary surfactant- a lipoprotein
increase work of breathing.
secreted by alveolar that mixes with the
tissue fluid within the alveoli to
RESPIRATORY CENTERS are located in:
decreases surface tension permitting the
Medulla Oblongata
inflation of the alveoli. This prevents
 is the primary respiratory center.
collapse of the smaller airways during
Pons
expiration and makes it easier to inflate
 while involved in the regulation of
the alveoli during inspiration.
functions carried out by the cranial
nerves it houses, works together with the
THORAX and the DIAPHRAGM
medulla oblongata to serve an especially
critical role in generating the
THORAX
respiratory rhythm of breathing.
 Contains the major structures of the
Active functioning of the pons may also
respiratory system.These includes the
be fundamental to rapid eye movement
thoracic cage, the muscles of ventilation,
  a portion of the hindbrain that connects RESPIRATION
the cerebral cortex with the medulla  The goal of respiration is to provide oxygen
oblongata. It also serves as a to tissues and to remove carbon dioxide.
communications and coordination
center between the two hemispheres
of the brain
 contains the following:
The physiology of respiration processes

Apneustic center 1. Ventilation, or breathing- the movement of

- responsible for deep, prolonged inspiration air into and out of the lungs
- It controls the intensity of breathing and 2. External Respiration/ Diffusion-the
is inhibited by the stretch receptors of exchange of oxygen (O2) and carbon dioxide
the pulmonary muscles at maximum (CO2) between the air in the lungs and the
depth of inspiration, or by signals from blood
the pneumotaxic center. 3. Transport
- It increases tidal volume.
 The transport of O2 and CO2 in the blood
Pneumotaxic center 4. Internal respiration
- responsible for the rhythmic quality of
breathing  The exchange of O2 and CO2 between the
- located in the upper pons, sends blood and tissues.
inhibitory impulses to the inspiratory After these tissue capillary exchanges, blood enters
center, terminating inspiration, and the systemic venous circulation and travels to the
thereby regulating inspiratory volume pulmonary circulation. The oxygen concentration in
and respiratory rate. This center likely is blood within the capillaries of the lungs is lower than
involved in the fine-tuning of breathing. that in the lungs’ alveoli. Because of this
concentration gradient, oxygen diffuses from the
Question: what will happen if there is too much
alveoli to the blood. Carbon dioxide, which has a
carbon dioxide in the body?
higher concentration in the blood than in the
Answer: Build-up of carbon dioxide can damage alveoli, diffuses from the blood into the alveoli.
the tissues and organs and further impair oxygenation Movement of air in and out of the airways
of blood and, as a result, slow oxygen delivery to the continually reloads the oxygen and removes the
tissues. Acute respiratory failure happens quickly CO2 from the airways and the lungs. This
and without much warning.
process of gas exchange between the
PHYSIOLOGY OF THE RESPIRATORY atmospheric air and the blood and between the
SYSTEM blood and cells of the body is call respiration.
The cells of the body derive the energy they need
from the oxidation of carbohydrate, fats and proteins.
This process requires oxygen. Vital tissues like the TYPES OF PRESSURE INVOLVE IN
brain and the heart cannot survive long without a RESPIRATION
continuous supply of oxygen. As a result of With respect to breathing, three types of
oxidation, carbon dioxide is produced and must be
pressure are important.
removed from the cells to prevent the build up of acid
waste products. The respiratory system performs this 1. Atmospheric pressure- the pressure of
function by facilitating life sustaining processes such the air around us. At sea level,
as oxygen transport, respiration, ventilation and gas atmospheric pressure is 750 mmHG. At
exchange.
 high altitudes, atmospheric pressure is between the atmosphere and the
low. gases inside the lungs.
2. Intrapleural pressure.  This requires movement of the walls
 Pressure within the pleural space of the thoracic cage and of its floor.
between the parietal and visceral The effect of these movements is
pleura.
alternately to increase and decrease
 Intrapleural pressure is always Slightly
the capacity of the chest.
below than Atmospheric Pressure and is
called negative pressure, it creates a
Phases of Ventilation
suction that holds the lungs open to
Inhalation (Inspiration)
their resting level.
 Air gases flow into the lungs or the
 Without this negative pressure to hold
the lungs against the chest wall, the process of air flowing into the lungs
elastic recoil properties of the lungs  Breathing in, voluntary phase.
would cause them to collapse.  The rib cage elevated as intercostal
3. Intra-pulmonic pressure/Intra- muscles contract
alveolar pressure - the pressure within  The size of the thoracic cavity increases
the bronchial tree and alveoli. This  (External air is pulled into the lungs
pressure fluctuates below and above due to an increase in intrapulmonary
atmospheric pressure during each cycle volume)
of breathing.
 During the inspiration as the
4. Transpulmonary Pressure- the
difference between intra-alveolar and diaphragm and intercostal muscles
intra-pleural pressure contracts, moves downward, and
5. Intrathroracic pressure – the pressure expands the chest cavity from top to
within the entire thoracic cavity. bottom. When the capacity of the
chest is increased. Air enters through
3 PROCESSES OF RESPIRATION the nose, pharynx, larynx, trachea
1. VENTILATION (inspiration) and moves into the
 refers to the movement of gases in and bronchi, bronchioles and alveoli and
out of the lungs. (The exchange of air inflates the lungs.
between the lungs and the atmosphere  As the chest expanded, the parietal
so that oxygen can be exchanged for pleura expands with it. Intrapleural
carbon dioxide in the alveoli) pressure becomes negative and
 commonly referred to as breathing. intra-pulmonic becomes more
 Ventilation is needed to provide negative and falls below atmospheric
oxygen for metabolism and to dilute pressure, and air enters the nose and
metabolic pollutants (carbon dioxide and travels through respiratory passages
odour)
to the alveoli. Entry of air continuous
 It is the process of air flowing into
until intra-pulmonic pressure is equal
the lungs during inspiration
(inhalation) and out of the lungs to atmospheric pressure; this is
during expiration (exhalation). Air Normal Inhalation. Inhalation can
flows because of pressure differences be continued beyond normal, that is
 deep breathing. This requires more What is the difference between ventilation
forceful contraction of the and oxygenation?
respiratory muscles to further expand Answer: Ventilation and oxygenation are
the lungs, permitting more air to distinct but interdependent physiological
processes. While ventilation can be thought of
enter.
as the delivery system that
 The inspiratory phase of respiration
presents oxygen rich air to the
normally active because it requires alveoli, oxygenation is the process of delivering
energy. O2 from the alveoli to the tissues in order to
Exhalation (Expiration) maintain cellular activity.
 The air leaves the lungs/ Air gases flow
out the lungs the muscles are relax What are the types of mechanical ventilation?
 Breathing out, involuntary phase. Answer:
 The ribs depressed as external muscles
Positive pressure ventilation: pushes the air
relaxed
into the lungs.
 Diaphragm moves superiorly during
relaxation
Negative pressure ventilation: sucks the air
into the lungs by making the chest expand
 the diaphragm and external intercostal
and contract.
muscles relax. As the chest cavity
becomes smaller, the lungs recoil and
force the air out through the bronchi MECHANICS OF VENTILATION
and the trachea.  Physical factors that govern airflow
 As the intra-pulmonic pressure becomes in and out of the lungs are
positive or rises above atmospheric collectively referred to as the
pressure, air is force out of the lungs mechanics of ventilation and include
until the two pressures are again equal.
Air pressure variances, Resistance
 Forced expiration can occur mostly
to air flow, and Lung Compliance.
by contracting internal intercostal
muscles to depress the rib cage
AIR PRESSURE VARIANCES
 the expiratory phase of the
 Air flows from a higher region of high
respiration is normally passive,
pressure to a region of lower pressure.
requiring very little energy.  During inspiration, movement of the
diaphragm and intercostal muscles
Inhalation and expiration is brought by the enlarge the thoracic cavity and thereby,
nervous system and your respiratory muscles. lower the pressure inside the thorax to
a level below that of atmospheric
What is the difference between ventilation pressure. As a result, air is drawn
and respiration? through the trachea and the bronchi into
Answer: Ventilation is the movement of a the alveoli. (
volume of gas into and out of the  During EXPIRATION; the diaphragm
lungs. Respiration is the exchange of oxygen relaxes resulting in a decrease in the size
and carbon dioxide across a membrane
of the thorax cavity. The alveolar
either in the lungs or at the cellular level.
pressure exceeds atmospheric pressure,
 and the air flows from the lungs into the  Compliance is normal (1L/cm H2O) if
atmosphere. the lungs and thorax easily stretch and
distend when pressure is applied.
AIRWAY RESISTANCE  Factors that determine lung compliance
 Resistance is determined by the radius are the surface tension of the alveoli,
or size of the airway (which the air is the connective tissue and water content
flowing), as well as by lung volumes of the lungs and the compliance of the
and airflow velocity. thoracic cavity.
 Any process that changes the bronchial  Lungs is made up of collagen and elastin
diameter or width affects airway fibers. Collagen fibers resist stretching
resistance and alters the rate of airflow and make lung inflation difficult,
for a given pressure gradient during whereas elastin fibers are easily
respiration stretched and increased the ease of lung
 With increased resistance, greater than inflation. When elastin fibers are
normal respiratory effort is required to replaced with scar tissue the lungs
achieve normal levels of ventilation. becomes stiff and non-compliant
Common phenomena that may alter bronchial  The fluid lining the alveoli has a high
diameter which affects airway resistance: surface tension. When the surface
 Contraction of bronchial smooth tension is high, the most interior surface
muscle- due to asthma of the alveoli are difficult to separate
 Thickening of bronchial mucosa- due to from one another and more energy is
bronchitis required to fill the alveoli with air
 Obstruction of airway- due to mucus, during inspiration. A lipoprotein
tumour or foreign body substance called Surfactant secreted by
 Loss of lung elasticity-due to type 2 cells decreases the surface tension
emphysema which is characterized by of these fluids in the alveoli.
connective tissue encircling the airways,  Surfactant exerts 4 important effects on
thereby keeping them open during both lung inflation. 1. It lowers surface
inhalation and exhalation. tension, it increases lung compliance
COMPLIANCE and ease of inflation, it provides stability
 Is the elasticity and expandability of and more inflation into the alveoli and
the lungs and thoracic structures/ the assist in preventing pulmonary edema
extent to which the lungs expand. by keeping the alveoli dry.
 A measurement of distensibility or how  Without surfactant, lung inflation is very
a tissue is stretched. difficult. The type 2 alveolar cells that
 Compliance allows the lung volume to produce surfactant do not mature until
increase when the difference in pressure 26th to 28th weeks of gestation. Premature
between the atmosphere and the thoracic infants do not have sufficient surfactant
cavity causes air to flow in. leading to alveolar collapse and severe
 Compliance is determined by examining respiratory distress or IRDS among
the volume-pressure relationship in the infants and ARDS among adults.
lungs and thorax.  Increased compliance occurs if the
lungs lost their elastic recoil and
become more overdistended (ex:
 emphysema)/ it is easier to expand lung  The amount of air that remains in the
tissue. lungs after forceful/maximum
 Decreased compliance occurs if the expiration/exhalation.
lungs and thorax are stiff (rigid,  It prevents collapse of the lungs
inflexible, firm)/it is more difficult to during expiration
expand the lungs. Conditions  1200ml
associated with decreased compliance  Significance: Residual volume may be
include morbid obesity, pneumothorax, increased with obstructive disease
hemo-thorax, pleural effusion, Inspiratory Reserve Volume (IRV)
pulmonary edema, atelectasis,  The maximum volume of air that can be
pulmonary fibrosis and ARDS. inhaled after a normal inhalation
Decreased compliance requires greater  Normal value (Brunner 2018) 3000mL
than normal energy expenditure by the  Usually between 2100 and 3200 ml
patient to achieve normal level of
ventilation.
Expiratory Reserve Volume (ERV)
LUNG VOLUMES AND CAPACITIES  The maximum volume of air that can be
 Lung function reflects the mechanics of exhaled forcibly after a normal
ventilation, is viewed in terms of lung exhalation
volumes and capacities.  Normal Value: 1100 ml
 The flow of air in and out of the lungs  ERV is decreased with restrictive
provides tangible measures of lung conditions such as obesity, ascites, and
volumes although referred to as pregnancy
pulmonary function.
 Lung volumes are categorized as tidal LUNG CAPACITIES
volume, IRV, ERV and residual volume VITAL CAPACITY/VC
 Lung capacity is evaluated in terms of  The maximum volume of air exhaled
vital capacity, inspiratory capacity, from the point of maximum inspiration
functional residual capacity and total (VC= TV+IRV+ ERV)
lung capacity.  Normal value 4600 mL
 A decreased in viatl capacity may found
LUNG VOLUMES in neuromuscular disease, atelectasis,
Tidal Volume pulmonary edema, COPD and obesity
 is the amount of air that moves in and Inspiratory Capacity
out of the lung with each normal breath  The maximum volume of air inhaled
 The volume of air inhaled and exhaled after a normal expiration
with each normal breath  IC= TV + IRV
 Normal Value: 500ml or 5-10mL/kg  3500ml
 Significance: The TV may not vary  A decreased in IC may indicate
even with severe disease restrictive disease or obesity
Functional Residual Capacity
Residual volume  is the amount of air that remains in the
lungs after normal exhalation/expiration.
 FRC= ERV + RV
  FRC may increased with COPD and exchange (1) the surface area available
decreased in ARDS and obesity for diffusion, (2)the thickness of the
Total Lung Capacity alveolar-capillary membrane, (3) the
 The volume of air in the lungs after a partial pressure of gas across the
maximum inspiration membrane, (4) solubility and molecular
 Is the total of all four volumes (RV, TV, characteristics of the gas. Any condition
IRV, ERV)500 +1200+3000+1100 or disease that affects one or more
 TLC may decreased with restrictive factors may impair the diffusion of O2
disease such as atelectasis and and CO2 across the alveolar- capillary
pneumonia and increased in COPD membrane.

Many factors that affect respiratory capacity OXYGEN TRANSPORT

 A person’s size  Oxygen is supplied to, and carbon
 Sex dioxide is removed from cells by
 Age way of circulating blood through the
 Physical condition
thin walls of the capillaries. Oxygen
2. Pulmonary Diffusion
diffuses/ distribute from the capillary
 The process by which the oxygen and
carbon dioxide are exchange from an through the capillary wall to the
area of higher pressure to an area of interstitial fluid. At this point, it
lower concentration at the air-blood diffuses through the membrane of
interface. The alveolar capillary tissue cells where it is used by
membrane is ideal for diffusion because mitochondria for cellular respiration.
of its thinnest and large surface area. In  O2 is carried in the blood in two
the normal healthy adult, O2 and CO2 forms: dissolved in plasma (less than
travel across the alveolar capillary 3%) and attached to hemoglobin
membrane without difficulty as a result (97%). The partial pressure of
of differences in gas concentrations in
oxygen in arterial blood (PaO2)
the alveoli and capillaries.
represents the level of dissolve
 Diffusion of oxygen from the alveoli to
the pulmonary capillaries and diffusion oxygen in plasma. Less than 3% is
of CO2 from the pulmonary capillaries carried in this form.
to the alveoli.  And 97% of O2 is carried in the
 Lung diffusion testing measures how blood bound to hemoglobin is called
well the lungs exchange gases. This is Oxyhemoglobin. Oxyhemoglobin is
an important part of lung testing, transported in arterial blood and
because the major function of the lungs made available to tissues for use in
is to allow oxygen to "diffuse" or pass cell metabolism. The saturation of
into the blood from the lungs, and to O2 in arterial blood (SaO2)
allow carbon dioxide to "diffuse" from
represents the percentage of
the blood into the lungs
hemoglobin molecules that are
 CO2 diffuses about 20 times more
rapidly than the O2. There are 4 factors bound with oxygen.
that affect alveolar-capillary gas
  The hemoglobin molecule is full Hg. Because of these low pressures, the
saturated with oxygen to all four of pulmonary vasculature normally can
its oxygen binding sites. The term vary its capacity to accommodate the
AFFINITY refers to the capacity of blood flow it receives. Reduced gas
transfer in patients with pulmonary
the hemoglobin to combine with O2.
arterial hypertension (PAH) is
 When the affinity is High,
traditionally attributed to remodeling
hemoglobin binds readily with and progressive loss of pulmonary
oxygen at the alveolar capillary arterial vasculature that results in
membrane. But at the tissue level, decreased capillary blood volume
Hemoglobin does not readily available for gas exchange
releases the oxygen  However, when a person is in upright
 When the affinity is Low, position, the pulmonary artery pressure
hemoglobin does not bind with the is not great enough to supply blood to
oxygen at the alveolar-capillary the apex of the lung against the force of
membrane. When the affinity is low, the gravity. Thus when the person is
upright, the mung may be considered to
hemoglobin releases oxygen more
be divided into three sections: an upper
readily at the tissue level
part with poor blood supply, the lower
part with maximum blood supply, and a
CO2 TRANSPORT
section between the two with an
 CO2 is carried in the blood in 3
intermediate supply of blood. When a
forms: as dissolves CO2-10%, attached
person is lying down turns to one side,
to hemoglobin (30%), and as
more blood passes to the dependent
bicarbonate (60%)
lung.
 CO2 is formed as a metabolic by
 Perfusion is also influence by alveolar
product. It diffuses out of the cells and
pressure. The pulmonary capillaries
into the capillaries.
are sandwich between adjacent alveoli.
3. Pulmonary Perfusion
If the alveolar pressure is high, the
 Is the actual blood flow through the
capillaries are squeezed.
pulmonary vasculature.
 The blood is pump into the lungs by the
RELATIONSHIP OF VENTILATION TO
right ventricle through the pulmonary
PERFUSION
artery.
 The pulmonary artery divides into the
DISTRIBUTION OF VENTILATION
right and left branches to supply both
 Not all areas in the lungs have the same
lungs.
ventilation. Body position affects
 Pulmonary artery pressure, gravity, and
distribution of ventilation.
alveolar pressure determine the patterns
 In a seated or standing position, lower
of perfusion.
regions of the lungs better than do upper
 The pulmonary circulation is
zones. In supine position, the apex and
considered a low pressure system
the base of the lungs ventilate about the
because the systolic blood pressure in
same; however, ventilation in the lower
the pulmonary artery is 20-30mm Hg
most (posterior) lung is greater than the
and the diastolic pressure is 5-15 mm
 uppermost (anterior) lung. In lateral, the VENTILATION and PERFUSION
dependent lung is best ventilated. BALANCE and IMBALANCE
Adequate gas exchange depends on adequate
DISTRIBUTION OF PERFUSION ventilation-perfusion (V/Q) ratio. In different
 The distribution of pulmonary blood areas of the lung, the V/Q ratio varies. Airway
flow is affected by body position and blockages, local changes in compliance, gravity
gravity. may alter ventilation. Alteration in perfusion
 In Upright position, blood flow is better may occur with a change in the pulmonary artery
at the base that the apex of the lungs. pressure, alveolar pressure or gravity.
 In supine position, the blood flow from VENTILATION (V)
apex to base is the same, but blood flow  the movement of gases in and out of the
in the posterior regions exceeds the lungs. It is the amount of gas or air into
anterior regions the alveoli ready for gas exchange.
 In prone position, blood flow in the PERFUSION (Q)
dependent/anterior exceeds the posterior  the amount of blood flow to the alveoli
region. prepared for gas exchange as well.
OXYHEMOGLOBIN DISSOCIATION  the actual blood flow through the
CURVE pulmonary vasculature.
 Shows the relationship between the V/Q mismatch
partial pressure 0f oxygen (PaO2) and  this occurs as a result of inadequate
the percentage of saturation of oxygen ventilation, inadequate perfusion or both
(SaO2)  there are four possible V/Q states in the
 Normal levels-PaO2>70mmHg lung. Normal V/Q ratio, Low V/Q
 Relatively safe level- PaO2 45- (Shunt), high V/Q ratio (dead space) and
70mmHG Absence of ventilation and perfusion
 Dangerous level-PaO2<40mmHG (Silent unit)
 The percentage of saturation can be Normal V/Q ratio
affected by CO2, hydrogen ion  in the healthy lung, a given amount of
concentration, temperature and 2,3- blood passes an alveolus and is matched
diphosphoglycerate. with an equal amount of gas. The ratio is
 An increase in these factors shift the 1:1 (ventilation matches perfusion)
curve to the right, less oxygen is pick up Low Ventilation Perfusion ratio: Shunts
in the lungs but more O2 is release to  when perfusion exceeds ventilation, a
the tissues if partial pressure of oxygen shunt exists (B). Blood bypasses the
is unchanged. alveoli without gas exchange occurring.
 A decrease in these factors causes the This is seen with obstruction of the
curve to shift to the left, making the distal airways such as with Pneumonia,
bond between oxygen and hemoglobin atelectasis, tumor or mucus plug.
stronger. If PaO2 is still unchanged,  V/Q imbalances causes shunting of
more oxygen is pick up in the lungs but blood resulting in HYPOXIA (low level
less oxygen in tissues. of cellular oxygen). Shunting appears to
be the main cause of hypoxia after
thoracic or abdominal surgery and
respiratory failure.
  Severe hypoxia results when the amount
of shunting exceeds 20%. Supplemental
oxygen may eliminate hypoxia

High Ventilation-Perfusion ratio: Dead Space

(C)
 When ventilation exceeds perfusion,
dead space results
 The alveoli does not have an adequate
blood supply for gas exchange to occur.
This is characteristic of a variety of
disorders including pulmonary emboli,
pulmonary infarction and cardiogenic
shock.

Silent Unit (D)

 Absence of both ventilation and
perfusion or with limited ventilation and
perfusion, a condition known as Silent
unit. This is seen in Pneumothorax, and
severe acute respiratory distress
syndrome.