Mechanics of Breathing Alveolar Ventilation

SSN Block 4 Shadi (csc43)

OBJE !"VES

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#no$ the definitions of all the listed l%ng vol%&es and ca'acities (nderstand ho$ l%ng vol%&es and ca'acities are &eas%red (nderstand the conce'ts of trans&%ral 'ress%re and co&'liance Be a)le to 'redict the i&'act of changes in l%ng and chest $all co&'liances on *+ (nderstand ho$ s%rface tension i&'acts on l%ng co&'liance and leads to h,steresis in the l%ng -. V relationshi' Be a)le to e/'lain ho$ s%rfactant red%ces s%rface tension and red%ces the tendenc, for alveoli to colla'se

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(nderstand and )e a)le to a''l,0 1enr,2s3 *ick2s and 4alton2s 5a$s (nderstand the relationshi' )et$een alveolar ventilation3 &eta)olic rate3 and ' O2 #no$ the )asis for the res'irator, 6%otient #no$ the definition of alveolar3 anato&ic and 'h,siologic dead s'ace and %nderstand the differences )et$een the three Be fa&iliar $ith the 'rinci'les and techni6%es of &eas%ring dead s'ace ventilation Be a)le to calc%late A.a gradient %sing the alveolar gas e6%ation

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!O-" S  5%ng  Vol%&es and a'acities  Alveolar Ventilation 4ead S'ace  Min%te and Alveolar Ventilation  Alveolar Ventilation E6%ation  Alveolar 7as E6%ation o&'liance (5%ng3 hest 8all3 S.ste&)  S%rface !ension and S%rfactant  7as 5a$s  3 .

 Slides  (se $ill )e 'osted on SSN $e) site slide n%&)ers if .o% like 4 .

5%ng Vol%&es and a'acities  a'acit. : 2 or &ore vol%&es 9 .

"f "2& )reathing nor&all. .3 then "2& )reathing at< < <  !idal = vol%&e 9>> &5  8hich one is it? !idal vol%&e .

reserve vol%&e : the "+V &a/i&%& vol%&e of air " can )reathe in< *A5SEA   A44"!"ONA5 vol%&e ins'ired a)ove tidal vol%&e  8hich one is it? @ .!r%e or *alse?  "ns'irator.

8hich one is E/'irator. +eserve Vol%&e?  A44"!"ONA5 vol%&e of air e/'ired BE5O8 tidal vol%&e E+V B .

+esid%al Vol%&e  1o$ &%ch air is left in the l%ngs after the s%)Dect has forcef%ll. e/'ired  ANNO! BE MEAS(+E4 BE S-"+OME!+E +V C . and &a/i&all.

.H  *+ : E+V G +VH  Vol%&e re&aining in l%ngs after nor&al tidal vol%&e e/'ired  EI("5"B+"(M  !otal 5%ng a'acit. s'iro&etr. a'acit.H  !5 : V G +VH  F> Hcannot )e &eas%red ).  V : "+V G !V G E+V  Ma/i&%& tidal vol%&e  *%nctional +esid%al a'acit.5%ng a'acities "ns'irator.  " : !V G "+V  Vital a'acit.

 So $e take a )reath in < < <  Air goes into the air$a.s FF .

O Ldil%tionM 2  V4 : V! N O(-a O2 P -e O2)K-a O2Q $here V4 is 'h.4ead S'ace  Vol%&e of air$a.O2 of e/'ired air F2 .siologic  Anato&ic G alveolar  Meas%red ).O2R and -e O2 is .siologic dead s'aceR V! is tidal vol%&eR -a O2 is arterial .s (= F &5Kl))  Alveolar  dead s'ace dead s'ace Alveol%s not 'erf%sed3 so no gas e/change  -h.s and l%ngs that does NO! 'artici'ate in gas e/change  Anato&ic dead s'ace (*"JE4)  Vol%&e of cond%cting air$a.

F3 .siologic dead s'ace) N Breathing fre6%enc.Ventilation +ate  Vol%&e of air &oved into and o%t of l%ngs 'er %nit ti&e  Min%te ventilation (&5K&in)  !idal vol%&e N Breathing fre6%enc.  Alveolar  (!idal ventilation (&5K&in) vol%&e P 'h.

Alveolar Ventilation E6%ation PA CO2  CO 2 production α alveolar ventilation "f O2 'rod%ction is constant3 then .O2 decreases   1alve ventilation  .O2 do%)les (takes a fe$ &ins) F4 .O2 "S 4E!E+M"NE4 BE A5VEO5A+ VEN!"5A!"ON "f ventilate &ore  get rid of &ore O2  .

'artial V : fl%/ 'ress%re gradient 4 : diff%sion coefficient of the gas S sol%)ilit.KTM8 A : s%rface area F9 U. Nor&all.3 e6%ili)ration is achieved )et$een alveol%s and ca'illar.: 'artial 'ress difference of gas .  -A O2 : -c O2 •  *ick2s D × A × ∆P la$0 Move&ent of = V thickness gas is driven ).

O2 is &ain &echanis& of ac%te reg%lation of '1  O G 1 O  1 O  1G G 1 O . . +eg%lation of .s for long ter& reg%lation F. 2 2 2 3 3 #idne.

: 4@ && 1g 12O F@ *" : 2FVR changes if on ventilator .gen?  Alveolar 7as E6%ation PA O2 = P O2 − 2 PA CO R 2 -AO2 : alveolar O2 -"O2 : ins'ired O2 = F O (Patm − PH 2O ) −  PA CO R 2   +es'irator. 6%otient (+)0 ratio of O2 'rod%ction to O2 cons%&'tion  + = ><B -12O0 )eca%se air is h%&idified in trachea  .8hat a)o%t o/.

 E6%ili)ration  -A O2 is achieved : -cO2  -cO2 is NO! O2 content  4issolved3 not )o%nd3 O2 is $hat drives &ove&ent  4issolved O2 : -cO2 N ><>>3 &l O2 K d5  A.a gradient FB .

correlated $ith their elastic 'ro'erties  !he greater the a&o%nt of elastic tiss%e3 the greater the tendenc.o&'liance  1o$ vol%&e changes as a res%lt of 'ress%re change ( : VK-)  4escri)es distensi)ilit. of the s.ste&  o&'liance of l%ngs and chest $all inversel. to Lsna' )ack3M and the lo$er the co&'liance FC .

-ress%re.Vol%&e %rve for 5%ngs3 hest 8all3 and o&)ined 5%ngK hest 8all  Slo'e   : co&'liance !rans&%ral (in P o%t) *or l%ng  alveolar P 'le%ral 'le%ral P at& alveolar P at&    *or chest $all  *or %nit    5%ng 'ress%res referred to at& 'ress (Wero) hest $all likes to e/'and 5%ng likes to colla'se 2> .

Vol%&e %rve for 5%ngs3 hest 8all3 and o&)ined 5%ngK hest 8all Vol%&e : *+  E6%ili)ri%& 'osition  olla'sing force : e/'anding force  Vol%&e X *+  5ess vol%&e in l%ng  colla'sing (elastic) force s&aller  E/'anding force on chest $all still greater  S.-ress%re.ste& $ants to e/'and  Vol%&e Y *+  More vol%&e in l%ng  colla'sing force greater  E/'anding force on chest $all s&aller  S.ste& $ants to colla'se 2F  .

 At *+ (end.alveolar : > -'le%ra X >  -ne%&othora/  -'le%ra : >  !ension 'ne%&othora/ (air st%ck in)  -'le%ra rises and kee's rising ( &ediastin%& shifts to contralateral side) 22 .e/'iration)   .

 E&'h.se&a  5%ng is &ore co&'liant  chest $all stronger  higher *+ is less co&'liant  $ill )e stronger  lo$er *+ 23  *i)rosis  5%ng .

into larger alveoli Z decreases 'ress%re re6%ired to o'en a closed alveol%s  increases l%ng co&'liance 24 .: colla'sing 'ress%reK'ress%re to kee' alveol%s o'en  ! : s%rface tension (constant)  r : radi%s of alveol%s   S&aller alveol%s has higher 'ress%re  S%rfactant forces  &olec%les )reak %' the attractive red%ces s%rface tension (&ore red%ction at lo$er vol%&es)  decreases tendenc. la$ of 5a'lace  .: 2!Kr .S%rface tension and S%rfactant  S%rface  tension )c of attractive forces )t$n li6%id &olec%les lining the alveoli 7enerates 'ress%re given ). of s&aller alveoli to e&'t.

o&'liance of the 5%ngs  1.steresis red%ces 29 .steresis  o&'liance different for ins'iration and e/'iration  S%rfactant h.

2s  la$0 oncentration of dissolved gas de'ends on 'artial 'ress%re and sol%)ilit.7as la$s  *ick2s la$ (see a)ove)  4alton2s la$0  -artial 'ress%re of gas in &i/t%re is e6%al to 'ress%re gas $o%ld e/ert if it occ%'ied entire vol%&e  1enr. 2. .

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