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Biomedical Instrumentation I

Lecture-10: Measurements of the Respiratory System

Dr Muhammad Arif, PhD
Lecture Outline
Block Diagram of Air Pathway
Breathing Reflex Mechanisms
Lung Volumes and Capacities
Respiratory Therapy
Positive Pressure Breathing Apparatus
Medical Gases and Safety Systems
Respiration is the interchange of gases between an organism and the
medium in which it lives.

Internal respiration is the exchange of gases between the bloodstream

and nearby cells.

External respiration is the exchange of gases between the lungs and

Internal Respiration
Exchange of O2 and CO2 between the Capillary and the Body Cell
Organs of Respiration
The Lungs
The Alveoli and Blood Circulation
The Alveoli and Blood Circulation
Block Diagram of Air Pathway
Breathing Reflex Mechanisms
Lung Volumes and Capacities
Lung Volumes and Capacities
Important volumes to consider are shown in Figure. They are for a standard
70-kg male breathing at rest.

Tidal Volume (TV) 500 mL, is the depth of breathing or the volume of gas
inspired or expired during each respiratory cycle.

Inspiratory Reserve Volume (IRV) 3600 m L, is the maximal amount of

gas that can be inspired from the end-inspiratory position (extra inspiration
from the high peak tidal volume).

Expirarory Reserve Volume (ERV) 1200 mL, is the maximal amount of

gas chat can be expired from end-expiratory level (extra expiration from the
low peak tidal volume).

Residual Volume (RV) 1200 mL, is the amount of gas remaining in the
lungs at the end of maximal expiration (amount that cannot be squeezed out
of the lung). Even a collapsed lung contains 500 to 600 mL.
Lung Volumes and Capacities
Important capacities (addition of various lungs volumes) to consider are also
shown in the figure.

Total Lung Capacity (TLC) 600 mL, is the amount of gas contained in the
lungs at the end of maximal inspiration and is the sum of inspiratory capacity
(IC) and functional residual capacity (FRC).

Vital Capacity (VC) 4800 mL, is the maximal amount of gas that can be
expelled from the lungs by forceful effort from maximal inspiration.

Inspiratory Capacity (IC) 3600 mL, is the maximal amount of gas that can be
inspired from the resting expiratory level and is the sum of TV and IRV.

Functional Residual Capacity (FRC) 2400 mL, is the amount of gas

remaining in the lungs at the resting expiratory level (end-expiratory position is
used as a base because it varies less than the end-inspiratory state). It is the
sum of ERV and RV.
Respiratory Therapy

When a patient is incapable of adequate ventilation by natural processes,

mechanical assistance must be provided so that sufficient oxygen is
delivered to the organs and tissues of the body and excessive levels of
carbon dioxide are not permitted to accumulate.

The procedures and instrumentation involved in providing mechanical

assistance in respiration and in supplying hypoxic patients with higher than
normal concentrations of oxygen or other therapeutic gases or medications
constitute a field known as respiratory therapy.
Respiratory Therapy

Instruments for respiratory therapy include such devices as;

Positive Pressure Breathing Apparatus

Many of these instruments however have overlapping functions and the name
used for a particular device may vary among manufacturers.
An inhaler or puffer is a medical device used for delivering medication into
the body via the lungs.

It is mainly used in the treatment of asthma and Chronic Obstructive

Pulmonary Disease (COPD).

It is used to supply oxygen and other therapeutic gas to a patient who is

able to breath spontaneously without assistance.

Inhalators are used when concentration of oxygen higher than the air is
The inhalator consists of:

1. A source of the therapeutic gas,

2. Equipment for reducing the pressure and controlling the flow of the gas,

3. A device for administering the gas.


Devices for administering the gas to patients include nasal cannula and
catheters, face masks that cover the nose and mouth, and, in certain
settings such as pediatric, oxygen tents.

The oxygen concentration presented to the patient is controlled by adjusting

the flow of gas into the mask.
Ventilators & Respirators
The term ventilator and respirator are used interchangeably to describe

equipment that may be employed continuously or intermittently to improve

ventilation of the lungs and to supply humidity or aerosol medications to the

pulmonary tree.
Ventilators & Respirators
A medical ventilator may be defined as an automatic machine designed to
mechanically move breathable air into and out of the lungs, to provide the
mechanism of breathing for a patient who is physically unable to breathe, or is
breathing insufficiently.

A mechanical ventilator is a complex system consisting of a power supply,

compressed air and oxygen, a drive mechanism to provide motive force to push
oxygen into the patients lungs and a control mechanism to manage the gas
flow, volume, pressure and timing.

It is connected to the patients lungs through breathing hoses and a special

tube inserted into the patients airway.
Ventilators & Respirators
Classification of Ventilators

The main ventilator classifications are

Power input

Power transmission or conversion

Control scheme

Output (pressure, volume and flow waveforms)

Ventilators & Respirators
Block Diagram of Ventilator System
Ventilators & Respirators
Modes of Ventilators

Most ventilators and respirators are classified as assistor-controllers, and can

be operated in any of three different modes.

1. Assist Mode

2. Control Mode

3. Assist-Control Mode
Ventilators & Respirators
Modes of Ventilators

1. Assist Mode

In the assist mode inspiration is triggered by the patient.

A pressure sensor responds to the slight negative pressure that occur

each time the patient attempts to inhale and triggers the apparatus to
begin inflating the lungs.

Thus the respirator helps the patient inspire when he wants to breathe.

A sensitivity adjustment is provided to select the amount of patient effort

required to trigger the machine.

The assist mode is used for patients who are able to control their
breathing but are unable to inhale a sufficient amount of air without
Ventilators & Respirators
Modes of Ventilators

2. Control Mode

In the control mode breathing is controlled by a timer set to provide the

desired respiration rate.

This mode required for patients who are unable to breath on their own.

In this mode the respirator has complete control over the patients respiration
and does not respond to any respiratory effort on the part of the patient.
Ventilators & Respirators
Modes of Ventilators

3. Assist-Control Mode

In the assist-control mode the apparatus is normally triggered by the

patients attempt to breathe, as in assist mode.

However if the patient fail to breathe within a predetermined time, a timer

automatically triggers the device to inflate the lungs.

Thus patient controls his own breathing as long as he can, but if he fail to do
so, the machine is able to take over for him.

This mode is most frequently used in critical care settings .

Ventilators & Respirators
Methods to Stop Inspiration in Ventilators

When inspiration process is controlled by ventilator, then inflation of the lungs

continues until one of the following conditions occurs:

1.The delivered gas reaches a predetermined pressure in the proximal or upper

airways. A ventilator that operates in the mode is said to be pressure-cycled

2.A predetermined volume of gas has been delivered to the patient. A ventilator
that operates in the mode is said to be volume-cycled ventilator.

3.The air or oxygen has been applied for a predetermined period of time. A
ventilator that operates in the mode is said to be time-cycled ventilator.
Intermittent Positive Pressure
Breathing Apparatus
Intermittent positive pressure breathing (IPPB) therapy involves special
procedures and equipment.

IPPB is a type of assisted breathing pattern in which the lungs are inflated
by positive pressure during inspiration and, on release of the pressure,
expiration occurs passively.

IPPB is indicated for patients with the following problems: chest disorders,
such as bronchitis. bronchiectasis, asthma, pulmonary emphysema. and
edema: central nervous system disorders (e.g.. drug overdose); chronic
broncho-pulmonary diseases (e.g., bronchial infections, respiratory
acidosis); and postoperative conditions (to prevent pneumonia).
Intermittent Positive Pressure
Breathing Apparatus
The objectives of IPPB are to assist and promote more uniform ventilation,
facilitate better O2 and CO2 exchange and aspiration of antibiotic drugs,
relieve broncho-spasm, assist in removal of broncho-pulmonary secretions
(drainage), and exercise respiratory muscles.

Medical gases commonly used are oxygen, compressed air, and oxygen-
helium mixtures.
Cardiopulmonary Resuscitation

Under emergency circumstances in which IPPB respiration are not

available, cardiopulmonary resuscitation (CPR) may save the patient's

This is a technique used to maintain blood flow and oxygenation when heart
attack (fibrillation) or respiratory arrest is present.

In simple terms, it consists of pumping rhythmically on the patient's chest

with the palm of one hand while periodically blowing air into the patient's

For long-term respiratory treatment. respiratory therapy devices must be

In order to prevent damage to the patients lungs, the air or oxygen applied
during respiratory therapy must be humidified.

Virtually all inhalators and respirators include equipment to humidify the air.

The process of humidification can be done in two ways.

1. Heat Vaporization (Steam).

2. Bubbling an air steam through a jar of water.

Humidifiers add water vapour to medical gases administered to a patient.

This is necessary because alveolar-capillary gas transfer membranes

require high humidity to be effective.

This is accomplished by passing the gas through sterile water, which

creates tiny bubbles.
Two types are the Ohio Medical jet humidifier, and Puritan-Bennett bubble-
jet humidifier are shown in the Figure.

When therapy requires that water or some type of medication be suspended

in the inspired air as aerosol a device called a nebulizer is used.

In a nebulizer the water or medication is picked up by a high velocity jet of

oxygen and thrown against one or more baffles or other surfaces to break
the substance into controllable sized droplets or particles, which are then
applied to the patient via a respirator.
Ultrasonic Nebulizers

A more effective type of nebulizer is the ultrasonic nebulizer.

Ultrasonic nebulizers are more expensive than the conventional nebulizers.

Ultrasonic nebulizer is an electronic device that produces high intensity sound

energy (1.35 MHz) well above the audible range.

When applied to water or medication, the ultrasonic energy vibrates the

substance with such intensity that a high volume of minute particles is
Ultrasonic Nebulizers

Ultrasonic nebulizers consists of two parts:

1.A generator that produces a radio frequency current to derive the ultrasonic

2.A transducer that generates the ultrasound energy that is applied to the water
or medication.
Ultrasonic Nebulizers

Unlike the conventional nebulizer, the ultrasonic nebulizer does not depend on
the breathing gas for operation.

In the ultrasonic nebulizer, the therapeutic agent can be administered during

oxygen therapy or mechanical ventilation procedure.

Aspirator is a type of suction apparatus that is used to remove mucus and

other fluids from the airways.
Medical Gases and Safety Systems
A variety of medical gases, cylinders. and regulating equipment is used by the
respiratory therapist.

The following regulating agencies and acts are important to the therapist:

1. National Fire Protection Agency (NFTA)

Voluntary agency (National Consensus Standards) that promotes prevention

and detection of fire hazards.

2. U.S. Department of Transportation (DOT)

Regulates gas cylinder construction, testing. and maintenance.

Medical Gases and Safety Systems
3. Compressed Gas Association (CGA)

Develops safest methods for handling compressed gases.

4. Federal Food Drug and Cosmetic Act

Regulates shipment of medical gases in interstate commerce and provides

standards through the Pharmacopeia of the United States (USP).

5. Federal Occupational Safety and Health Act of 1970 (OSHA)

Provides for federal inspections of facilities used for storage of flammable

Medical Gases and Safety Systems
6. Local and State Agencies

Providing safeguards for their communities from hazards of storage,

transportation, and use of compressed gases.
Medical Gases and Safety Systems
Gas Cylinders

Gas cylinders are made from seamless tubing (brazed or welded) or from flat
sheets of drawn steel shaped into a cylinder.

Some common types are:

ICC-3A (seamless high pressure, 150 to 15000 psig),

ICC3AA (seamless high pressure above 3A rating),

ICC-3B (seamless, 150 to 500 psig),

ICC-3E (seamless, 2 inch maximum diameter, 24 inch maximum length, 1800


ICC-8 (seamless low pressure. 250 psig, for acetylene service).

Medical Gases and Safety Systems
Gas Cylinders

Gas cylinders ore dangerous and if mishandled may result in fire and

Markings on gas cylinders are required. For example, first line: ICC spec 3AA,
2015 psig; second line: H 396042: third line: BAP (manufacture marking): and
fourth line: 8-10 (month and year of qualification test).
Medical Gases and Safety Systems
Piping systems, as shown in the Figure, are used throughout the hospital.
Medical Gases and Safety Systems
Piping Systems

Central oxygen cylinders supply oxygen to specific hospital areas through a

pressure regulating valve, which maintains a pressure between 50 and 100 psi
at the service outlet.

The main supply must have a shutoff valve and an alarm system.

Separate station manual or automatic shutoff valves are also required.

All personnel must be educated as to the placement and use of these valves.
Medical Gases and Safety Systems
Therapeutic Gases

Oxygen: Essential to life (normally 21% of room air).

Carbon Dioxide: Important to the control of respiration and circulation

(normally 0.025% of room air).

Helium: Lightweight inert gas used in cases of respiratory obstruction.

Nitrous Oxide: Inorganic gas used as an anaesthetic agent.

Helium-Oxygen Mixtures: Low-density gas used on asthmatic patients.

Oxygen-Carbon Dioxide Mixture: Used to stimulate deep breathing and to

relieve cerebral vascular spasm.
Medical Gases and Safety Systems
Safety Systems

Safety systems for compressed gases in hospitals are essential.

The Diameter-Index Safety System (DISS) was developed by the CGA to

provide interchangeable threaded connections.

Each connection of DISS (make-and-break threaded connections) consists of

a body, nipple. and nut.

The Pin-Index Safety System (PISS) is the two-pin approach that prevents
incorrect interchange of medical gas cylinders with flush-type valves.

Ten combinations are possible, of which eight are in current use.

With the two-pin approach, no two incompatible cylinders can be attached