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MECANICA RESPIRATOIA

RESPIRACION NORMAL

Cmo respiramos?
La Inspiration is normalmente activa La Espiracin is normalmente pasiva

Musculos de la Respiracin

Msculos inspiratorios
Diafragma. Intercostales Externos. Msculos Accesorios.
Incluye los msculos esternocleidpmastoideos, eslenos, y alas de la nariz.

Msculos Espiratorios:
Msculos abdominales. Intercostales Internos.

Figure 1: Presiones Respiratorias


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Diferencias de Presiones Respiratorias Importantes.

Gradiente de presin de la va area: PM - PALV. Presin Transpulmonar: PTP = PALV - PPl Presin de la pared transtorcica: PTC = PPl Pbs(presion
superficial)

Presin Transmural del sistema respira- torio:

PRS = PALV - Pbs

Balance de Fuerzas Estticas


Increase to Inflate Increase with Inflation

Tres Maneras de Inflar los pulmones

Aumentando la presin alveolar


Respiradores a presin positiva.

Disminuyendo la presin de la superficie corporal (bs)


Pulmones de acero

Activacin de los msculos inspiratorios


Manera normal de la respiracin.

Dinmica de la Inflacin

La presin Transmural debe vencer:


Fuerzas Elasticas de retraccin Resistencia de la va area al flujo.

MECANICA DE LA RESPIRACION
Part 2

PROPIEDADES ELASTICAS DE LOS PULMONES

Histeresis de la Inflacin

Hysteresis

Compliance

Volume

Pin

DV DP Transmural Pressure

Vo

Pout

Lung Compliance vs. Volume

DV DP

Stiff

DV

Compliant
DP

C=

DV DP

Dos Fuerzas Principales que afectan el Compliance Pulmonar


Fuerzas elsticas de los tejidos Fuerzas de tensin superficial.

Air vs. Saline Inflation


More Compliant Saline Inflation

Less Compliant Air Inflation

Tension Superficial
En cada interfase gas-lquido se presenta la tensin superficial. La Tensin Superficial es una propiedad de los lquidos 2T P Ley de LaPlace: r
P1
r1

P1 r1 P2 r2 T 2 2

P2
r2

If r1 r2 Then, P2 P1

Result: Small Bubble Collapses

Surface Tension.
At every gas-liquid interface surface tension develops. Surface Tension is a liquid property LaPlaces Law: 2T
P
T

P1
r1

P1 r1 P2 r2 T 2 2

P2
r2

If r1 r2 Then, P2 P1

Result: Small Bubble Collapses

Surfactante
Secretado por clulas alveolares de Tipo II Dipalmitoyl phosphatidyl choline Tapiza los alveolos Propiedades nicas de la tensin superficial:

Tensin superficial promedio bajo. La tensin superficial vara con el rea:


La tensin superficial aumenta a medida que aumenta el rea. La tensin superficial disminuye a medida que el rea disminuye.

Figure 4: Surfactante

Importancia Fisiolgica del surfactante


Aumenta el compliance pulmonar (menos resistencia) Promueva la estabilidad alveolar y previene el colapso alveolar. Promueve la sequedad alveolar:

El colapso alveolar tiende a succionar lquido desde los capilares pulmonares. Estabilizando el alveolo previene la trasudacin de lquido previniendo el prolapso.

Sndrome de Enfermedad Respiratoria Infantil (IRDS)

El Surfactante se forma tarde en la vida fetal.


Gestacin total: 39 wks Surfactante: 23 wks 32-36 wks

Los infantes con surfactante inmaduro (IRDS)


Los pulmones se llenan de agua, gran resis tencia Areas Atelectaticas (colapso alveolar )
Alvelos colapsados estn pobremente evntilados. Shunt efectivo derecha a izquierda (Sanmgre mixta)

Relacin [lecithin]/[sphingomyelin] Madurez gestacional.

Dependeiente del Pulmn


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Dependiente del Pulmnel pulmn en la parte ms baja del campo gravitacional.


La basde cuando es en la posicin erecta. En la porcin dorsal cuando est en supino.

Gravidad e Inflacin Pulmonar


PTP 0 ( 10) 10 cmH2 0

PPL = -10 cm H2O P1

PALV = 0
PPL = -2.5 cm H2O P2

PTP 0 ( 2.5) 2.5 cmH2 0

Figure 5: Compliance Regional Differencias Durinte la inflacin

DV DV

Stiff

Compliant

Volumen pulmonar regional vs. Ventilacin pulmonar regional.

En la posicin de pie:
El volumen pulmonar relativo es mayor en el pex El pulmn en menos complaciente en el apex (ms resistente) La ventilacin pulmonar regional es ma yor en la base.

Constante de tiempo para el llenado.

Inhomogeneidades regionales importantes:


Diferencias regionales en la resistencia de la va area. Diferencias regionales en las caractersticas elsticas

Alta resistencia y alta complianse cuasan llenado lento.


C
PALV

Time Const ant RC

Compliance Especfica.

Compliance Specific Compliance = FRC

La normalizacin permite comparar las caractersticas elsticas de los tejidos. Pregunta: Cmo difiere el compliance en un nio y en un adulto, ambos con pulmones normales?

INTERACCIONES ENTRE LOS PULMONES Y LA PARED TORACICA.

Principios Generales
Los pulmones y la pared torcica operan en serie. Los compliances de los pulmones y la pared torcica se suman recprocamente

1 CTotal

1 CChestwall

1 CLung

Figure 6: Mecanica de la pared torcica

Resumen de la Mecnica de la pared torcica

Negative PTT : Found at RV and FRC.


Normal tidal breathing in this condition chest wall below its unstressed volume chest tends to spring out

Unstressed Volume: 65% of TLC


No net recoil

Postive PTT: Above 65% of TLC


volumes above 65% TLC Chest tends to collapse (spring in).

Figure 7: Mechanica Pulmonar

Resumen de la Mecnica Pulmonar


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Always above unstressed volume (minimal volume = 10% TLC). PTP is positive from RV to TLC Lungs always tends to collapse.

Figure 8: Combined Mechanics


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Combined Mechanics Summary

Functional residual capacity


Respiratory system unstressed volume Chest and lung recoil equal and opposite

Pneumothorax
Uncouples lungs and chestwall Lungs and chest wall move to their unstressed volume
lungs always recoil inward chest wall springs outward below 65% TLC chest wall springs inward above 65% TLC

Lung Compliance in Disease

Diseases increasing compliance:


natural aging emphysema.

Diseases decreasing compliance (stiffer lung):


pulmonary fibrosis edema (e.g. rheumatic heart disease)

Chestwall Compliance in Disease

Actually less compliant (stiffer):


chest wall deformation (eg. kyphoscoliosis)

Functionally less compliant (stiffer): (Abdominal cavity changes)


displacement of the diaphragm (eg. pregnancy) ascites

AIRWAY RESISTANCE

Resistive Forces and Breathing

Quiet breathing -- Air flow laminar


Resistance -- Poiseuilles Law Pressure gradient proportional to flow.

High airflow (e.g. exercise)


turbulence and eddy flow Extra pressure gradient proportional to flow rate squared

Distribution of Airway Resistance

Major portion larger airways


specifically medium size bronchi

Small airways (< 2 mm)


Only 20% of total airway resistance Resistance increases may foretell coming problems FEF25-75 supposedly sensitive

Airway Resistance --Smooth Muscle


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Bronchoconstrictors
Vagal tone Histamine

Bronchoconstrictors
Beta agonists Anti-cholinergics Bronchodilation

Airways and V/Q Matching

PACO2

Bronchodilation

Find high PACO2 in poorly ventilated regions These airways tend to dilate. Promotes homogeneous ventilation

Homeostatic Summary

Low V/ Q units
Alveolar hypoxia Alveolar hypercapnia

Homeostasis
Alveolar hypercapnia tends to raise ventilation Alveolar hypoxemia tends to lower blood flow

Result: V/ Q tends back towards normal

Airway Resistance -- Minimized by High Elastic Recoil

Radial traction normally holds bronchi open Airway


Low elastic recoil forces causes less radial traction and higher airway resistances:
Lower lung volumes Chronic obstructive disease (eg. Emphysema)

Maximum Forced Expiration


Peak Flow TLC

Volume

RV

time
Peak Flow

Effort Independent Limb

Flow
TLC

Volume

RV

Summary of Forced Expiration


Peak flow occurs early Envelope of effort-independence:

Flow depends only on elastic recoil. Flow falls as expiration continues

Envelope is eventually joined independent of:


Starting volume Initial effort.

Figure 10: Flow Limitation and EPP


Palv = Ppl+Pel
Ppl

PEPP=Ppl

Pel

Mechanism of Flow Limitation Summary


Force expiration: PPL is positive outside the airways. Equal pressure point (EPP).

Point at which Pairway falls just enough to equal PPL Bronchi collapse

Flow proportional to: PALV - PEPP

Effort Independence of Flow-Volume Envelope


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Increased effort
Similar increases in PALV and PEPP. Pressure difference unchanged Therefore, Flow unchanged.

Figure 11: Flow Limitation at Various Lung Volumes

High Lung Volume

Medium Lung Volume

Low Lung Volume

Flow Limitation in COPD (Emphysema)

Normal Lung Medium Volume

Emphysematous Lung Medium Volume

Forced Inspiration: is Effort-Dependent


PPL is Negative Airways are held open.

Clinical Flow-Volume Loops Obstruction

Preguntas?