Respiratory Ventilation and Pressure

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Questions and Answers

During the process of inspiration at rest, which relationship between alveolar pressure (Palv) and atmospheric pressure (Patm) is accurate?

  • Palv is significantly higher than Patm, initiating forceful air entry.
  • Palv is slightly positive relative to Patm, facilitating air inflow.
  • Palv is slightly negative relative to Patm, facilitating air inflow. (correct)
  • Palv equals Patm, resulting in no air flow.

In a scenario where an individual's intrapleural pressure equals their alveolar pressure, what immediate physiological consequence would likely occur?

  • Increased tidal volume as more air is drawn into the lungs.
  • Collapse of the lung as the pressure gradient maintaining inflation is lost. (correct)
  • Forced expiration due to increased pressure on the alveoli.
  • Increased lung compliance due to enhanced alveolar expansion.

A patient with a pneumothorax has air entering the pleural space, causing their intrapleural pressure to rise to 0 mm Hg. What effect will this have on transpulmonary pressure and lung volume?

  • Transpulmonary pressure will increase, leading to lung hyperinflation.
  • Transpulmonary pressure will decrease, causing the lung to collapse. (correct)
  • Transpulmonary pressure will remain unchanged, preserving lung volume.
  • Transpulmonary pressure will oscillate, causing fluctuating lung volume.

Consider a patient with advanced emphysema who exhibits increased lung compliance. What corresponding change in intrapleural pressure would you expect during normal inspiration, compared to a healthy individual?

<p>A less negative intrapleural pressure due to reduced elastic recoil. (B)</p> Signup and view all the answers

How would significant scarring and thickening of the alveolar membrane primarily affect gas exchange in the lungs?

<p>Impair both oxygen and carbon dioxide diffusion due to increased diffusion distance. (D)</p> Signup and view all the answers

Under what circumstances would the rate of oxygen transfer from the alveoli into the blood be most limited by perfusion rather than diffusion?

<p>During strenuous exercise when blood flow through pulmonary capillaries is maximized. (D)</p> Signup and view all the answers

If a climber ascends to high altitude, where the partial pressure of oxygen in the atmosphere is significantly reduced, what immediate physiological response would help maintain adequate alveolar ventilation?

<p>Increased tidal volume to enhance alveolar ventilation. (B)</p> Signup and view all the answers

How does an increase in anatomical dead space affect alveolar ventilation, assuming minute ventilation remains constant?

<p>Alveolar ventilation decreases because more air is trapped in conducting airways. (A)</p> Signup and view all the answers

Calculate the alveolar ventilation (VA) if a person has a tidal volume (VT) of 600 mL, a respiratory rate of 15 breaths per minute, and an anatomical dead space (VD) of 150 mL.

<p>6,750 mL/min (B)</p> Signup and view all the answers

A patient with a pulmonary embolism has reduced blood flow to a portion of their lung. How will this affect the ventilation-perfusion (V/Q) ratio in the affected area, and what compensatory mechanism might the body employ?

<p>V/Q ratio will increase; compensatory mechanism: bronchoconstriction in the affected area. (A)</p> Signup and view all the answers

Consider a scenario where an individual's minute ventilation remains constant, but their breathing pattern changes from deep, slow breaths to rapid, shallow breaths. How will this altered breathing pattern affect alveolar ventilation and gas exchange efficiency?

<p>Alveolar ventilation decreases, reducing gas exchange efficiency. (D)</p> Signup and view all the answers

In a patient with chronic obstructive pulmonary disease (COPD), what changes in lung mechanics and alveolar structure contribute to increased air trapping and hyperinflation?

<p>Increased airway resistance and destruction of alveolar walls. (C)</p> Signup and view all the answers

How is the partial pressure of oxygen (PO2) affected as dry air enters the trachea and is humidified at body temperature (37°C)?

<p>PO2 decreases because the total pressure is now shared with water vapor. (A)</p> Signup and view all the answers

A patient's arterial blood gas analysis shows a PaCO2 of 60 mm Hg. Considering Dalton's Law, how does this hypercapnia affect the partial pressures of other gases in the alveoli, assuming total alveolar pressure remains constant?

<p>Decreases the partial pressures of both oxygen and nitrogen proportionally. (B)</p> Signup and view all the answers

According to Fick's Law of Diffusion, if the thickness of the alveolar membrane doubles due to pulmonary fibrosis, how will this directly affect the rate of gas transfer across the membrane, assuming all other factors remain constant?

<p>Gas transfer rate will be halved. (A)</p> Signup and view all the answers

How would a significant decrease in the surface area of the alveoli, as seen in emphysema, affect the diffusing capacity of the lungs for carbon monoxide (DLCO)?

<p>DLCO would decrease proportionally to the surface area decrease. (C)</p> Signup and view all the answers

In a scenario where the partial pressure difference for oxygen between the alveolar air and pulmonary capillary blood is reduced by half, what impact will this have on oxygen diffusion according to Fick’s Law?

<p>Oxygen diffusion will be reduced by half. (B)</p> Signup and view all the answers

A patient with anemia has a reduced concentration of hemoglobin in their blood. How will this affect the oxygen-carrying capacity of the blood and the partial pressure of oxygen in arterial blood (PaO2)?

<p>Decreased oxygen-carrying capacity; unchanged PaO2. (C)</p> Signup and view all the answers

How does carbon monoxide (CO) exposure affect oxygen transport in the blood, and what is the underlying mechanism for this effect?

<p>CO competitively binds to hemoglobin, reducing oxygen binding. (D)</p> Signup and view all the answers

If a patient is administered 100% oxygen, and their arterial partial pressure of oxygen (PaO2) does not increase as expected, what primary issue might be suspected?

<p>Significant shunt or ventilation-perfusion mismatch. (B)</p> Signup and view all the answers

During exercise, ventilation and perfusion both increase. How does this physiological change affect the overall efficiency of gas exchange in the lungs?

<p>Efficiency increases due to improved matching of ventilation and perfusion. (C)</p> Signup and view all the answers

A patient has a condition that causes a significant reduction in the production of surfactant in the lungs. What immediate physiological consequence would be most likely?

<p>Decreased surface tension and alveolar collapse. (B)</p> Signup and view all the answers

How does the body typically respond to chronic hypoxemia, such as that seen in individuals living at high altitudes or those with chronic lung diseases?

<p>Increased production of red blood cells to enhance oxygen-carrying capacity. (D)</p> Signup and view all the answers

What mechanisms explain why carbon dioxide diffuses more readily across the alveolar-capillary membrane compared to oxygen, despite having a similar molecular weight?

<p>Carbon dioxide’s greater solubility in the liquid lining the respiratory tract. (A)</p> Signup and view all the answers

If the ventilation rate increases without a corresponding increase in pulmonary blood flow, what effect would this have on the partial pressure of oxygen (PO2) and carbon dioxide (PCO2) in the alveoli?

<p>Increased PO2, decreased PCO2. (A)</p> Signup and view all the answers

Which of the following is the most accurate description of how oxygen and carbon dioxide are exchanged across the alveolar-capillary membrane?

<p>Oxygen and carbon dioxide passively diffuse down their respective pressure gradients. (B)</p> Signup and view all the answers

What impact does an increase in body size (height, weight, and surface area) typically have on the diffusing capacity of the lungs for carbon monoxide (DLCO)?

<p>DLCO increases as larger individuals typically have larger lungs and greater alveolar surface area. (A)</p> Signup and view all the answers

How does the diffusing capacity of the lungs for carbon monoxide (DLCO) generally change with age, and what factors contribute to this change?

<p>DLCO decreases due to reduced alveolar surface area and thickened alveolar membranes. (A)</p> Signup and view all the answers

How does moderate exercise typically affect the diffusing capacity of the lungs for carbon monoxide (DLCO), and what physiological mechanisms explain this change?

<p>DLCO increases due to increased pulmonary capillary blood volume and improved ventilation-perfusion matching. (C)</p> Signup and view all the answers

What is the primary reason for the observed decrease in diffusing capacity of the lungs for carbon monoxide (DLCO) in patients with emphysema?

<p>Destruction of alveolar walls and decreased surface area for gas exchange. (D)</p> Signup and view all the answers

How would pulmonary edema, characterized by fluid accumulation in the interstitial space of the lungs, affect gas exchange and the diffusing capacity of the lungs?

<p>Decrease diffusing capacity due to increased diffusion distance and impaired membrane properties. (B)</p> Signup and view all the answers

In the context of measuring diffusing capacity of the lungs (DLCO) using carbon monoxide, why is carbon monoxide used rather than oxygen?

<p>Carbon monoxide uptake is primarily diffusion-limited, whereas oxygen uptake is perfusion-limited under normal conditions. (C)</p> Signup and view all the answers

During the measurement of diffusing capacity using the single-breath method, what does the patient do immediately after a single inspiration of a carbon monoxide mixture?

<p>Holds their breath for a specific duration to allow for CO diffusion before exhaling. (B)</p> Signup and view all the answers

If a patient's diffusing capacity measurement shows a value significantly lower than the normal range both at rest and during exercise, what underlying condition may be suspected?

<p>Severe anemia or advanced emphysema. (B)</p> Signup and view all the answers

What is the typical normal value of diffusing capacity for carbon monoxide (DLCO) at rest in a healthy adult, and how is this value typically expressed?

<p>25 mL/min/mm Hg (C)</p> Signup and view all the answers

In a patient with polycythemia, a condition characterized by an abnormally high red blood cell count, how would you expect the diffusing capacity of the lungs for carbon monoxide (DLCO) to be affected?

<p>DLCO will increase due to the greater number of red blood cells available for CO uptake. (A)</p> Signup and view all the answers

A patient taking rapid shallow breaths has a tidal volume of 200 mL and a respiratory rate of 30 breaths per minute. If their anatomical dead space is estimated to be 150 mL, what is their alveolar ventilation?

<p>1.5 L/min (C)</p> Signup and view all the answers

During expiration, the intrapleural space experiences a change in pressure as the thoracic wall recoils. Which of the following statements accurately describes this change and its immediate effect?

<p>Intrapleural pressure rises, reducing the transpulmonary pressure and allowing the lungs to recoil. (D)</p> Signup and view all the answers

Consider two individuals with the same minute ventilation. Individual A has a tidal volume of 700 mL and a respiratory rate of 10 breaths per minute, while Individual B has a tidal volume of 400 mL and a respiratory rate of 17.5 breaths per minute. Assuming both have an anatomical dead space of 150 mL, who has a higher alveolar ventilation?

<p>Individual A has a higher alveolar ventilation. (D)</p> Signup and view all the answers

In a scenario where an individual's lung compliance significantly decreases due to pulmonary fibrosis, how would this altered compliance affect the transpulmonary pressure required for a normal tidal volume inspiration, compared to a healthy lung?

<p>Transpulmonary pressure would need to be significantly higher to overcome the increased elastic recoil of the lungs. (A)</p> Signup and view all the answers

Following a major car accident, a patient has a pneumothorax and fractured ribs which limits the expansion of the thoracic cavity during inspiration. How would this affect the pressure gradient and air flow during inspiration, as compared to a healthy individual?

<p>The pressure gradient would be significantly reduced, resulting in decreased air flow into the lungs due to limited thoracic expansion. (C)</p> Signup and view all the answers

Flashcards

Ventilation

Movement of air into and out of the lungs.

Air Movement

Air moves from an area of high pressure to an area of low pressure.

Transpulmonary Pressure

The difference between alveolar and pleural pressure. It Prevents Airway Closure

Intrapleural pressure

Pressure exerted by fluids within the pleural cavity.

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Alveolar Ventilation (VA)

Total volume of air entering alveoli per minute.

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Minute Ventilation (VE)

Total ventilation per minute.

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Formula for (VA)

V minus the dead space volume (VD) x f

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Ventilation

Moving air into and out of the lungs.

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Airflow

Air moves by bulk flow from high to low pressure

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Diffusion of Gases

Process by which gases move across membranes

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Fick's Law

It describes diffusion through tissues

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Directly Proportional to… (Diffusion)

Area available for diffusion (A), Diffusion constant (D), Difference in partial pressure (P1-P2)

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Inversely Proportional to…(Diffusion)

Thickness of the tissue (T)

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Dalton's Law

Each gas contributes to the total pressure in proportion to its abundance.

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Vapor Pressure

The pressure exerted by water vapor in a gas mixture.

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Ventilation-Perfusion Limitations

Gas crosses the alveolar membrane and dissolves in blood

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Ventilation Perfusion

Gas crosses membrane and binds to hemoglobin and exerts NO partial pressure

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Diffusion Limited

limited the gasses ability to diffuse across the membrane

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CO Transfer

Carbon monoxide uptake into the blood is limited by diffusion capacity.

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Nitrous Oxide (N2O)

N2O diffuses into capillary, dissolves in plasma, and equilibrates.

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CO measurement

A method to measure the diffusion properties of the lungs by means of carbon monoxide

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Normal Lung

Diffusion of Oâ‚‚ is rapid and the transfer is typically perfusion limited.

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Abnormal Lung

With a thickened barrier, diffusion is impaired and blood Po₂ ≠ Alveolar Po₂.

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CO2 vs O2 Diffusion

CO2 diffuses more readily than O2 due to its higher solubility.

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Study Notes

Learning Objectives

  • Ventilation must be understood in the context of gas laws and air movement during respiration
  • Comprehending pressure changes in the respiratory cycle is key
  • Understanding trans-pulmonary pressure and its changes during respiration is necessary
  • Recognize the meaning of minute and alveolar ventilation and the effects of breathing patterns
  • Identify factors affecting gas diffusion at alveolar and cell membranes
  • The role of partial pressures of gases must be understood

Ventilation

  • Ventilation describes the movement of air into and out of the lungs
  • Airflow happens because of bulk flow, going from high pressure to low pressure areas
  • Flow rate is directly related to the pressure difference

Pressure Changes During Respiration

  • At rest, alveolar pressure equals atmospheric pressure, which is 760mmHg (0mmHg when referenced)
  • At rest, intrapleural pressure is less than atmospheric pressure, which is 756mmHg (-4mmHg)

Trans-pulmonary Pressure

  • This prevents airway closure via the pressure difference between alveolar and pleural pressure
  • Can be calculated by subtracting pleural pressure from alveolar pressure; a normal value is 4mmHg
  • Trans-pulmonary pressure resists the lung's elastic recoil when resting, and is equivalent to the distending pressure

Trans-pulmonary Pressure and Inspiration

  • During inspiration, intrapleural pressure becomes more negative at -7mmHg
  • Trans-pulmonary pressure increases from the pressure difference between alveoli and intrapleural pressure
  • The increased pressure from TPP leads to lung expansion, greater the inward elastic recoil of the lungs
  • Lung expansion reduces alveolar pressure, air moves due to air pressure gradient, and TPP remains greater than lung elastic recoil

Trans-pulmonary Pressure and End of Inspiration

  • Maximal lung volume is achieved
  • Lung fibers stretch, exerting a higher elastic recoil
  • Elastic recoil pressure equals the TPP
  • Equilibrium establishes with no more airflow

Trans-pulmonary Pressure and Expiration

  • Expiration is passive
  • Respiratory muscles relax, but can also be enhanced by muscle contraction in forced expiration
  • Inward chest wall recoil reduces lung size
  • Intra-pleural and trans-pulmonary pressures decrease
  • The force holding the lungs is less than the elastic recoil, allowing the lungs to return to baseline size
  • Alveolar pressure becomes greater than atmospheric pressure
  • Air flows from the alveoli into the atmosphere, reaching a new equilibrium

Intrapleural Pressure Change

  • Thoracic wall moves outward and upwards during inspiration
  • Pleural cavity volume increases slightly resulting in a pressure drops (Boyle's Law)
  • Thoracic wall recoils during passive expiration
  • Pleural cavity volume decreases resulting in intrapleural pressure rises (Boyle's Law)

Ventilation Volumes

  • Minute ventilation is the total ventilation volume per minute
  • Minute ventilation (VE) is Tidal Volume (VT) x Respiratory Rate (f)
  • VE (6000ml/min) = VT(500ml) x f(12/min)
  • Alveolar ventilation refers to the portion of VE that reaches the alveoli
  • The remaining volume ventilates the conducting airways and cannot be used for gas exchange, or anatomic dead space.
  • Alveolar ventilation is the the volume of fresh air entering the alveoli each minute
  • Calculated by subtracting dead space volume from tidal volume(VT) x f
  • Alveolar ventilation is a better indicator of effective gas exchange

Ventilation

  • Ventilation is air moving in and out of the lungs
  • Air moves from high to low pressure areas
  • Flow (F) is proportional to the pressure difference between two points and inversely proportional to resistance
  • F = ΔP/R

Diffusion of Gases

  • Laws of diffusion, diffusion/ perfusion limitations, O2 uptake along the pulmonary capillary, measurement and interpretation of diffusing capacity all influence how gases diffuse

Fick's Law of Diffusion

  • Diffusion through tissues can be described by Fick’s Law
  • It is directly proportional to:
    • Area available for diffusion (A)
    • Diffusion constant(D)
    • Difference in partial pressure (P1-P2)
  • It is inversely proportional to:
    • Thickness of the tissue (T)

Diffusion

  • Diffusion constant is proportional to gas solubility, and inversely proportional to the square root of its molecular weight
  • The pressure that drives gas across the alveolar membrane stems from a partial pressure difference of the gas in the alveolus

Ventilation-Perfusion Limitations

  • Gas crosses the alveolar membrane and dissolves in blood
  • Partial pressure of the gas in the capillary quickly equilibrates with alveolar partial pressure
  • Further transfer is only possible if more blood with lower partial pressures passes through the alveolar capillary, indicating perfusion limitation.

Ventilation Perfusion Limitations

  • Gas crosses the alveolar membrane and binds to hemoglobin, exerting NO Partial Pressure
  • NO is in equilibration of partial pressures
  • The gases ability to diffuse across the membrane is a limiting factor (Diffusion Limited)

Carbon Monoxide

  • This crosses rapidly into RBCs, binds tightly to Hb
  • Partial pressure of CO in blood doesn't rise much and there is little back diffusion
  • CO Transfer - requires diffusion

Nitrous Oxide N2O

  • Diffuses into capillaries but does not bind to Hb and Hb has low avidity for N20
  • N2O dissolves in plasma and partial pressure is rapid, equilibrating with alveolar PNO
  • No more N2O is transferred

Oxygen

  • This binds to Hb but has less avidity than CO
  • Oxygen starts relatively high
  • Normal lungs equilibrate with Alveolar P02 quick
  • No more O2 is transferred

Abnormal Lungs

  • There is a thickened barrier, resulting in impaired diffusion and equilibrium may not be reached
  • Ability to diffuse across the membrane is a limiting factor, and Blood P02 becomes not equal to Alveolar P02
  • In non-healthy Lungs, Oxygen Transfer is Diffusion Limited

Exercise

  • During severe exercise the RBC capillary time decreases from 0.75 to 0.25 seconds
  • Normal lungs have normal diffusion, blood oxygenation is quick, and Capillary P02 = PA02 by 0.25 sec
  • Thicken means an impaired diffusion and blood p02 will not reach the alveolar

Measurement of Diffusing Capacity

  • If transfer of O2 is limited by blood Xlow, the transfer of CO is exclusively diffusion limited
  • A = area available to gas exchange, and T = thickness of alveolar membrane

Diffusing Capacity

  • When A and T cannot be measured during life, a new entity (DL Diffussing Capacity of the Lungs) is used
  • Equation further simplified (Normally caillary blood Pco =0)
  • Single Breath Method used to calculate diffusion
  • Single inspiration of CO mixture, hold for 10s, then expire
  • Calculate rate of CO diffusion by subtracting CO in expired air from original CO concentration
  • Normal diffusing capacity is 25 mL.min-1.mm Hg-1, but increases 2 or 3 times during exercise

Ideal Lung Gas Barrier

  • Area of barrier is large
  • Thin membrane 0.3 µm occurs on most places

Diffusion Parameters

  • Blood gas barrier in lungs should is ideally constructed to maximize are and minimize the membrane
  • This is achieved because CO2 diffuses 20 more readily, and the higher solubility it has in tissues

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