Mechanics of Breathing - Florida International...
Transcript of Mechanics of Breathing - Florida International...
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MECHANICS OF BREATHINGMECHANICS OF BREATHING
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NORMAL BREATHINGNORMAL BREATHING
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How Do We Breath?How Do We Breath?
Inspiration is normally active Expiration is normally passive.
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Muscles of RespirationMuscles of Respiration
Inspiratory muscles– Diaphragm.– External intercostals. – Accessory muscles.
• Include sternomastoids, scalene muscles, and alae nasi.
Expiratory muscles– Abdominal muscles. – Internal intercostals.
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Figure 1: Respiratory PressuresFigure 1: Respiratory Pressures
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Important Respiratory Pressure Important Respiratory Pressure Differences.Differences.
Airway pressure gradient:PM - PALV.
Transpulmonary pressure:PTP = PALV - PPl
Transchest wall pressure:PTC = PPl - Pbs
Transmural respiratory system pressure:PRS = PALV - Pbs
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Balance of Static ForcesBalance of Static Forces
+
Increase to Inflate Increase with Inflation
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Three Ways to Inflate the LungsThree Ways to Inflate the Lungs
Increase alveolar pressure– Positive pressure respirators.
Decrease body surface pressure– “Iron lungs”
Activate inspiratory muscles– Normal way to breath.
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Inflation DynamicsInflation Dynamics
Transmural pressure must overcome:– Elastic recoil forces– Airway resistance
to flow.
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MECHANICS OF BREATHINGMECHANICS OF BREATHING
Part 2
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ELASTIC CHARACTERISTICS ELASTIC CHARACTERISTICS OF THE LUNGOF THE LUNG
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Inflation HysteresisInflation Hysteresis
Hysteresis
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ComplianceCompliance
∆V∆P
TransmuralPressure
Vol
ume
Vo
Pin
Pout
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Lung Compliance vs. VolumeLung Compliance vs. Volume
Stiff
Compliant∆V
∆V
∆ P
∆ P
C= ∆V∆ P
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Two Major Forces affect Lung Two Major Forces affect Lung ComplianceCompliance
Tissue elastic forces Surface tension forces.
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Air vs. Saline InflationAir vs. Saline InflationMore
CompliantSaline Inflation
LessCompliant
Air Inflation
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Surface Tension.Surface Tension.
– At every gas-liquid interface surface tension develops.
– Surface Tension is a liquid property– LaPlace’s Law:
PTr
=⋅2
P1
P2
T
T
r1
r2
TP r
2P r
21 1 2 2=
⋅=
⋅
If r r Then, P P1 2 2 1> >
Result: Small Bubble Collapses
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Surface Tension.Surface Tension.
– At every gas-liquid interface surface tension develops.
– Surface Tension is a liquid property– LaPlace’s Law:
PTr
=⋅2
P1
P2
T
T
r1
r2
TP r
2P r
21 1 2 2=
⋅=
⋅
If r r Then, P P1 2 2 1> >
Result: Small Bubble Collapses
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SurfactantSurfactant
Secreted by Type II alveolar cells Dipalmitoyl phosphatidyl choline Lines alveoli Unique surface tension properties:– Average surface tension low.– Surface tension varies with area:• Surface tension rises as area gets bigger• Surface tension falls as area gets smaller.
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Figure 4: SurfactantFigure 4: Surfactant
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Physiological Importance of Physiological Importance of SurfactantSurfactant Increases lung compliance (less stiff) Promotes alveolar stability and
prevents alveolar collapse Promotes dry alveoli:– Alveolar collapse tends to “suck” fluid
from pulmonary capillaries– Stabilizing alveoli prevents fluid
transudation by preventing collapse.
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Infant Respiratory Disease Infant Respiratory Disease Syndrome (IRDS)Syndrome (IRDS) Surfactant starts late in fetal life
– Total gestation: 39 wks– Surfactant: 23 wks 32-36 wks
Infants with immature surfactant (IRDS)– Stiff, fluid-filled lungs– Atelectatic areas (alveolar collapse)
• Collapsed alveoli are poorly ventilated• Effective right to left shunt (Admixture)
[lecithin]/[sphingomyelin] ratioGestational Maturity
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Dependent LungDependent Lung
Dependent Lung—the lung in the lowest part of the gravitational field– base when in the upright position– dorsal portion when supine.
Q63
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Gravity and Lung InflationGravity and Lung Inflation
P2
P1
PALV = 0PPL = -2.5 cm H2O
PPL = -10 cm H2O
P 0 ( 10) 10 cmH 0TP 2= − − = +
P 0 ( 2.5) cmH 0TP 2= − − = + 2 5.
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Figure 5: Regional Compliance Figure 5: Regional Compliance Differences During InflationDifferences During Inflation
∆V
∆VStiff
Compliant
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Regional Lung Volume vs. Regional Lung Volume vs. Regional Lung VentilationRegional Lung Ventilation
In the upright posture:– Relative lung volume is greater at the
apex– Lung is less compliant (stiffer) at the
apex
– Regional lung ventilation is greatest at the base
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Time Constants for EmptyingTime Constants for Emptying
Important regional inhomogeneities:– regional differences in airway
resistances– regional differences in elastic
characteristics High resistance and high compliance
cause slow emptying.
PALVRC Time Constant RC∝
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Specific ComplianceSpecific Compliance
Normalization allows comparison of tissue elastic characteristics
Question: How would compliance differ in a child and an adult, both with normal lungs?
Specific Compliance =Compliance
FRC
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INTERACTIONS BETWEEN INTERACTIONS BETWEEN LUNGS AND CHEST WALLLUNGS AND CHEST WALL
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General PrincipleGeneral Principle
The lungs and chest wall operate in series
Lung and chestwall compliances add reciprocally:
1C
1C
1CTotal Chestwall Lung
= +
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MECHANICS OF BREATHINGMECHANICS OF BREATHING
Part 3
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Figure 6: Chest Wall MechanicsFigure 6: Chest Wall Mechanics
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Chest Wall Mechanics SummaryChest Wall Mechanics Summary
Negative P TT : 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 P TT: Above 65% of TLC– volumes above 65% TLC– Chest tends to collapse (spring in).
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Figure 7: Lung MechanicsFigure 7: Lung Mechanics
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Lung Mechanics SummaryLung Mechanics Summary
Always above unstressed volume (minimal volume = 10% TLC).
PTP is positive from RV to TLC Lungs always tends to collapse.
Q64
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Figure 8: Combined MechanicsFigure 8: Combined Mechanics
Q65
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Combined Mechanics SummaryCombined 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
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LungLung Compliance in Disease Compliance in Disease
Diseases increasing compliance:– natural aging– emphysema.
Diseases decreasing compliance (stiffer lung):– pulmonary fibrosis– edema (e.g. rheumatic heart disease)
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ChestwallChestwall Compliance in Disease 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
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AIRWAY RESISTANCEAIRWAY RESISTANCE
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Resistive Forces and BreathingResistive Forces and Breathing
Quiet breathing -- Air flow laminar– Resistance -- Poiseuille’s Law– Pressure gradient proportional to flow.
High airflow (e.g. exercise)– turbulence and eddy flow– Extra pressure gradient proportional to
flow rate squared
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Distribution of Airway Distribution of Airway ResistanceResistance 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
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Airway ResistanceAirway Resistance --Smooth Muscle --Smooth Muscle
Bronchoconstrictors– Vagal tone– Histamine
Bronchoconstrictors– Beta agonists Bronchodilation– Anti-cholinergics
Q66
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Airways and V/Q MatchingAirways and V/Q Matching
PACO2 Bronchodilation– Find high PACO2 in poorly ventilated
regions– These airways tend to dilate.– Promotes homogeneous ventilation
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Homeostatic SummaryHomeostatic 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
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Airway Resistance -- Minimized Airway Resistance -- Minimized by High Elastic Recoilby High Elastic Recoil Radial traction normally holds bronchi
open
Low elastic recoil forces causes less radial traction and higher airway resistances:➔Lower lung volumes➔Chronic obstructive disease (eg. Emphysema)
Airway
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Maximum Forced ExpirationMaximum Forced Expiration
Effort Independent Limb
Volume
Flow
TLC RV
PeakFlow
time
Vol
ume
TLC
RV
PeakFlow
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Summary of Forced ExpirationSummary 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.
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Figure 10: Flow Limitation and Figure 10: Flow Limitation and EPPEPP
Palv = Ppl+Pel PEPP=Ppl
Pel
Ppl
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Mechanism of Flow Limitation Mechanism of Flow Limitation SummarySummary
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
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Effort Independence ofEffort Independence of Flow-Volume Envelope Flow-Volume Envelope
Increased effort– Similar increases in PALV and PEPP.– Pressure difference unchanged– Therefore, Flow unchanged.
Q67
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Figure 11: Flow Limitation at Figure 11: Flow Limitation at Various Lung VolumesVarious Lung Volumes
High LungVolume
Medium LungVolume
Low LungVolume
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Flow Limitation in COPD Flow Limitation in COPD (Emphysema)(Emphysema)
Normal LungMedium Volume
Emphysematous LungMedium Volume
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Forced Inspiration: Forced Inspiration: is is Effort-DependentEffort-Dependent
PPL is Negative Airways are held open.
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Clinical Flow-Volume LoopsClinical Flow-Volume LoopsObstructionObstruction
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ReferenceReference
http://www.ursa.kcom.edu/Department/SlideSets/Summer/MechBreathing/PPMechBreathing.ppt