Disorders Of Gas Exchange
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This document discusses disorders of gas exchange, including hypercapnia (elevated carbon dioxide levels) and hypoxia (low oxygen levels). It provides mathematical equations to describe gas exchange in the lungs and blood. It then describes the causes, signs, and treatments of hypercapnia and hypoxia. Four case studies are presented to illustrate examples of patients experiencing hypercapnia or hypoxia.
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Central and sleep-related hypoventilation disorders involve reduced ventilation that is often only present or worsened during sleep. Central hypoventilation is caused by issues in the brainstem or spinal cord and affects control of breathing. Sleep-related hypoventilation includes conditions like sleep apnea syndrome where breathing stops periodically during sleep. Obesity hypoventilation syndrome involves obesity, sleep disturbances, and chronic hypoventilation. Diagnosis involves blood gas tests showing high carbon dioxide levels, especially during sleep. Treatments include weight loss, breathing exercises, positive airway pressure, and sometimes mechanical ventilation.
Resp physiology & respiratory failure in children
pediatric respiratory physiology and respiratory distress and respiratory failure identification and management from a pediatric point of view
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- 3. Overview of Gas Exchange in the Lungs Adapted from: Costanzo, LS. Physiology , 1 st ed. 1998.
- 10. Oxygen Transport (cont) Total O 2 content of blood (C a O 2 ) = + Dissolved O 2 O 2 bound to hemoglobin
- 11. Oxygen Transport (cont) Total O 2 content of blood (C a O 2 ) = P a O 2 Solubility of O 2 in blood + O 2 binding capacity of Hb x x x [Hb] O 2 sat
- 12. Oxygen Transport (cont) Total O 2 content of blood (C a O 2 ) = P a O 2 Solubility of O 2 in blood + O 2 binding capacity of Hb x x x [Hb] O 2 sat (During Normal Gas Exchange)
- 13. Oxygen Transport (cont) Total O 2 content of blood (C a O 2 ) = 100 mmHg 0.003mL O 2 ___ 100mL blood ∙ mmHg + 1.34mL O 2 1g Hb x x x 15g Hb 1dL blood 0.98 (During Normal Gas Exchange)
- 14. Oxygen Transport (cont) Total O 2 content of blood (C a O 2 ) = 0.3mL O 2 _ 100mL blood + 19.7mL O 2 _ 100mL blood (During Normal Gas Exchange) (Dissolved O 2 ) (Hb-bound O 2 )
- 16. Hypercapnia - Etiologies P a CO 2 = (V CO 2 x P I ) / V A Alveolar Ventilation Equation V A = RR (V T – V D ) V A – Alveolar Ventilation RR – Respiratory Rate V T – Tidal Volume V D – Dead Space
- 17. Hypercapnia - Etiologies V CO 2 x P I RR (V T – V D ) P a CO 2 = ↑ V CO 2 (Hypermetabolism) Fever Seizures Sepsis Hyperalimentation ↓ RR (Central hypoventilation) Drugs Brainstem lesions Obesity-hypoventilation syndrome ↓ V T Skeletal muscle weakness Impaired neuromuscular transmission ↓ Lung / chest wall compliance Airway obstruction COPD Asthma Obstructive sleep apnea ↑ V D Excessive PEEP
- 20. Hypoxia - Etiologies A-a Gradient = P A O 2 – P a O 2 Rearrangement: P a O 2 = P A O 2 – A-a gradient Alveolar Gas Equation P A O 2 = [F I O 2 (P I – P H 2 O )] – (P a CO 2 / RQ) Substitution: P a O 2 = [F I O 2 (P I – P H 2 O )] – (P a CO 2 / RQ) – (A-a gradient)
- 21. Hypoxia - Etiologies P a O 2 = [F I O 2 (P I – P H 2 O )] – (P a CO 2 / RQ) – (A-a gradient) ↑ A-a gradient V/Q mismatch COPD Pulmonary embolus Pneumonia Pulmonary edema Anatomic shunt Right to left intracardiac shunts Pulmonary AVMs Impaired diffusion Emphysema Pulmonary fibrosis ↓ F I O 2 Suffocation ↓ P I High altitude ↑ P a CO 2 As above