This document provides an overview of respiratory physiology. It discusses the processes of external and internal respiration, ventilation, lung volumes and capacities, pressures and gradients, spontaneous and positive pressure ventilation, lung characteristics, compliance, elastic forces, surface tension, surfactant, ventilation, perfusion, gas tensions, the oxygen cascade, oxygen transport via dissolved oxygen and hemoglobin, and factors affecting hemoglobin dissociation.
Hypoxia :types , causes,and its effects Aqsa Mushtaq
hypoxia :oxygen defecincy at tissue level.in these slides you are going to in touch with its types ,causes effects.share whatever you wanted to say comment us .
these notes are provided by our loving mam MAM SANIA .thanks to teach us mam :)
Ventilation and Perfusion in different zones of lungs.Gyaltsen Gurung
This powerpoint presentation will make you explore about the Perfusion and Ventilation in different zones of lungs with its co-relation with pulmonary tuberculosis.
Gas exchange between the alveoli and the pulmonary capillary blood occurs by diffusion, as will be discussed in the next chapter. Diffusion of oxygen and carbon dioxide occurs passively, according to their concentration differences across the alveolar-capillary barrier. These concentration differences must be maintained by ventilation of the alveoli and perfusion of the pulmonary capillaries.
Alveolar ventilation brings oxygen into the lung and removes carbon dioxide from it. Similarly, the mixed venous blood brings carbon dioxide into the lung and takes up alveolar oxygen. The alveolar Image not available. and Image not available. are thus determined by the relationship between alveolar ventilation and pulmonary capillary perfusion. Alterations in the ratio of ventilation to perfusion, called the Image not available., will result in changes in the alveolar Image not available. and Image not available., as well as in gas delivery to or removal from the lung.
Alveolar ventilation is normally about 4 to 6 L/min and pulmonary blood flow (which is equal to cardiac output) has a similar range, and so the Image not available. for the whole lung is in the range of 0.8 to 1.2. Image not available. However, ventilation and perfusion must be matched on the alveolar-capillary level, and the Image not available. for the whole lung is really of interest only as an approximation of the situation in all the alveolar-capillary units of the lung. For instance, suppose that all 5 L/min of the cardiac output went to the left lung and all 5 L/min of alveolar ventilation went to the right lung. The whole lung Image not available. would be 1.0, but there would be no gas exchange because there could be no gas diffusion between the ventilated alveoli and the perfused pulmonary capillaries.
Oxygen is delivered to the alveolus by alveolar ventilation, is removed from the alveolus as it diffuses into the pulmonary capillary blood, and is carried away by blood flow. Similarly, carbon dioxide is delivered to the alveolus in the mixed venous blood and diffuses into the alveolus in the pulmonary capillary. The carbon dioxide is removed from the alveolus by alveolar ventilation. As will be discussed in Chapter 6, at resting cardiac outputs the diffusion of both oxygen and carbon dioxide is normally limited by pulmonary perfusion. Thus, the alveolar partial pressures of both oxygen and carbon dioxide are determined by the Image not available. If the Image not available. in an alveolar-capillary unit increases, the delivery of oxygen relative to its removal will increase, as will the removal ...
Surfactant & compliance, LAW OF LAPLACE, Work of Breathing (the guyton and ha...Maryam Fida
It is a lipoprotein mixture present in thin layer of fluid lining the alveoli at the air fluid interface.
COMPOSITION
It is composed of
Apoprotein
Calcium ions
Phospholipids i.e. dipalmitoyl lecithin
Surfactant is secreted by
1. Mainly type II alveolar cells in the lungs.
2. Clara cells, which are situated in the bronchioles.
It lowers the surface tension of fluid lining the alveoli.
Surface tension is inversely proportional to surfactant concentration.
During inspiration surfactant molecules move apart as lungs are expanded and during expiration surfactant molecules become concentrated as lungs shorten.
When there is no surfactant, Surface Tension is 50 dynes/cm. when surfactant is present it is 5-30 dynes/cm depending upon the concentration
Prevents collapse of lungs
Stabilize size of alveoli
Surfactant helps to keep lungs expanded. If there is deficiency of surfactant then the pressure of -20 to -30 mm of Hg will be required to keep the lungs expanded
Surfactant also helps to keep the alveoli dry and prevent development of pulmonary edema.
Surfactant is also helpful in lung expansion at birth. If there is deficiency then there is Respiratory Distress Syndrome.
LAW OF LAPLACE:
pressure required to keep a hollow viscous distended = 2 T/R
Where T is tension and R is radius.
During expiration, size of alveoli decreases so R is decreased and if T does not decrease, much higher pressure will be required to keep the alveoli distended.
When adequate amount of surfactant is there T also decreases so increased pressure is not required. This prevents the collapse of lungs and also stabilizes the equal size of alveoli
Definition:
“Compliance is the measure of expansibility or distensibility of the lungs. It indicates with how much ease lungs can be expanded”.
Work of Breathing
In certain diseases there is increased work of breathing and depending upon the nature of breath there will be specific increase in work of breathing.
In asthma there is increase in work of breathing to overcome airway resistance
In restrictive lung diseases there is increase work of breathing in both tissue resistance and elastic recoil.
Random motion of molecules
Movement in both directions through the membranes & fluids of the respiratory structure
Mechanism & rate of molecule transfer dependant on physics of gas diffusion and partial pressures of gases involved
Hypoxia :types , causes,and its effects Aqsa Mushtaq
hypoxia :oxygen defecincy at tissue level.in these slides you are going to in touch with its types ,causes effects.share whatever you wanted to say comment us .
these notes are provided by our loving mam MAM SANIA .thanks to teach us mam :)
Ventilation and Perfusion in different zones of lungs.Gyaltsen Gurung
This powerpoint presentation will make you explore about the Perfusion and Ventilation in different zones of lungs with its co-relation with pulmonary tuberculosis.
Gas exchange between the alveoli and the pulmonary capillary blood occurs by diffusion, as will be discussed in the next chapter. Diffusion of oxygen and carbon dioxide occurs passively, according to their concentration differences across the alveolar-capillary barrier. These concentration differences must be maintained by ventilation of the alveoli and perfusion of the pulmonary capillaries.
Alveolar ventilation brings oxygen into the lung and removes carbon dioxide from it. Similarly, the mixed venous blood brings carbon dioxide into the lung and takes up alveolar oxygen. The alveolar Image not available. and Image not available. are thus determined by the relationship between alveolar ventilation and pulmonary capillary perfusion. Alterations in the ratio of ventilation to perfusion, called the Image not available., will result in changes in the alveolar Image not available. and Image not available., as well as in gas delivery to or removal from the lung.
Alveolar ventilation is normally about 4 to 6 L/min and pulmonary blood flow (which is equal to cardiac output) has a similar range, and so the Image not available. for the whole lung is in the range of 0.8 to 1.2. Image not available. However, ventilation and perfusion must be matched on the alveolar-capillary level, and the Image not available. for the whole lung is really of interest only as an approximation of the situation in all the alveolar-capillary units of the lung. For instance, suppose that all 5 L/min of the cardiac output went to the left lung and all 5 L/min of alveolar ventilation went to the right lung. The whole lung Image not available. would be 1.0, but there would be no gas exchange because there could be no gas diffusion between the ventilated alveoli and the perfused pulmonary capillaries.
Oxygen is delivered to the alveolus by alveolar ventilation, is removed from the alveolus as it diffuses into the pulmonary capillary blood, and is carried away by blood flow. Similarly, carbon dioxide is delivered to the alveolus in the mixed venous blood and diffuses into the alveolus in the pulmonary capillary. The carbon dioxide is removed from the alveolus by alveolar ventilation. As will be discussed in Chapter 6, at resting cardiac outputs the diffusion of both oxygen and carbon dioxide is normally limited by pulmonary perfusion. Thus, the alveolar partial pressures of both oxygen and carbon dioxide are determined by the Image not available. If the Image not available. in an alveolar-capillary unit increases, the delivery of oxygen relative to its removal will increase, as will the removal ...
Surfactant & compliance, LAW OF LAPLACE, Work of Breathing (the guyton and ha...Maryam Fida
It is a lipoprotein mixture present in thin layer of fluid lining the alveoli at the air fluid interface.
COMPOSITION
It is composed of
Apoprotein
Calcium ions
Phospholipids i.e. dipalmitoyl lecithin
Surfactant is secreted by
1. Mainly type II alveolar cells in the lungs.
2. Clara cells, which are situated in the bronchioles.
It lowers the surface tension of fluid lining the alveoli.
Surface tension is inversely proportional to surfactant concentration.
During inspiration surfactant molecules move apart as lungs are expanded and during expiration surfactant molecules become concentrated as lungs shorten.
When there is no surfactant, Surface Tension is 50 dynes/cm. when surfactant is present it is 5-30 dynes/cm depending upon the concentration
Prevents collapse of lungs
Stabilize size of alveoli
Surfactant helps to keep lungs expanded. If there is deficiency of surfactant then the pressure of -20 to -30 mm of Hg will be required to keep the lungs expanded
Surfactant also helps to keep the alveoli dry and prevent development of pulmonary edema.
Surfactant is also helpful in lung expansion at birth. If there is deficiency then there is Respiratory Distress Syndrome.
LAW OF LAPLACE:
pressure required to keep a hollow viscous distended = 2 T/R
Where T is tension and R is radius.
During expiration, size of alveoli decreases so R is decreased and if T does not decrease, much higher pressure will be required to keep the alveoli distended.
When adequate amount of surfactant is there T also decreases so increased pressure is not required. This prevents the collapse of lungs and also stabilizes the equal size of alveoli
Definition:
“Compliance is the measure of expansibility or distensibility of the lungs. It indicates with how much ease lungs can be expanded”.
Work of Breathing
In certain diseases there is increased work of breathing and depending upon the nature of breath there will be specific increase in work of breathing.
In asthma there is increase in work of breathing to overcome airway resistance
In restrictive lung diseases there is increase work of breathing in both tissue resistance and elastic recoil.
Random motion of molecules
Movement in both directions through the membranes & fluids of the respiratory structure
Mechanism & rate of molecule transfer dependant on physics of gas diffusion and partial pressures of gases involved
the beautiful thing about learning is that no one can take it away from you...so study and hard .....i hope it is helpful to you and its useful for study...best of luck
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
2. RESPIRATION
• Respiration involves the exchange of O2 and CO2 between
an organism and its environment.
• External respiration exchange between alveoli and
pulmonary capillaries.
• Internal respiration cellular level O2 from
blood into cells. CO2 is produced by this aerobic
metabolism cells to systemic capillaries.
4. VENTILATION
• Ventilation is the movement of air into and out of the
lungs.
• Spontaneous ventilation contraction of the muscles
of inspiration (diaphragm and external intercostals)
expansion of the thorax.
• Normal quiet exhalation is passive and does not require
any work.
• Maximal spontaneous inspiration or expiration
accessory muscles.
11. LUNG CHARACTERISTICS
• Normally, two types of forces oppose inflation of the
lungs: elastic forces and frictional forces.
• Elastic forces arise from the elastic properties of the
lungs and chest wall.
• Frictional forces are the result of two factors: the
resistance of the tissues and organs and resistance to gas
flow through the airways.
13. ELASTIC FORCES
• 1. Elastic resistance of lung tissue and chest wall :
Compliance and Elastance
• 2. Resistance from surface forces at the alveolar gas-
liquid interface : Surface tension
• Much of the elastic recoil is due to the surface tension
acting throughout the vast air/water interface lining the
alveoli, as shown by von Neergard by comparing the
elastance of lung filled with air and lung filled with water.
14. COMPLIANCE
• Compliance the relative ease with which a structure
distends.
• Elastance tendency of a structure to return to its
original form after being stretched.
• Thus, C = 1/e or e = 1/C.
• Compliance of the respiratory system is determined by
measuring the change (Δ) of volume (V) that occurs when
pressure (P) is applied to the system: C = ΔV/ ΔP.
15. COMPLIANCE
• Static compliance : relationship between volume change
of lung and the transpulmonary pressure change
measured under known static conditions (zero airflow).
• Dynamic compliance : measurements are made during
rhythmic breathing, but compliance is calculated from
pressure and volume measurements made when no gas
is flowing, usually at end-inspiratory and end-expiratory
‘no-flow’ points.
18. VALUES
• In spontaneously breathing individual, total respiratory
system compliance is about 100 (50-170) mL/cm H2O.
• For intubated and mechanically ventilated patients with
normal lungs and a normal chest wall, compliance varies
from 40 to 50 mL/cm H2O in men and 35 to 45 mL/cm
H2O in women to as high as 100 mL/cm H2O in either
gender.
20. SURFACE TENSION
• The gas–fluid interface lining the alveoli causes them to
behave as bubbles. Surface tension forces tend to reduce
the area of the interface and favor alveolar collapse.
• Laplace Equation :
• To prevent the alveoli from collapsing, a transmural
pressure should be acting across the alveolar wall.
• This pressure, for a single alveolus, is equal to 2 X surface
tension / radius of the alveolus (2T/r).
21. SURFACE TENSION AND SURFACTANT
• Surface-active
substance called
Surfactant.
• The ability of
surfactant to lower
surface tension is
proportional to its
concentration within
the alveolus.
• It thus acts to stabilize
the alveolar size.
22. SURFACTANT SYNTHESIS
• Surfactant is both formed in and liberated from the
alveolar epithelial type II cell.
• The lamellar bodies contain stored surfactant that is
released into the alveolus by exocytosis in response to high
volume lung inflation, increased ventilation rate or
endocrine stimulation.
• After release, surfactant initially forms a lattice structure
termed tubular myelin, which is then reorganized into
monolayered or multilayered surface films.
• Main constituents are DPPC, a phospholipid and Surfactant
proteins (SP) A-D.
23. ALVEOLAR INTERDEPENDENCE
When an alveolus in a group of alveoli collapses, the
surrounding alveoli are stretched. As the other alveoli
recoil in resistance, they pull outward on the collapsing
alveolus.
24. FRICTIONAL FORCES
• Resistance is a measurement of the frictional forces that
must be overcome during breathing.
• This non-elastic resistance is due to
– Resistance to airflow ~ 80%
– Tissue viscous resistance ~ 20%
25. AIRWAY RESISTANCE
• Poiseuille’s law
• The diameter of airway lumen and flow of gas into the
lungs can decrease as a result of bronchospasm,
increased secretions, mucosal edema, or kinks in the
endotracheal tube.
26. AIRWAY RESISTANCE
• The relationship of gas flow, pressure, and resistance in
the airways is described by the equation for airway
resistance,
Raw = Pta/flow, Pta = PIP-Pplat
• In normal, conscious individuals with a gas flow of 0.5
L/s, resistance is about 0.6 to 2.4 cm H2O/(L/s).
• The actual amount varies over the entire respiratory
cycle. The variation occurs because flow during
spontaneous ventilation usually is slower at beginning
and end of the cycle and faster in the middle.
27. TISSUE RESISTANCE
• Due mainly to the movement of pleural layers between
lobes, and between the lungs and chest wall during
inspiration & expiration.
• Tissue viscous resistance remains constant under most
circumstances.
• For example, an obese patient or one with fibrosis has
increased tissue resistance, but the tissue resistance
usually does not change significantly when these patients
are mechanically ventilated.
28. WORK OF BREATHING
• It is the work required by the respiratory muscles to
overcome the mechanical impedance to respiration.
• The physical work of breathing can be divided into
– Resistance work
– Compliance work
29. RESISTANCE WORK
• Raw = ΔP/V
(Raw= Airway resistance, ΔP = PIP-Pplat and V= Flow )
• The pressure change ΔP amount of work imposed on
the patient.
• If WOB remains constant increase in the airway
resistance decrease the flow.
• If a patient is unable to overcome the airway resistance
by increasing WOB hypoventilation.
30. COMPLIANCE WORK
• C = ΔV/ΔP
• If the change in pressure remains constant decrease
in compliance decrease in the tidal volume and thus
minute ventilation.
• In low compliance situations such as ARDS, the decrease
in minute ventilation is characterized by low tidal volume
and high respiratory rates.
• In the clinical setting, atelectasis is one of the most
frequent causes of increased WOB.
31. WORK OF BREATHING
• Triangle APAE represents
the Compliance work.
• Area ACBPA represents
Inspiratory Resistance
work.
• Triangle APAD
represents Expiratory
Resistance work.
• The area within the
hysteresis represents
total Resistance work.
32. TIME CONSTANTS
• Regional differences in compliance and resistance exist
throughout the lungs.
• That is, the compliance and resistance values of a
terminal respiratory unit (acinus) may be considerably
different from those of another unit.
• Thus the characteristics of the lung are heterogeneous,
not homogeneous.
• Alterations in C and Raw affect how rapidly lung units fill
and empty.
34. TIME CONSTANTS
• Calculation of time constants is important when setting the
ventilator’s inspiratory and expiratory time.
• Ti less than 3 time constants may result in incomplete
delivery of tidal volume.
• Prolonging the Ti allows even distribution of ventilation
and adequate delivery of tidal volume.
• Te less than 3 time constants may lead to incomplete
emptying of lungs.
• This can increase the FRC and cause trapping of air in the
lungs.
35. VENTILATION
• Ventilation is usually measured as the sum of all exhaled
gas volumes in 1 minute.
• Minute ventilation = RR x Tidal volume
• Not all the inspired gas mixture reaches alveoli; some of
it remains in the airways and is exhaled without being
exchanged with alveolar gases.
• Alveolar ventilation is the volume of inspired gases
actually taking part in gas exchange in 1 minute.
36. DEAD SPACE
• That part of the VT not participating in alveolar gas
exchange is known as dead space (VD).
• Dead space is actually composed of gases in non-
respiratory airways (Anatomic dead space) as well as in
alveoli that are not perfused (Alveolar dead space).
• Sum of the two is referred to as Physiological dead space.
• In the upright position, dead space is normally about 150
mL for most adults (approximately 2 mL/kg) and is nearly
all anatomic.
38. PERFUSION
• Of the approximately 5 L/min of blood flowing through
the lungs, only about 70–100 mL at any one time is within
the pulmonary capillaries undergoing gas exchange.
• At the alveolar–capillary membrane, this small volume
forms a 50–100 m2 sheet of blood approximately one red
cell thick.
• Hypoxia is a powerful stimulus for pulmonary
vasoconstriction.
• Hypoxic pulmonary vasoconstriction is an important
physiological mechanism in reducing intrapulmonary
shunting and preventing hypoxemia.
40. DISTRIBUTION OF PERFUSION
• Zone 1 is not observed in the normal lung; only observed
with positive pressure ventilation. This becomes the
alveolar dead space.
• Zone 2 is the part of lung about 3 cm above heart. In this
region blood flows in pulses. At first there is no flow
because of obstruction at the venous end. Pressure from
the arterial side builds up until it exceeds alveolar pressure
and flow resumes (Waterfall effect).
• Zone 3 comprises the majority of the lungs in health. Blood
flow is continuous throughout the cardiac cycle. Flow is
determined by the Ppa-Ppv difference, which is constant
down this portion of the lung.
41. DISTRIBUTION OF PERFUSION
• Zone 4 can be seen at the lung bases at low lung volumes
or in pulmonary edema.
• Pulmonary interstitial pressure (Pi) rises as lung volume
decreases due to reduced radial tethering of the
lung parenchyma.
• An increase in Pi causes extralveolar blood vessels to
reduce in caliber and so blood flow decreases.
• Flow in zone 4 is governed by the arterio-interstitial
pressure difference (Pa − Pi).
42. VENTILATION/PERFUSION RATIO
• Because alveolar ventilation is normally about 4 L/min and
pulmonary capillary perfusion is 5 L/min, the overall V/Q
ratio is about 0.8.
• V/Q for individual lung units (each alveolus and its
capillary) can range from 0 (no ventilation) to infinity (no
perfusion); the former is referred to as intrapulmonary
shunt, whereas the latter constitutes alveolar dead space.
• Because perfusion increases at a greater rate than
ventilation, nondependent (apical) areas tend to have
higher V/Q ratios than do dependent (basal) areas.
44. SHUNT
• Shunting denotes the process whereby desaturated,
mixed venous blood from the right heart returns to the
left heart without being oxygenated in lungs.
• Intrapulmonary shunts are often classified as absolute or
relative.
• Absolute shunt refers to anatomic shunts and lung units
where V/Q is 0.
• A relative shunt is an area of lung with a low but finite
V/Q ratio.
• Clinically, hypoxemia from a relative shunt can usually be
partially corrected by increasing FiO2; hypoxemia caused
by an absolute shunt cannot.
45. VENOUS ADMIXTURE
• Venous admixture is the amount of mixed venous blood
that would have to be mixed with pulmonary end-
capillary blood to account for the difference in O2 tension
between arterial and pulmonary end-capillary blood.
• Pulmonary end-capillary blood is considered to have the
same concentrations as alveolar gas.
• Venous admixture is usually expressed as a fraction of
total cardiac output QS/QT.
• The equation may be derived with the law for the
conservation of mass for O2 across the pulmonary
capillary bed.
46. VENOUS ADMIXTURE
•Normal QS/QT is primarily due to communication
between deep bronchial veins and pulmonary veins, the
Thebesian circulation in the heart, and areas of low but
finite V/Q in the lungs.
•Venous admixture in normal individuals (physiological
shunt) is typically less than 5%.
47. GAS TENSIONS
• ALVEOLAR OXYGEN TENSION (PAO2)
• PULMONARY END-CAPILLARY OXYGEN TENSION(Pc’O2)
• ARTERIAL OXYGEN TENSION (PaO2)
– The A–a gradient for O2 is directly proportional to shunt
but inversely proportional to mixed venous O2 tension.
• MIXED VENOUS OXYGEN TENSION (PvO2)
– Normal PvO2 is about 40 mm Hg and represents the
overall balance between O2 consumption and delivery.
48. GAS TENSIONS
• MIXED VENOUS CO2 TENSION (PvCO2)
– Normal PvCO2 is about 46 mmHg and is end result of
mixing of blood from tissues of varying metabolic
activity.
• ALVEOLAR CO2 TENSION (PACO2)
– PACO2 = VCO2 / VA
• PULMONARY END-CAPILLARY CO2 TENSION(Pc’CO2)
• ARTERIAL CO2 TENSION (PaCO2)
• END-TIDAL CO2 TENSION (PETCO2)
– The PACO2–PETCO2 gradient is normally less than 5 mmHg
and represents dilution of alveolar gas with CO2-free gas
from non-perfused alveoli (alveolar dead space).
49. OXYGEN CASCADE
• The Po2 of dry air is 159 and humidified air is 149 mmHg
at sea level.
• Oxygen moves by mass transport and down partial
pressure gradients from the inspired air to the
mitochondria where it is consumed. At this point, the Po2
is about 3.8–22.5 mmHg.
• The steps by which the Po2 decreases from air to the
mitochondria are known as the Oxygen Cascade.
• Any one step in the cascade may be increased under
pathological circumstances and may result in hypoxia.
51. OXYGEN TRANSPORT
• Oxygen is carried in the blood in two forms
1. dissolved in solution and
2. in reversible association with hemoglobin.
52. DISSOLVED OXYGEN
• Henry’s Law,
Gas concentration = α x partial pressure
where α = the gas solubility coefficient for a given
solution at a given temperature
• The solubility coefficient for O2 at normal body
temperature is 0.003 mL/dL per mmHg.
• Even with a PaO2 of 100 mmHg, the maximum amount of
O2 dissolved in blood is very small (0.3 mL/dL) compared
with that bound to hemoglobin.
55. FACTORS AFFECTING
• P50 is the O2 tension at which
Hb is 50% saturated.
• Each factor shifts the
dissociation curve either to
the right (increasing P50) or to
the left (decreasing P50).
• A rightward shift lowers O2
affinity, displaces O2 from Hb
and makes more O2 available
to tissues.
• The normal P50 in adults is
26.6 mmHg.
56. EFFECTS
• Bohr Effect : An increase in blood [H+] reduces O2
binding to Hb. The result is facilitation of O2 release to
tissue with little impairment in O2 uptake.
• The influence of CO2 tension on Hb affinity for O2 is
secondary to the associated rise in [H+] when CO2
tension increases.
• The high CO2 content of venous capillary blood (by
decreasing Hb affinity for O2) facilitates the release of O2
to tissues; conversely, the lower CO2 content in
pulmonary capillaries increases Hb affinity for O2 again,
facilitating O2 uptake from alveoli.
58. OXYGEN TRANSPORT
• O2 transport is dependent on both respiratory and
circulatory function.
• Fick Equation
• Oxygen Extraction Ratio (O2ER)
O2ER = VO2/DO2
O2ER = CaO2-CvO2/CaO2
• The O2ER is normally about 0.25 (range = 0.2–0.3).
59. CONTROL OF OXYGEN UPTAKE
• When DO2 is moderately
reduced, VO2 remains normal
because of increased O2ER.
• With further reductions in
DO2, a critical point is reached
beyond which VO2 becomes
directly proportional to DO2.
• This state of supply-
dependent O2 is typically
associated with progressive
lactic acidosis caused by
cellular hypoxia.
60. CO2 TRANSPORT
• Carbon dioxide is
transported in blood in
three forms: dissolved in
solution, as bicarbonate,
and with proteins in the
form of carbamino
compounds . The sum of
all three forms is the total
CO2 content of blood.
61. BICARBONATE
• Mainly in RBCs and endothelium, where Carbonic
anhydrase greatly accelerates the reaction.
• On the venous side of systemic capillaries, CO2 enters
RBCs and is converted to bicarbonate, which diffuses out
of RBCs into plasma; chloride ions move from plasma
into RBCs to maintain electrical balance.
• In the pulmonary capillaries, the reverse occurs: chloride
ions move out of RBCs as bicarbonate ions re-enter for
conversion back to CO2, which diffuses out into alveoli.
• This sequence is referred to as the Chloride or
Hamburger shift.
62. CARBAMINO COMPOUNDS
• At physiological pH, only a small amount of CO2 is carried
in this form, mainly as carbaminoHb.
• Deoxygenated Hb has a greater affinity (3.5 times) for
CO2 than does oxygenated Hb.
• As a result, venous blood carries more CO2 than arterial
blood (Haldane effect).
63. HEMOGLOBIN BUFFERING
• Hb can act as a buffer at physiological pH because of its
high content of histidine. The acid–base behavior of Hb is
influenced by its oxygenation state.
• Removal of O2 from Hb in tissue capillaries causes the Hb
molecule to behave more like a base, favoring
bicarbonate formation.
• In the lungs, the reverse is true. Oxygenation of Hb favors
its action as an acid, favoring CO2 formation.
64. CONTROL OF RESPIRATION
• Spontaneous ventilation is the result of rhythmic neural
activity in respiratory centers within the brain stem.
• This activity regulates respiratory muscles to maintain
normal tensions of O2 and CO2 in the body.
• The basic neuronal activity is modified by inputs from
other areas in the brain, volutional and autonomic, as
well as various central and peripheral receptors.
65. CENTRAL RESPIRATORY CENTERS
• The basic breathing rhythm originates in the medulla.
• Two medullary groups of neurons: a dorsal respiratory
group - active during inspiration; and a ventral
respiratory group - active during expiration.
• Two pontine areas influence the dorsal (inspiratory)
medullary center.
• A lower pontine (apneustic) center is excitatory, whereas
an upper pontine (pneumotaxic) center is inhibitory.
• The pontine centers appear to fine-tune respiratory rate
and rhythm.
66. CENTRAL SENSORS
• Central chemoreceptors lie on the antero-lateral surface
of medulla and respond primarily to changes in CSF [H+].
• This mechanism is effective in regulating PaCO2, because
the blood–brain barrier is permeable to dissolved CO2
but not to HCO3–. Acute changes in PaCO2 but not in
arterial [HCO3–] are reflected in CSF; thus, a change in
CO2 results in a change in [H+].
• PaCO2 leads to CSF [H+] and activates the
chemoreceptors. Secondary stimulation of the adjacent
medullary centers increases alveolar ventilation and
reduces PaCO2 back to normal.
67. CENTRAL SENSORS
• The relationship between
PaCO2 and minute volume
is nearly linear.
• Very high PaCO2 levels
depress the ventilatory
response (CO2 narcosis).
• The PaCO2 at which
ventilation is zero is
known as the apneic
threshold.
68. PERIPHERAL SENSORS
• Peripheral chemoreceptors include the carotid bodies
and the aortic bodies.
• The carotid bodies are the principal peripheral
chemoreceptors and are sensitive to changes in PaO2,
PaCO2, pH, and arterial perfusion pressure.
• They interact with central respiratory centers via the
glossopharyngeal nerves, producing reflex increases in
alveolar ventilation in response to reductions in PaO2 and
arterial perfusion, or elevations in [H+] and PaCO2.
• Stimulated by cyanide, doxapram and large doses of
nicotine.
69. PERIPHERAL SENSORS
• Carotid bodies are most
sensitive to PaO2.
• Receptor activity does
not appreciably increase
until PaO2 decreases
below 50 mmHg.
• Anti-dopaminergic
drugs, anesthetics, and
bilateral carotid surgery
abolish the peripheral
ventilatory response to
hypoxemia.
70. PERIPHERAL SENSORS
• Stretch receptors (in the smooth muscle of airways) are
responsible for inhibition of inspiration when the lung is
inflated to excessive volumes (Hering–Breuer inflation
reflex) and shortening of exhalation when the lung is
deflated (deflation reflex).
• Irritant receptors (in the tracheobronchial mucosa) upon
activation produce reflex increases in respiratory rate,
bronchoconstriction, and coughing.
• J (juxtacapillary) receptors (in the interstitial space)
induce dyspnea in response to expansion of interstitial
space volume and various chemical mediators following
tissue damage.
72. NON-RESPIRATORY FUNCTIONS
• Filtration : The entire cardiac output passes through the
pulmonary circulation, lungs thus act as filters preventing
emboli from passing to the left side of the circulation.
• Defence against inhaled substances : Lungs constitute a
huge interface between environment and the body and
has multiple physical, chemical and biological defence
systems against inhaled hazards.
• Metabolism : Active uptake and metabolism of many
endogenous compounds including amines, peptides and
eicosanoids.