PULMONARY

SESSION 11:
VENTILATION

B. Mponda. MD,MMED
 Learning Objectives

 Explain respiratory process

 Explain mechanism of Breathing

 Explain control of breathing

 Recognize pulmonary volumes and

capacities
 Respiratory Process
 The term respiration means the exchange of
gases between body cells and the
environment.

This involve two main processes

 Breathing (pulmonary ventilation): Ventilation is
the process of moving air into the lungs
(inspiration) and out of the lungs (expiration).
 The flow of air in and out of the lungs require
pressure gradient in the opposite direction.
 Exchange of gases in the lungs; external
respiration and in the tissues; internal respiration
 Breathing (ventilaton)

 Breathing supply oxygen to the alveoli and

eliminate carbon-dioxide

 Expansion of the chest during inspiration

occurs as a result of muscular activity, partly
involuntary and partly voluntary.

 The main muscles used in normal breathing

are the intercostals muscles and the
diaphragm.
 Intercostal muscles. There are eleven
pairs of intercostals muscles that occupy
the spaces between the 12 pairs of ribs.

 They are arranged in two layers, the

external and internal intercostal muscles.
 Thoracic diaphragm.

 The Diaphragm is a dome-shaped musculo-

fibrous septum which separates the thoracic
cavity from the abdominal cavity.

 It is convex upper surface forming the floor

of the thoracic cavity, and its concave under
surface the roof of the abdominal cavity.

 The diaphragm is pierced by a series of

apertures to permit of the passage of
structures between the thorax and abdomen.
 There are three large openings (diaphragmatic
hiatus); the aortic, the esophageal, and the
vena cava openings and a series of smaller ones.

 The clinical importance of oesophageal opening is

that; weakness can occur and this can cause the
development of hiatus hernia.

 The diaphragm is crucial for breathing and

respiration.

 The diaphragm is innervated by the phrenic nerve.

 During difficult or deep breathing,
muscles of the neck, shoulders and
abdomen assist in respiration.

 These muscles are:

 sternocleidomastoid
 scaleneus muscles-
 anterior,
 middle and
 posterior.
 Mechanism of breathing

 The average respiratory rate is 12 to 15

breaths per minute in adult. Each breath
consists of three phases:
 Inspiration
 Expiration
 Pause
 Insipiration
 During inspiration, the diaphragm
contracts and moves downwards while
the external intercostals muscles
contracts raising the ribs and elevate the
sternum, increasing the size of the
thoracic cavity even more.

 This causes expansion of the lungs, as a

result, the intra-alveolar pressure falls
and the atmospheric pressure forces
more air into the airways.
 The process of inspiration is active, as it needs
energy for muscle contraction.

 This process is enhanced by the following:

 Compliance; ability of pulmonary tissue to stretch,
making inspiration possible

 The pressure between parietal and visceral pleura is

always less than atmospheric pressure

 Elastic coil – tendency of pulmonary tissue to return

to a smaller size after having been stretched,
passively during expiration
 Expiration

 During expiration, the Diaphragm and

intercostals muscles relax, causing the
lungs to recoil, and return to the
original shape.

 Thisincreases the intra-alveolar

pressure above the atmospheric
pressure, so the air inside the lungs is
forced out through the respiratory
passages.
 Because normal resting expiration occurs
without the contraction of muscles, it is
considered a passive process.

 At rest, expiration lasts about 3 seconds and

after expiration there is a pause before the
next cycle begins.

 Expiration – a passive process that begins

when the inspiratory muscles are relaxed,
decreasing the size of the thorax and
increasing intra-pleural pressure.
 Control of breathing
 Normal breathing is a rhythmic, involuntary
act that continues when a person is
unconscious.

 Groups of neurons in the brainstem form the

respiratory centre which controls breathing.

 This centre periodically initiates impulses

that travel on cranial and spinal nerves to
the breathing muscles causing inspiration
and expiration.
 Voluntary control of breathing is exerted
during activities such as speaking and
singing but it is overridden if blood
carbon dioxide rises.

 Breathing may be modified by the higher

centres in the brain by:
 speech, singing
 emotional displays, e.g. crying, laughing, fear
 drugs, e.g. sedatives, alcohol
 Sleep
 Temperature influences breathing.

 In fever, respiration is increased due to

increased metabolic rate,

while

 In hypothermia it is depressed, as is metabolism.

 Temporary changes in respiration occur in

swallowing, sneezing and coughing.
 Factors affecting Breathing

 The partial pressure of a gas is determined

by the concentration of that gas in a
mixture of gases or the concentration of
gas dissolved in a liquid

 Chemicals, lung tissue stretching and

emotional state affect breathing

 Chemosensitive areas are associated with

the respiratory centre. Stimulation of these
areas increases alveolar ventilation
 Peripheral chemoreceptors in the carotid bodies
and aortic bodies of certain arteries sense low
oxygen concentration , when oxygen is low,
alveolar ventilation increases

 Stretching of the lung tissue trigger an inflation

reflex.
 This reflex reduces the duration of inspiratory
movement, so prevent overinflation of the lung during
forceful breathing

 Emotional upset or strong sensory stimulation

may alter the normal breathing pattern.
 Gasping, and rapid breathing are familiar
responses to fear, anger, shock,
excitement, horror, surprise, sexual
stimulation or even the chill of stepping
into a cold water

 Hyperventilation decrease carbon dioxide

concentration, but this is very dangerous
when it associated with breath holding
during underwater swimming
 Sometime a person who is emotionally upset may
hyperventilate, become dizzy, and lose
consciousness.

 This is due to a lowered carbon dioxide concentration

followed by a rise in pH (respiratory alkalosis) and a
localised vasoconstriction of cerebral arterioles,
decreasing blood flow to nearby brain cells. Hampered
oxygen supply to the brain causes fainting.

 A person should never hyperventilate to help hold the

breath while swimming, because the person may lose
consciousness under water and drown
 Pulmonary Volumes and
Capacities
 Spirometry is the process of measuring volumes
of air that move into and out of the respiratory
system.

 Spirometer is a device used to measure these

pulmonary volumes.

 Pulmonary volumes are the amount of air

moved in and out and the remaining.

 These are important for normal exchange of

oxygen and carbon dioxide to take place.
 There are four volumes that can be measured
by spirometer, these are:

 Tidal volume (TV) - amount of air exhaled or

inhaled after normal inspiration or expiration is
approximately 500mls

 Expiratory reserve volume (ERV) – Maximum

volume of air that can be forcibly exhaled after
a normal expiration (normal tidal volume) it is
approximately between 1.0 and 1.2 litres.
 Inspiratory reverse volume (IRV) –
Maximum amount of air that can be
forcibly inhaled after normal inspiration
(normal IRV is 3 - 3.3 litres)

 Residual volume amount of air that

cannot be forcibly exhaled (1.2 litres) i.e.
the amount of air that remain in the lungs
after the most forceful expiration
 Pulmonary capacities are the sum of two or more
pulmonary volumes. The following are pulmonary
capacities:

 Vital capacity: is the maximum volume of air that a

person can exhale after maximum inhalation.

 It can also be the maximum volume of air that a

person can inhale after maximum exhalation.

 Therefore; it equals the inspiratory reserve volume plus

the tidal volume plus the expiratory reserve volume; it
is about 4600 millilitres. (IRV + TV + ERV it is 4.6 litres)
 A person’s vital capacity depends on
many factors, including the size of the
thoracic cavity and posture
 so with other physiological measurements, the
vital capacity can help make a diagnosis of
underlying lung disease

 Functional residual capacity – the amount

of air remaining in the lungs at the end of
a normal expiration, therefore it the sum
of ERV + RV = 2.2 -2.4 litres
 Total lung capacity – the sum of all four lung
volumes – the total amount of air a lung can
hold i.e. = TV+ IVR + EVR + RV = 5.7 – 6.2
litres

 Inspiratory capacity is the Tidal volume plus

the inspiratory reserve volume, which is the
amount of air that a person can inhale after
the end of a normal expiration.


 Dead space. Since gaseous exchange in
the respiratory system occurs only in the
terminal portions of the airways, the gas
that occupies the rest of the respiratory
system is not available for gas exchange
with pulmonary capillary blood.

 This gas is known to be in dead space.

Dead space can be:
 Anatomical dead space –Is the gas in the conducting areas
of the respiratory system, such as the mouth, trachea and
bronchi where the air doesn't come to the alveoli of the
lungs, that do not participate in gas exchange

 Physiological dead space. The physiological dead space is

equal to the anatomical dead space plus the alveolar dead
space.

 Alveolar dead space: Is the area in the alveoli that does

get air to be exchanged, but there is no enough blood
flowing through the capillaries for exchange to be
effective.
 It is normally very small (less than 5 mL) in healthy individuals. It
can increase dramatically in some lung diseases.
 Physiologic dead space can be measured by
Bohr's method.
An equation and example are provided below:

v
Where;

 VD = dead space
 VT = tidal volume
 PaCO2 = partial pressure of carbon dioxide in arteries
 PECO2 = partial pressure of carbon dioxide in exhaled
air

 In physiology, dead space is air that is inhaled by the

body in breathing, but does not partake in gas
exchange. In adults, it is usually in the range of 150
mL.
 Key Points

 The main muscles of respiration are the intercostals

muscles and the diaphragm.

 There are two types of respiration, the external and

internal respiration

 Pulmonary capacities are the sum of two or more

pulmonary volumes

 Pulmonary volumes are the amount of air moved in and

out and the remaining

 Dead space is the space that does not participate in gas

exchange.
Thank you