the art of breathing
DESCRIPTION
This illustrative slide show explains the process and the mechanics of breathing.Was first presented at 5th of January 2012 in the Tripoli Medical Center meeting hall of the Anesthesia Department.TRANSCRIPT
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Dr.Hamza Rayes
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Dr.Hamza Rayes
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ReasoningDiagnosisManagement
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Parietal Pleura
Visceral Pleura
Chest Wall
Alveolus
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Boyle's law:
Volume
Pressure
1
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Pressure gradient:
Air will flow from a high pressure to low pressure down it is gradient
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The atmospheric pressure will be considered as Zero for simplification
0 cm H2O
0 cm H2O
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Surface tension:
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5
5
6
6
7
7
As the lung enlarges, recoil increases; As the lung gets smaller, recoil decreases.
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-5-5
Outward recoiling force of 5 meaning The same but in opposite directionHence , the negative charge
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-5-5 Alveolar elasticity exerting a force of recoil of approximately 5
As a result the net force will sum to Zero. -5 So no net change
5
5
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-5-5
5
50 cm H2O
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0 cm H2O
-5 -5
When this stretch ability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
Begining of Inspiration:
Inspiratory Muscles
InspiratoryMuscles
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0 cm H2O
-6 -6
When this stretch ability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
Begining of Inspiration:
Inspiratory Muscles
InspiratoryMuscles
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0 cm H2O
-7 -7
When this stretch ability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
Begining of Inspiration:
Inspiratory Muscles
InspiratoryMuscles
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Beginning of Inspiration:
5
5
Inspiratory Muscles
-8
Inspiratory Muscles
-8
Which is obviously higher that the recoil force of 5
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Inspiratory Muscles
Inspiratory Muscles
-8 -8
5
5
So the alveolus and the small air ways will expand
Beginning of Inspiration:
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Inspiratory Muscles
Inspiratory Muscles
-8 -8
0 cm H2O
0 cm H2O
-1 cm H2O
Inspiration
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Inspiratory Muscles
Inspiratory Muscles
-8 -8
0 cm H2O
-1 cm H2O
Inspiration
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Inspiratory Muscles
Inspiratory Muscles
-8 -8
0 cm H2O
-1 cm H2O
As the air accumulates inside the alveolus the pressure do not increase because the alveoli stretches and gets bigger
Inspiration
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Inspiratory Muscles
Inspiratory Muscles
-8 -8
0 cm H2O
-1 cm H2O
As the air accumulates inside the alveolus the pressure do not increase because the alveoli stretches and gets bigger
Inspiration
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Inspiratory Muscles
Inspiratory Muscles
-8 -8
0 cm H2O
-1 cm H2O
As the air accumulates inside the alveolus the pressure do not increase because the alveoli stretches and gets bigger
Inspiration
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Inspiratory Muscles
Inspiratory Muscles
-8 -8
0 cm H2O
0cm H2O
As the air accumulates inside the alveolus the pressure do not increase because the alveoli stretches and gets bigger
End of Inspiration
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This stretchibility can be professionally designated as Compliance volume/pressure
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This stretchibility can be professionally designated as Compliance.
Compliance
Lung Recoil
1
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Decreased compliance:
Surfactant
Lung Fibrosis
Pulmonary HTN
Laparoscopic Gas
Lithtomyposition
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This stretchibility can be professionally designated as Compliance.
Compliance
Lung Recoil
Surface Tension & Elastic tissue
1
+
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This stretchibility can be professionally designated as Compliance.
Compliance
Lung Recoil
Surfactant
Surface Tension & Elastic tissue
1
+-
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Decreased compliance:
Surfactant
Lung Fibrosis
Pulmonary HTN
Laparoscopic Gas
Lithtomy position
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Increased compliance:
Emphysema ( elastin)
Asthma ?
Saline
Age
Surface Tension & Elastic tissue
Compliance Lung Recoil
1
+
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Lung 0.1 L / cmH20 Chest
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Inspiratory Muscles
Inspiratory Muscles
-8 -8
0 cm H2O
0cm H2O
When this stretchability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
5
5
End of Inspiration
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Inspiratory Muscles
Inspiratory Muscles
-8 -8
0 cm H2O
0cm H2O
When this stretch ability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
8
8
End of Inspiration
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0 cm H2O
0 cm H2O
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0 cm H2O
0 cm H2O
0 cm H2O
1- cm H2O
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0 cm H2O
0 cm H2O
1 cm H2O
0 cm H2O
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Relaxation
Inspiratory Muscles
RelaxationInspiratory Muscles
-8 -8
0 cm H2O
0cm H2O
When this stretch ability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
8
8
Begining of expiration
![Page 43: The art of breathing](https://reader033.vdocuments.net/reader033/viewer/2022052908/5597133f1a28ab34108b4722/html5/thumbnails/43.jpg)
Relaxation
Inspiratory Muscles
RelaxationInspiratory Muscles
-7 -7
0 cm H2O
0cm H2O
When this stretch ability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
8
8
Begining of expiration
![Page 44: The art of breathing](https://reader033.vdocuments.net/reader033/viewer/2022052908/5597133f1a28ab34108b4722/html5/thumbnails/44.jpg)
Relaxation
Inspiratory Muscles
RelaxationInspiratory Muscles
-6 -6
0 cm H2O
0cm H2O
When this stretch ability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
8
8
Begining of expiration
![Page 45: The art of breathing](https://reader033.vdocuments.net/reader033/viewer/2022052908/5597133f1a28ab34108b4722/html5/thumbnails/45.jpg)
Relaxation
Inspiratory Muscles
RelaxationInspiratory Muscles
-5 -5
0 cm H2O
0cm H2O
When this stretch ability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
8
8
Begining of expiration
![Page 46: The art of breathing](https://reader033.vdocuments.net/reader033/viewer/2022052908/5597133f1a28ab34108b4722/html5/thumbnails/46.jpg)
Relaxation
Inspiratory Muscles
RelaxationInspiratory Muscles
-5 -5
0 cm H2O
0cm H2O
When this stretch ability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
5
5
Begining of expiration
![Page 47: The art of breathing](https://reader033.vdocuments.net/reader033/viewer/2022052908/5597133f1a28ab34108b4722/html5/thumbnails/47.jpg)
Relaxation
Inspiratory Muscles
RelaxationInspiratory Muscles
-5 -5
0 cm H2O
1cm H2O
When this stretch ability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
5
5
Expiration:
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Relaxation
Inspiratory Muscles
RelaxationInspiratory Muscles
-5 -5
0 cm H2O
1 cm H2O
When this stretch ability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
5
5
Expiration:
![Page 49: The art of breathing](https://reader033.vdocuments.net/reader033/viewer/2022052908/5597133f1a28ab34108b4722/html5/thumbnails/49.jpg)
Relaxation
Inspiratory Muscles
RelaxationInspiratory Muscles
-5 -5
0 cm H2O
0cm H2O
When this stretch ability reaches a maximum the inflow of air will eventually increase theintra alveolar pressure to reach zero equilibrating with atmospheric pressure Meanwhile, as the alveoli stretches it increases its recoil force from 5 to 8 cmH2O
5
5
End of Expiration:
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emphysema
5
5
5
5
5
5
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CPAP PEEP
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CPAP PEEP
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Total Ventilation ( Minute Ventilation )
Tidal Volume x Respiratory Rate
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Dead space
Approximately the weight of the patient in Pounds Ex. A 100 pounds patient will have a dead space
of 100 ml
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Alveolar Ventilation:
TV – Dead space x RR
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Thank you
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Lange Pulmonary Physiology
Basics of Anesthesia ( Miller )
Board Review Series
http://emsstaff.buncombecounty.org
http://www.uams.edu
http://www.anaesthetist.com
http://www.ncbi.nlm.nih.gov