Physiology of Ventilation

Principles of
Ventilation

Educational Objectives
Define and differentiate between compliance,
elastance, and resistance
List the normal values for the pressures
associated with the act of breathing

Educational Objectives
Describe the distribution of ventilation within
the lung, listing factors that affect how air is
distributed
Describe the normal perfusion of the lung,
listing the factors that affect blood flow
Define ventilation/perfusion ratio

Definitions
Ventilation movement of air between the
atmosphere and the alveoli
Respiration movement of gas molecules
across a membrane

Airflow Into And Out of The Lungs

Intrapulmonary Pressure (Palv)
Pressure at the alveolus; changes from positive
to negative during ventilatory cycle (-5 to +5 cm
H2O)

Airflow Into And Out of The Lungs

Intrapleural pressure (Ppl)

Always negative during normal breathing
(-5 to -10 cm H2O)

Airflow Into And Out of The Lungs

Normal Inspiration
Diaphragm contracts
Intrathoracic volume increases
Intrapleural pressure increases in negativity
Increase in volume causes decrease in
intrapulmonary pressure

Normal Inspiration
Decrease in intrapulmonary pressure creates
negative pressure gradient relative to the
atmospheric pressure
Air flows into the lungs until pressures
equalize

Normal Expiration
Diaphragm relaxes, moving upward
Intrathoracic volume decreases
Intrapleural pressure becomes less negative
Decrease in volume creates increase in
intrapulmonary pressure

Normal Expiration
Increase in intrapulmonary pressure creates
positive pressure gradient relative to the
atmospheric pressure
Air flows out of the lungs until pressures
equalize

Airflow Into And Out of The Lungs

Factors Affecting Lung Volume

Compliance
Elastance (Elasticity)
Resistance
Muscle strength and endurance

Compliance
The ratio of the change in volume to a
given change in pressure
Normal value 100 ml/cm H2O

Types of Compliance
Dynamic

compliance

during normal breathing cycle

Cdyn =

Volume

Peak Inspiratory Pressure

measured

Types of Compliance
Static compliance measured during breathholding procedure
Cplat =

Volume
_
Plateau Pressure

Elastance
The physical tendency of an object to return
to its initial state after deformation
Inverse of compliance

Resistance
Opposition to a force; ratio of pressure
change to flow change
Poiseuilles Law P = 8nlV
r4
R = P1 P 2
Volume

Factors Affecting Muscle Strength

and Endurance
Gender
Age
Training
Position

Factors Affecting Muscle Strength

and Endurance
Underlying cardiac, pulmonary, and muscular
disorders
Electrolyte imbalances
Acid-base disturbances

Factors Affecting Muscle Strength

and Endurance
Endocrine abnormalities (e.g., thyroid
disorders)
Prolonged use of steroids
Neuromuscular blocking drugs

Evaluation of Muscle Strength and

Endurance
Measurement of transdiaphragmatic
pressure
Maximum voluntary ventilation (MVV)

Distribution of Ventilation
Dead Space
Ventilation not involved in gas exchange

Dead Space
Anatomic dead space
Volume of ventilation in conducting airways

Alveolar dead space

Volume of ventilation in alveoli which are under
perfused or not perfused

Dead Space
Physiologic dead space
Sum of anatomic and alveolar dead space

Normal Distribution of Ventilation

(Upright Position)
Pleural pressure lower (more negative) at
apex of lung
Greater transpulmonary pressure at apex

Normal Distribution of Ventilation

(Upright Position)
Alveoli at apex more distended at FRC than
those at base
Alveoli at base receive greater ventilation
(are able to distend further) than the alveoli
at apex

Factors Affecting Distribution of

Ventilation
Increased regional resistance (inflammation)
Localized changes in compliance (blebs)

Distribution of Perfusion
Blood flow determined by difference between
pulmonary vascular pressure and alveolar pressure
At apex, alveolar pressure greater than pulmonary
vascular pressure no blood flow (Zone 1)
At base, pulmonary vascular pressure greater than
alveolar pressure minimal ventilation (Zone 3)

Distribution of Perfusion
Blood flow determined by difference between
pulmonary vascular pressure and alveolar pressure
Between Zones 1 And 3 (Zone 2), blood flow determined
by the difference between pulmonary vascular pressure
and alveolar pressure

Three Lung Zones

Distribution of Perfusion

Lowest resistance to blood flow is at FRC;

resistance increases at either residual volume or
total lung capacity

Ventilation/Perfusion Ratio
Ideally V/Q ratio is 1

Shunt
Perfusion Without Ventilation
V/Q Ratio is 0

Causes of Shunts
Atelectasis
Fluid in the alveolar space
Airway obstruction
Anatomic abnormalities

Modified Shunt Equation

Qs =
(PAO2 PaO2) x 0.003
_
QT (CaO2 CvO2) + (PAO2) x 0.003

Ventilation/Perfusion

Oxygen Uptake and Diffusion

Capacity
Time of transit of RBC through the
pulmonary capillary
At rest 0.75 seconds
During exercise 0.25 seconds

Number of RBCs available

Oxygen Uptake and Diffusion

Capacity
Biochemical characteristics of hemoglobin
(e.g., sickle cell, carbon monoxide, presence
of fetal hemoglobin)
Evaluation done by measuring single breath
carbon monoxide diffusion