Work of Ventilation Flashcards

1
Q

What is Work of breathing?

A
  • Work is required to move the lung and chest wall
  • W = P x ΔV
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What happens during normal, quiet breathing?

A
  • Inspiratory muscles do all the work
  • Expiration is passive
  • Elastic work: 70%
  • Non-elastic work: 30%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What increases oxygen cost in breathing?

2-5% normally, 50L/min

A
  • Exercise
  • Disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is minute volume/ventilation?

L/min

A
  • Respiratory rate per minute x Tidal volume
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is increased with an increase in tidal volume?

A
  • Elastic work
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is increased with an increase with respiratory rate?

A
  • Flow and resistive work

(non-elastic work)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the optimal values of RR and tidal volume?

A
  • RR: 15/min
  • TV: 500ml
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In which lung diseases do you get an increase in elastic resistance?

A
  • Restrictive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

In which lung diseases do you get an increase in airway resistance?

A
  • Obstructive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is Compliance?

A
  • The measure of ease with which the lungs can be stretched or inflated
  • CL = ΔV / ΔP
  • Normal adult lung compliance = 0.1-0.4
  • Total respiratory system compliance < compliance of lung/chest alone
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What causes increased compliance?

A
  • Loss of elastin fibres
  • Emphysema + aging

decreased elastance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What causes decreased compliance?

A
  • Scoliosis, ankylosing spondylitis
  • Pulmonary fibrosis

increased elastance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is elastance?

A
  • Inversely related to compliance
  • elastic recoil force
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What contributes to elastic work?

A
  1. Tissue elasticity: energy needed to deform elastic tissue
  2. Surface tension: minimises SA of alveoli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is surface tension alleviated?

A
  • Surfactant
  • Increases compliance
  • prevents collapse of alveoli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is surfactant?

A
  • 10% surfactant proteins, 90% lipid
  • synthesized by type II pneumocytes
  • stored in lamellar bodies
16
Q

How does the law of Laplace relate to alveolar surface tension?

absence of surfactant*

A
  • pressure in smaller alveoli is higher
  • so air from small alveoli would enter big alveoli
  • causes small alveoli to collapse, however with surfactant this would not happen!
17
Q

What is the surface tension lowering effect of surfactant?

A
  • Surfactant hydrophobic chains face alveolar air
  • Hydrophillic ends face alveolar fluid
  • Works more at low volumes (small alveoli, expiration)
18
Q

How is RDS treated?

A
  • corticosteroids given to mother prior delivery
  • O2 delivery
  • Survanta
19
Q

We know that surfactant prevents alveolar collapse, but what else does?

A
  • Alveoli interdependence
  • surrounding alveoli pull outwards to keep middle alveoli open
20
Q

What is non-elastic work?

A
  • Resistance to air flow
21
Q

What components determine airway resistance?

A
  1. Diameter of airway + distance air must travel
  2. Flow type (laminar vs turbulent)
22
Q

How is airway diameter linked to flow resistance?

A
  • Hagen-Poiseuille Law
  • If airway radius is reduced 50%, resistance increases 16-fold
23
Q

Since a reduced airway radius causes more resistance, how do the bronchioles adapt?

A
  • Large number of bronchioles
  • Compensates, so overall airway widens
  • Tracheal resistance higher than bronchioles

increase in cross-sectional area as you go down respiratory tract

24
How does lung volume affect resistance?
- Increased lung volume → airway expands → less resistance - Decreased lung volume → airways contract → more resistance
25
What are the determinants of airway diameter?
Trachea and bronchi - cartilage rings Small bronchi and bronchioles - no cartilage - smooth muscle tone - radial traction of elastic tissue - small diameter - mucus, thickness of mucosa, submucosa all the factors of small bronchi cause significant disease
26
How is smooth muscle tone controlled extrinsically?
- Catecholamines cause broncodilation, β2-receptors - PNS causes bronchoconstriction via Ach - NANC release dilators like NO and constrictors like neurokinin A | NANC = non adrenergic non-cholinergic
27
How is smooth muscle tone controlled intrinsically?
- Mast cell degranulation → bronchoconstriction - ↓CO2 = bronchconstriction - ↑CO2 = bronchodilation
28
What controls mucus secretions?
- **PNS** - decreased in atropine - increased in bronchitis
29
What type of flow increases air flow resistance?
- Turbulent
30
What is Reynolds number? | flow
- Dimensionless number to determine whether airflow is turbulent or laminar | turbulence occurs if Reynold number > 2000
31
What causes turbulence?
- **High velocities** - **Large diameters** - usually upper airways; Empty nose syndrome | hence no turbulence in bronchioles since both parameters are low
32
What are the sites of airway resistance in the lungs?
- 1/2 total resistance in nose, pharynx, larynx - below larynx 80% in trachea and main bronchi - less than 20% in bronchioles
33
What is Chronic Bronchitis? | COPD
- Excess production of mucous
34
What is emphysema? | COPD
- Loss of elastic tissue - lung elastase inhibited by α1–anti-trypsin - 1/4000 genetic deficiency
35
What is pulmonary fibrosis?
- **Excess fibrous connective tissue** in lungs
36
How are obstructive diseases classified?
- **Increased flow-resistive work** (non-elastic) - Compliance normal, but increased in emphysema - Decreases FEV1/FVC ratio
37
How are restrictive diseases classified?
- **Increased elastic work** - decreased compliance - FEV1/FVC ratio normal or increased