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Why do we breathe? Take in O 2 (which we need to make ATP) Get rid of CO 2 (which is a waste product of ATP synthesis). Thought questions What happens to our cells and our bodies if we don’t get enough O 2 , or if CO 2 is made but never removed from the body? - PowerPoint PPT Presentation
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Why do we breathe?
•Take in O2 (which we need to make ATP)
•Get rid of CO2 (which is a waste product of ATP synthesis)
Thought questions
•What happens to our cells and our bodies if we don’t get enough O2, or if CO2 is made but never removed from the body?
•Is the amount we breathe always the same?
•What kinds of things change it?
Partial pressure of a gas (P)
P = F x Patm
F = fraction of the gas in the atmosphere that is that gasPatm: atmospheric pressure
Partial pressure of a gas (P)
P = F x Patm
F = fraction of the gas in the atmosphere that is that gasPatm: atmospheric pressure
Example: partial pressure of O2 in this room•21% of the atmosphere is O2
•Atmospheric pressure in Boston (see level) is 760 mmHg
PO2 = 0.21 x 760 = 160 mmHg
Hypercarbia: PaCO2 greater than set point of 40 mmHg
What determines the PaCO2?
What determines the PaCO2?
Answer: The PACO2
What determines the PACO2?
What determines the PaCO2?
Answer: The PACO2
What determines the PACO2?
Answer: Alveolar ventilation
Time (sec)
0 1 2 3 4 5 6 7
Minute Ventilation = tidal volume (VT) x frequency
Breathing frequency: 1 breath/ 4 sec = 15 breaths/minVT = 0.6 liters
Ch
ange
in v
olu
me
( lit
ers)
0
.2
.4
.6
.8
VT
Is all the air that we take in useful?
A useful model of the lung – balloon on a tube
Tube: airways
Balloon: alveoli
VD = volume
of cylinder
End Expiration Begin Inspiration Mid Inspiration
End Inspiration
VT = total volume of white area
Mid Expiration End Expiration
PANTING: high frequency but low volume breathing
(assume a dead space of 0.1 L)
Breathing at rest:VT = 0.5 Lf = 10 breaths/minVE=5 L/minVA = 4 L/min
Panting:VT = 0.14 Lf = 100 breaths/minVE = 14 L/minVA = 4 L/min
Examples of things that can cause hypoventilation
•drugs (i.e. morphine) that suppress respiratory drive•diseases of the muscles (like myasthenia gravis) •diseases of the nerves•diseases that affect central respiratory drive:
- CCHS (Ondine’s curse).
CCHS
What causes changes in dead space?
1) Breathing through a piece of equipment• Gas mask• Snorkel• Ventilator circuit
2) Loss of blood flow to a ventilated region of lung• pulmonary embolism• Certain lung diseases (emphysema)
What causes changes in dead space?
1) Breathing through a piece of equipment• Gas mask• Snorkel• Ventilator circuit
2) Loss of blood flow to a ventilated region of lung• pulmonary embolism• Certain lung diseases (emphysema)
Jeffrey et al, Am. J. Respir. Crit. Care Med. 2001 164: 28S-38S
EMPHYSEMA
Hypoxemia: PaO2 less than the set point of about 80 mmHg
CAUSES OF HYPOXEMIA
•Hypoventilation•Diffusion Impairment•Shunt•V/Q abnormalities
What determines how fast O2 (or CO2) diffusesacross the alveolar wall?
Diffusion Impairment
.VO2 = K x A x (PAO2 – PaO2)/T
.VO2 = flux of O2 across the lungK = a constantA = surface area of the lungT = thickness of the lung (distance between air and red blood cell)PAO2 and PaO2 = partial pressure for O2 in alveolus and in capillary blood
Jeffrey et al, Am. J. Respir. Crit. Care Med. 2001 164: 28S-38S
EMPHYSEMA
Shunt: blood passes from the right heart to the leftheart without becoming oxygenated
1. Blood goes from the right to the left heart without goingthrough the lungs
• Bronchial circulation• Foramen ovale, ductus arteriosus
2. Blood goes through the lungs but never comes into closecontact with alveolar gas
• Foreign object lodged in an airway• Pneumonia (accumulation of fluid and pus in the alveoli)
How much does a shunt affect PaO2?
Pus and fluid
Air
“Good” lung“Bad” lung
60% of C.O.40% of C.O.
How much does a shunt affect PaO2?
Pus and fluid
Air
“Good” lung“Bad” lung
60% of C.O.40% of C.O.
PO2 = 40 mmHg PO2 = 100 mmHg
How much does a shunt affect PaO2?
Pus and fluid
Air
“Good” lung“Bad” lung
60% of C.O.40% of C.O.
PO2 = 40 mmHgPO2 = 100 mmHg
PO2
In Out40 mmHg 40 mmHg
In Out40 mmHg 100 mmHg
O2 carrying capacity of hemoglobin
1 g Hemoglobin (Hg) can carry 1.34 ml O2 (when fully saturated)
Normal: 15 g Hg/ 100 ml blood x 1.34 = 20 ml O2/100 ml blood = 200 ml O2/L blood
100% x 200 ml O2/L blood x 3L
“Good” lung “Bad” lung
75% x 200 ml O2/L blood x 2L
Assume the cardiac output is 5 L/min: 60% to good lung and 40% to bad lung3 L/min 2 L/min
600 ml O2300 ml O2
Blood mixes inleft atrium
900 ml O2 in 5L blood 180 ml O2/L
(Fully saturated 200 mlO2/L) 90% saturated PaO2 of 60 mmHg
Pressure (cm H2O)
Volume(L)