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Learningobjectives
Ventilation(forcedexpiration, lungvolumes) Respiratorymusclestrength ThealveolararterialPO2 difference Diffusion,bloodflow, V/Qrelationships Blood Bl dgasesand dpH H Mechanicsofbreathing Controlofventilation

Lungvolumes
1.Staticlungvolumes

2. Dynamic lung volumes

Forcedexpiratoryvolume(FEV) forcedvital capacity (FVC) Forcedmidexpiratoryflowbetween25and75%ofthe FVC(FEF2575%)ormaximalmidexpiratoryflowrate

(IRV)

(IC) (VC) (TLC)

(ERV) (RV)

(FRC)

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Maximalvoluntaryventilation(MVV)or Maximalbreathingcapacity(MBC)
VT 1/2 VC, RR ~ 40-70 /min (12/15 sec)

Flowvolumecurve

Elasticrecoil, Strengthofexpiratorym. Raw

PEF

Predicted equation
() () FEV1 FVC MVV () () () () () () H= ( )

VC

= = = = = = = =

0.148H 0.025A 4.241 0.115H 0.024A 2.852 0.092H 0.032A 1.26 0.089H 0.025A 1.932 0.148H 0.025A 4.241 0.115H 0.024A 2.852 3.39H 1.26A 21.4 0.77A+138

A= ( )

MiniWrightpeakflowmeter

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What Can A PFT Be Used For ?

Respiratorymusclestrength
1. Maximal inspiratory pressure (Pimax) maximal inspiration

: Pulmonary function abnormalities can be grouped into two main categories 1. Obstructive lung disease narrowing of the airways due to bronchial smooth muscle contraction as is the case in asthma narrowing of the airways due to inflammation and swelling of bronchial mucosa and the hypertrophy and hyperplasia of bronchial glands as is the case in bronchitis

FRC or RV

(PimaxFRC, PimaxRV) Pimax (abnormal of inspiratory m.) Pimax (airflow obstruction) 2. Maximal expiratory pressure (PE max) maximal expiration

TLC

R = P/V

R = 8l r4

external compression of the airways by tumors and trauma destruction of lung tissue with the loss of elasticity and hence the loss of the external support of the airways as is the case in emphysema

+90

+50

Compliance Elastic recoil Radial traction

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Inequality of ventilation
2. Restrictive lung disease
"Restriction" Restriction in lung disorders always means a decrease in lung volumes compliance , Raw Pulmonary fibrosis,tuberculosis, pnuemonectomy Scoliosis, kyphosis, sarcoidosis Pneumothorax, pleural effusion (Ppl )
Single breath multiple breath methods

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Inequalityofventilationperfusionratio
Shunt-like effect

R constant

No VA/Q mismatch (ideal)

- Alveolar-arterial O2 difference [DO2(A-a)] : PAO2-PaO2 ; normal value 5-15 mmHg Alveolar gas equation

PAO2 =

PIO2 - PACO2 R

DO2 (A-a)

Alveolar dead space

- [DO2(A-a)] (A a)] > 15 mmHg mismatch, : VA/Q : diffusion impairment, : shunt

Hypoxemia : Hypoventilation : low PIO2 : Diffusion impairment [Vgas = AD(P1-P2)/T] : Shunt : Ventilation-perfusion inequality Hypercapnia : Hypoventilation P CO2 = 863xVCO PaCO 863 VCO 2 VA : Ventilation-perfusion inequality

BloodgasesandpH ABG;pH=7.4+ 0.04,PaCO2 =3545mmHg, PaO2 =80100mmHg,HCO3 =24+2mmol/l

PaO2 (mmHg) = 109 [0.43 x Age (yr)] Normal value PaO2 8 mmHg

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ABG
1. pHa : pHa < 7.36 pHa > 7.44 :p acidosis alkalosis respiratory acidosis respiratory alkalosis metabolic acidosis metabolic alkalosis

1. Respiratory alkalosis Acute

PaCO2

[HCO3-]

2 mEq/L &

2. PaCO2 ventilation function : >45 & pHa < 7.36 : <35 & pHa > 7.44 : <22 & pHa < 7.36 7 36 : >26 & pHa > 7.44

pH H 0.08 0 08 PaCO P CO2

Chronic

3. HCO3- metabolic function

10 . [HCO3-] 4 mEq/L & pH 0.08 PaCO2 10 .

2. Respiratory acidosis A Acute

PaCO2
1 mEq/L & PaCO2 10 . [HCO3-] 4 mEq/L & pH 0.03 PaCO2 10 .
[HCO3-] pH 0.08

4. PaO2 & SaO2 oxygenation

Chronic

pHa
- Uncompensated respiratory acidosis

PaCO2

HCO3

3. Metabolic alkolosis

HCO3-

0.7 . HCO3- mEq/L

PaCO2

- Uncompensated respiratory alkalosis - Uncompensated metabolic acidosis - Uncompensated metabolic alkalosis - Partially compensated respiratory acidosis - Partially compensated respiratory alkalosis - Partially compensated metabolic acidosis - Partially compensated metabolic alkalosis - Respiratory and metabolic acidosis - Respiratory and metabolic alkalosis

4. Metabolic acidosis

HCO3- PaCO2 1.3 1 3 .

HCO3- 1 mEq/L

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Lung compliance
TLC spirometer 500. esophageal p.

Airway resistance
Body plethysmograph
Boyles law (P1V1 = P2V2, )

Pbox x Pmouth (= Palv) V Pbox

Palv = V

Raw

Closing volume
Single breath N2 washout :Maximal inspiration with 100%O2

closing capacity = closing volume + RV

1 = Dead space 2 = Dead space & 3 = 4 =

= airway closure