GAS EXCHANGE and TRANSPORT I. Review of Respiration (Fig 16.1) A
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Chapter 22 We Won't Do Much Anatomy Here (Left Column; 22.1-22.3)
Chapter 22 Marieb & Hoehn (2019), p. 8181 We won’t do much anatomy here (left column; 22.1-22.3). Main issues (in lecture and lab): mechanics and measurement of breathing (22.4-22.5), chemoreceptor control of ventilation (22.8), and a few respiratory disorders (22.10). *** Sections 22.6-22.7 were briefly covered in Chapter 17. 1 Ch. 22: Test Question Templates • Q1. If given an appropriate graph of volume of air in lung vs. time, estimate or calculate FEV1/FVC ratio, FVC, residual volume, TLC, tidal volume, and/or minute ventilation. • Example (from Winter 2019 exam): 2 Q1. There are multiple ways to do this. The key is to choose a respiratory rate (breaths per minute) and a tidal volume (milliliters of air per breath) that, when multiplied together, give you 4000 mL air/minute. For example, I can draw a curve to show a tidal volume of 400 mL and a respiratory rate of 10 breaths/minute. Minute ventilation = (tidal volume)*(respiratory rate) = (400 mL air/breath)*(10 breaths/min) = 4000 mL air/min. 2 • Q2. If given two of the three values, calculate the third one: minute ventilation, respiratory rate, and tidal volume. • Example: Lola takes 10 breaths per minute, and her minute ventilation is 6000 mL air per minute. What is her tidal volume? • Q3. If given spirometry data and reference values, determine whether the data are consistent with obstructive pulmonary disease, restrictive pulmonary disease, both, or neither. • Example [from Fall 2019 test]: Rik is put through various pulmonary function tests. At time 0 in the table below, he begins deflating his fully inflated lungs as forcefully and rapidly as he can. -
Human Physiology an Integrated Approach
Gas Exchange and Transport Gas Exchange in the Lungs and Tissues 18 Lower Alveolar P Decreases Oxygen Uptake O2 Diff usion Problems Cause Hypoxia Gas Solubility Aff ects Diff usion Gas Transport in the Blood Hemoglobin Binds to Oxygen Oxygen Binding Obeys the Law of Mass Action Hemoglobin Transports Most Oxygen to the Tissues P Determines Oxygen-Hb Binding O2 Oxygen Binding Is Expressed As a Percentage Several Factors Aff ect Oxygen-Hb Binding Carbon Dioxide Is Transported in Three Ways Regulation of Ventilation Neurons in the Medulla Control Breathing Carbon Dioxide, Oxygen, and pH Infl uence Ventilation Protective Refl exes Guard the Lungs Higher Brain Centers Aff ect Patterns of Ventilation The successful ascent of Everest without supplementary oxygen is one of the great sagas of the 20th century. — John B. West, Climbing with O’s , NOVA Online (www.pbs.org) Background Basics Exchange epithelia pH and buff ers Law of mass action Cerebrospinal fl uid Simple diff usion Autonomic and somatic motor neurons Structure of the brain stem Red blood cells and Giant liposomes hemoglobin of pulmonary Blood-brain barrier surfactant (40X) From Chapter 18 of Human Physiology: An Integrated Approach, Sixth Edition. Dee Unglaub Silverthorn. Copyright © 2013 by Pearson Education, Inc. All rights reserved. 633 Gas Exchange and Transport he book Into Thin Air by Jon Krakauer chronicles an ill- RUNNING PROBLEM fated trek to the top of Mt. Everest. To reach the summit of Mt. Everest, climbers must pass through the “death zone” T High Altitude located at about 8000 meters (over 26,000 ft ). Of the thousands of people who have attempted the summit, only about 2000 have been In 1981 a group of 20 physiologists, physicians, and successful, and more than 185 have died. -
The Oxyhaemoglobin Dissociation Curve in Critical Illness
Basic sciences review The Oxyhaemoglobin Dissociation Curve in Critical Illness T. J. MORGAN Intensive Care Facility, Division of Anaesthesiology and Intensive Care, Royal Brisbane Hospital, Brisbane, QUEENSLAND ABSTRACT Objective: To review the status of haemoglobin-oxygen affinity in critical illness and investigate the potential to improve gas exchange, tissue oxygenation and outcome by manipulations of the oxyhaemoglobin dissociation curve. Data sources: Articles and published peer-review abstracts. Summary of review: The P50 of a species is determined by natural selection according to animal size, tissue metabolic requirements and ambient oxygen tension. In right to left shunting mathematical modeling indicates that an increased P50 defends capillary oxygenation, the one exception being sustained hypercapnia. Increasing the P50 should also be protective in tissue ischaemia, and this is supported by modeling and experimental evidence. Most studies of critically ill patients have indicated reduced 2,3-DPG concentrations. This is probably due to acidaemia, and the in vivo P50 is likely to be normal despite low 2,3-DPG levels. It may soon be possible to achieve significant P50 elevations without potentially harmful manipulations of acid-base balance or hazardous drug therapy. Conclusions: Despite encouraging theoretical and experimental data, it is not known whether manipulations of the P50 in critical illness can improve gas exchange and tissue oxygenation or improve outcome. The status of the P50 may warrant more routine quantification and consideration along with the traditional determinants of tissue oxygen availability. (Critical Care and Resuscitation 1999; 1: 93-100) Key words: Critical illness, haemoglobin-oxygen affinity, ischaemia, P50, tissue oxygenation, shunt In intensive care practice, manipulations to improve in the tissues. -
Pathophysiology of Acid Base Balance: the Theory Practice Relationship
Intensive and Critical Care Nursing (2008) 24, 28—40 ORIGINAL ARTICLE Pathophysiology of acid base balance: The theory practice relationship Sharon L. Edwards ∗ Buckinghamshire Chilterns University College, Chalfont Campus, Newland Park, Gorelands Lane, Chalfont St. Giles, Buckinghamshire HP8 4AD, United Kingdom Accepted 13 May 2007 KEYWORDS Summary There are many disorders/diseases that lead to changes in acid base Acid base balance; balance. These conditions are not rare or uncommon in clinical practice, but every- Arterial blood gases; day occurrences on the ward or in critical care. Conditions such as asthma, chronic Acidosis; obstructive pulmonary disease (bronchitis or emphasaemia), diabetic ketoacidosis, Alkalosis renal disease or failure, any type of shock (sepsis, anaphylaxsis, neurogenic, cardio- genic, hypovolaemia), stress or anxiety which can lead to hyperventilation, and some drugs (sedatives, opoids) leading to reduced ventilation. In addition, some symptoms of disease can cause vomiting and diarrhoea, which effects acid base balance. It is imperative that critical care nurses are aware of changes that occur in relation to altered physiology, leading to an understanding of the changes in patients’ condition that are observed, and why the administration of some immediate therapies such as oxygen is imperative. © 2007 Elsevier Ltd. All rights reserved. Introduction the essential concepts of acid base physiology is necessary so that quick and correct diagnosis can The implications for practice with regards to be determined and appropriate treatment imple- acid base physiology are separated into respi- mented. ratory acidosis and alkalosis, metabolic acidosis The homeostatic imbalances of acid base are and alkalosis, observed in patients with differing examined as the body attempts to maintain pH bal- aetiologies. -
CHEM 301 Assignment #3
CHEM 301 Assignment #3 Provide solutions to the following questions in a neat and well organized manner. Clearly state assumptions and reference sources for any constants used. Due date: November 18th 1. Methane and carbon dioxide are produced under anaerobic conditions by the fermentation of organic matter, approximated by the following equation 2 {CH2O} CH4 + CO2 As gas bubbles are evolved at the sediment interface at 5 m depth and remain in contact with water at the sediment surface long enough so that equilibrium is attained. The total pressure at this depth is 148 kPa. If the pH is 8.20, calculate the total carbonate concentration in the interstitial water at 25oC. How would you expect your answer to change if these gas bubbles were present at 500 m depth? Strategy: The total pressure inside the gas bubble must be equal to the total pressure on the outside of the gas bubble (or else it would either explode or collapse). Furthermore, the total pressure inside that gas bubble is equal to the sum of the partial pressures of CH4 and CO2. We can then use the partial pressure of CO2 inside the gas bubble and the corresponding Henry’s law constant to calculate the concentration of aqueous CO2 at equilibrium. Given the pH of the solution and the expressions for Ka1 and Ka2, we can determine the concentration of HCO3- and 2- CO3 . (see textbook pgs 241-242; Chap 11, Q9) Solution: The total carbonate concentration is given by; 2- - 2- [CO3 ]T = [CO2(aq)] + [HCO3 ] + [CO3 ] From the pH speciation diagram (Fig. -
Arterial Blood Gases: Acid-Base Balance
EDUCATIONAL COMMENTARY – ARTERIAL BLOOD GASES: ACID-BASE BALANCE Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE credits click on Earn CE Credits under Continuing Education on the left side of the screen. **Florida licensees, please note: This exercise will appear in CE Broker under the specialty of Blood Gas Analysis. LEARNING OUTCOMES On completion of this exercise, the participant should be able to • identify the important buffering systems in the human body. • explain the Henderson-Hasselbalch equation and its relationship to the bicarbonate/carbonic acid buffer system. • explain the different acid-base disorders, causes associated with them, and compensatory measures. • evaluate acid-base status using patient pH and pCO2 and bicarbonate levels. Introduction Arterial blood gas values are an important tool for assessing oxygenation and ventilation, evaluating acid- base status, and monitoring the effectiveness of therapy. The human body produces a daily net excess of acid through normal metabolic processes: cellular metabolism produces carbonic, sulfuric, and phosphoric acids. Under normal conditions, the body buffers accumulated hydrogen ions (H+) through a variety of buffering systems, the respiratory center, and kidneys to maintain a plasma pH of between 7.35 and 7.45. This tight maintenance of blood pH is essential: even slight changes in pH can alter the functioning of enzymes, the cellular uptake and use of metabolites, and the uptake and release of oxygen. Although diagnoses are made by physicians, laboratory professionals must be able to interpret arterial blood gas values to judge the validity of the laboratory results they report. -
Relationship Between PCO 2 and Unfavorable Outcome in Infants With
nature publishing group Articles Clinical Investigation Relationship between PCO2 and unfavorable outcome in infants with moderate-to-severe hypoxic ischemic encephalopathy Krithika Lingappan1, Jeffrey R. Kaiser2, Chandra Srinivasan3, Alistair J. Gunn4; on behalf of the CoolCap Study Group BACKGROUND: Abnormal PCO2 is common in infants with term infants with HIE, both minimum and cumulative expo- hypoxic ischemic encephalopathy (HIE). The objective was to sure to hypocapnia in the first 12 h of the trial were associated determine whether hypocapnia was independently associated with death or adverse neurodevelopmental outcome (13). The with unfavorable outcome (death or severe neurodevelopmen- dose–response relationship between PCO2 and outcome for tal disability at 18 mo) in infants with moderate-to-severe HIE. infants with moderate-to-severe HIE is unknown. METHODS: This was a post hoc analysis of the CoolCap Study The risk of developing hypocapnia or hypercapnia may be in which infants were randomized to head cooling or standard affected by severity of brain injury, intensity and duration of care. Blood gases were measured at prespecified times after newborn resuscitation, timing after the primary injury, and/or randomization. PCO2 and follow-up data were available for 196 response to metabolic acidosis. Thus, in this secondary analy- of 234 infants. Analyses were performed to investigate the rela- sis of the CoolCap Study (14), we sought to confirm the obser- tionship between hypocapnia in the first 72 h after randomiza- vation that -
The Basics of Ventilator Management Overview How We Breath
3/23/2019 The Basics of Ventilator Management What are we really trying to do here Peter Lutz, MD Pulmonary and Critical Care Medicine Pulmonary Associates, Mobile, Al Overview • Approach to the physiology of the lung and physiological goals of mechanical Ventilation • Different Modes of Mechanical Ventilation and when they are indicated • Ventilator complications • Ventilator Weaning • Some basic trouble shooting How we breath http://people.eku.edu/ritchisong/301notes6.htm 1 3/23/2019 How a Mechanical Ventilator works • The First Ventilator- the Iron Lung – Worked by creating negative atmospheric pressure around the lung, simulating the negative pressure of inspiration How a Mechanical Ventilator works • The Modern Ventilator – The invention of the demand oxygen valve for WWII pilots if the basis for the modern ventilator https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcRI5v-veZULMbt92bfDmUUW32SrC6ywX1vSzY1xr40aHMdsCVyg6g How a Mechanical Ventilator works • The Modern Ventilator – How it works Inspiratory Limb Flow Sensor Ventilator Pressure Sensor Expiratory Limb 2 3/23/2019 So what are the goals of Mechanical Ventilation • What are we trying to control – Oxygenation • Amount of oxygen we are getting into the blood – Ventilation • The movement of air into and out of the lungs, mainly effects the pH and level of CO 2 in the blood stream Lab Oxygenation Ventilation Pulse Ox Saturation >88-90% Arterial Blood Gas(ABG) Po 2(75-100 mmHg) pCO 2(40mmHg) pH(~7.4) Oxygenation How do we effect Oxygenation • Fraction of Inspired Oxygen (FIO 2) – Percentage of the gas mixture given to the patient that is Oxygen • Room air is 21% • On the vent ranges from 30-100% • So if the patient’s blood oxygen levels are low, we can just increase the amount of oxygen we give them 3 3/23/2019 How do we effect Oxygenation • Positive End Expiratory Pressure (PEEP) – positive pressure that will remains in the airways at the end of the respiratory cycle (end of exhalation) that is greater than the atmospheric pressure in mechanically ventilated patients. -
Risk Assessment of Recirculation Systems in Salmonid Hatcheries
Norwegian Scientific Committee for Food Safety (VKM) Doc.no 09/808-Final Risk Assessment of Recirculation Systems in Salmonid Hatcheries Opinion of the Panel on Animal Health and Welfare of the Norwegian Scientific Committee for Food Safety Date: 10.01.12 Doc. no.: 09-808-Final ISBN: 978-82-8259-048-8 VKM Report 2012: 01 1 Norwegian Scientific Committee for Food Safety (VKM) Doc.no 09/808-Final Risk Assessment of Recirculation Systems in Salmonid Hatcheries Brit Hjeltnes (chair of ad hoc group) Grete Bæverfjord Ulf Erikson Stein Mortensen Trond Rosten Peter Østergård 2 Norwegian Scientific Committee for Food Safety (VKM) Doc.no 09/808-Final Contributors Persons working for VKM, either as appointed members of the Committee or as ad hoc experts, do this by virtue of their scientific expertise, not as representatives for their employers. The Civil Services Act instructions on legal competence apply for all work prepared by VKM. Acknowledgements The Norwegian Scientific Committee for Food Safety (Vitenskapskomiteen for mattrygghet, VKM) has appointed an ad hoc group consisting of both VKM members and external experts to answer the request from the Norwegian Food Safety Authority. The members of the ad hoc group are acknowledged for their valuable work on this opinion. The members of the ad hoc group are: VKM members Brit Hjeltnes (Chair), Panel on Animal Health and Welfare Ulf Erikson, Panel on Animal Health and Welfare Stein Mortensen, Panel on Animal Health and Welfare External experts Grete Bæverfjord, Nofima Marin, Sunndalsøra Trond Rosten, SINTEF Fisheries and Aquaculture Peter Østergård, Sp/F Aquamed, Faroe Islands Other contributors to the assessment are Frode Mathisen, Anders Fjellheim and Brit Tørud. -
Pranayama Redefined/ Breathing Less to Live More
Pranayama Redefined: Breathing Less to Live More by Robin Rothenberg, C-IAYT Illustrations by Roy DeLeon ©Essential Yoga Therapy - 2017 ©Essential Yoga Therapy - 2017 REMEMBERING OUR ROOTS “When Prana moves, chitta moves. When prana is without movement, chitta is without movement. By this steadiness of prana, the yogi attains steadiness and should thus restrain the vayu (air).” Hatha Yoga Pradipika Swami Muktabodhananda Chapter 2, Verse 2, pg. 150 “As long as the vayu (air and prana) remains in the body, that is called life. Death is when it leaves the body. Therefore, retain vayu.” Hatha Yoga Pradipika Swami Muktabodhananda Chapter 2, Verse 3, pg. 153 ©Essential Yoga Therapy - 2017 “Pranayama is usually considered to be the practice of controlled inhalation and exhalation combined with retention. However, technically speaking, it is only retention. Inhalation/exhalation are methods of inducing retention. Retention is most important because is allows a longer period for assimilation of prana, just as it allows more time for the exchange of gases in the cells, i.e. oxygen and carbon dioxide.” Hatha Yoga Pradipika Swami Muktabodhananda Chapter 2, Verse 2, pg. 151 ©Essential Yoga Therapy - 2017 Yoga Breathing in the Modern Era • Focus tends to be on lengthening the inhale/exhale • Exhale to induce relaxation (PSNS activation) • Inhale to increase energy (SNS) • Big ujjayi - audible • Nose breathing is emphasized at least with inhale. Some traditions teach mouth breathing on exhale. • Focus on muscular action of chest, ribs, diaphragm, intercostals and abdominal muscles all used actively on inhale and exhale to create the ‘yoga breath.’ • Retention after inhale and exhale used cautiously and to amplify the effect of inhale and exhale • Emphasis with pranayama is on slowing the rate however no discussion on lowering volume. -
Respiratory Physiology
Physiology Unit 4 RESPIRATORY PHYSIOLOGY Respiraon • External respiraon – ven3laon – gas exchange • Internal respiraon – cellular respiraon – gas exchange • Respiratory Cycle – Inspiraon • Moving atmospheric air into the lungs – Expiraon • Moving air out of the lungs Lungs vs. Balloons • A lung is similar to a balloon in that it resists stretch, tending to collapse almost totally unless held inflated by a pressure difference between its inside and outside • Lungs and the chest have elas3c proper3es Lung Compliance • Compliance – Elas3city – Tendency to recoil – Tendency of an elas3c structure to oppose stretching or distor3on * Resists distension • Surface tension * Resists distension - Surfactant • Reduces surface tension • Increases compliance (makes them easier to stretch) Airway Resistance F = ΔP/R • Same variables that affect resistance in blood vessels – Tube length, tube radius, fric3on – Tube radius most important factor • Airway resistance is so small that small pressure differences produce large volumes of air flow – Average atmosphere-to-alveoli pressure difference is 1 mmHg, but 500 mL of air is moved (%dal volume) – Low pressure and low resistance • Pulmonary 1/10th of systemic vascular resistance Ven3laon • Exchange of air between atmosphere and alveoli • Atmospheric air pressure is 760 mmHg at sea level • Air moves by bulk flow – F = ΔP/R – F = (Palv – Patm)/R Boyle’s Law • Boyle’s law = (P/V) • Pressure of a given quan3ty of gas is inversely propor3onal to volume • An increase in the volume of the container (lungs) decreases the pressure of the gas (air) Ven3laon Mechanics • Lung volume depends on: 1. Transpulmonary pressure (Ptp) • Inside to outside of the lung • Ptp = Palv – Pip • The force that keeps the lungs inflated • Transmural pressure – Across the wall 2. -
Department of Internal Medicine, Both to End This Pandemic and to Ensure That Racial Inequities Are Ameliorated, E
DEPARTMENTVitals OF INTERNAL MEDICINE internalmedicineiowa.org Vitals Table of Contents From the chair .....................................................................................................................3 RESEARCH ...........................................................................................................................4 UI nephrologists collaborate on new textbook ......................................................6 Gehlbach, Richerson to investigate carbon dioxide role in SUDEP ................7 Abel to lead one of four AHA research networks .................................................8 Model developed to calculate patient risk for NAFLD decompensation .....9 Clinical trials in cancer at Iowa barely lose a step ..............................................10 EDUCATION .....................................................................................................................12 Grand Rounds expands its reach ..............................................................................14 Residency committees spotlight ...............................................................................16 On the cover OSCE gets national exposure, refines and expands again ..............................18 Microscopic image of a mouse lung expressing human ACE2, the receptor PATIENT CARE ................................................................................................................20 for SARS-CoV2. The blue staining represents the normal mouse lung, UI Hospitals & Clinics provides