Question

Describe the physical properties of the lungs and how they relate to ventilation. Be sure to explain what elasticity and compliance and relate these physical lung properties to specific aspects of ventilation. Explain they are important

Answer 1

Ventilation, or breathing, is the movement of air through the conducting passages between the atmosphere and the lungs. The air moves through the passages because of pressure gradients that are produced by contraction of the diaphragm and thoracic muscles.

Pulmonary ventilation

Pulmonary ventilation is commonly referred to as breathing. It is the process of air flowing into the lungs during inspiration (inhalation) and out of the lungs during expiration (exhalation). Air flows because of pressure differences between the atmosphere and the gases inside the lungs.

Air, like other gases, flows from a region with higher pressure to a region with lower pressure. Muscular breathing movements and recoil of elastic tissues create the changes in pressure that result in ventilation. Pulmonary ventilation involves three different pressures:

• Atmospheric pressure
• Intraalveolar (intrapulmonary) pressure
• Intrapleural pressure

Atmospheric pressure is the pressure of the air outside the body. Intraalveolar pressure is the pressure inside the alveoli of the lungs. Intrapleural pressure is the pressure within the pleural cavity. These three pressures are responsible for pulmonary ventilation.

Inspiration

Inspiration (inhalation) is the process of taking air into the lungs. It is the active phase of ventilation because it is the result of muscle contraction. During inspiration, the diaphragm contracts and the thoracic cavity increases in volume. This decreases the intraalveolar pressure so that air flows into the lungs. Inspiration draws air into the lungs.

ExpirationExpiration (exhalation) is the process of letting air out of the lungs during the breathing cycle. During expiration, the relaxation of the diaphragm and elastic recoil of tissue decreases the thoracic volume and increases the intraalveolar pressure. Expiration pushes air out of the lungs.

Physical Properties that affect Lung Function are:-

Compliance

Elasticity

Surface Tension

The compliance of a system is defined as the change in volume that occurs per unit change in the pressure of the system. In layman terms, compliance is the ease with which an elastic structure can be stretched. Compliance is, therefore, basically a measurement of the elastic resistance of a system. Pulmonary compliance (C) is the total compliance of both lungs, measuring the extent to which the lungs will expand (change in volume of lungs) for each unit increase in the trans-pulmonary pressure (when enough time is allowed for the system to reach equilibrium) .It is one of the most important concepts underpinning mechanical ventilation used to manage patient respiration in the operating room (OR) or intensive care unit (ICU) environment. To better understand pulmonary compliance, certain terminologies should be briefly reviewed. The following formula is used to calculate compliance:

Lung Compliance (C) = Change in Lung Volume (V) / Change in Transpulmonary Pressure {Alveolar Pressure (Palv) – Pleural Pressure (Ppl)}.

Transpulmonary pressure is the pressure gradient between the inside alveolar pressure and outside pleural pressure. It mainly measures the force of lung elasticity at each point of respiration (recoil pressure). Alveolar pressure is the air pressure inside the alveoli. Pleural pressure is the pressure of the fluid present inside the space between visceral pleura (layer adhered to lungs) and parietal pleura (chest wall lining layer). Normally the total compliance of both lungs in an adult is about 200 ml/ cm H2O. Physicians rely on this concept to understand some pulmonary pathologies and help guide therapy and adjust ventilator pressure and volume settings.

Elastic recoil means the rebound of the lungs after having been stretched by inhalation or rather, the ease with which the lung rebounds. With inhalation, the intrapleural pressure (the pressure within the pleural cavity) of the lungs decreases. Relaxing the diaphragm during expiration allows the lungs to recoil and regain the intrapleural pressure experienced previously at rest. Elastic recoil is inversely related to lung compliance.

This phenomenon occurs because of the elastin in the elastic fibers in the connective tissue of the lungs, and because of the surface tension of the film of fluid that lines the alveoli. As water molecules pull together, they also pull on the alveolar walls causing the alveoli to recoil and become smaller. But two factors prevent the lungs from collapsing: surfactant and the intrapleural pressure. Surfactant is a surface-active lipoprotein complex formed by type II alveolar cells. The proteins and lipids that comprise surfactant have both a hydrophilic region and a hydrophobic region. By absorbing to the air-water interface of alveoli with the hydrophilic head groups in the water and the hydrophobic tails facing towards the air, the main lipid component of surfactant, dipalmitoylphosphatidylcholine, reduces surface tension. It also means the rate of shrinking is more regular because of the stability of surface area caused by surfactant. Pleural pressure is the pressure in the pleural space. When this pressure is lower than the pressure of alveoli they tend to expand. This prevents the elastic fibers and outside pressure from crushing the lungs. It is a homeostatic mechanism.

Surface tension is the force exerted by water molecules on the surface of the lung tissue as those water molecules pull together. Water (H2O) is a highly polar molecule, so it forms strong covalent bonds with other water molecules. The force of these covalent bonds effectively creates an inward force on surfaces, such as lung tissue, with the effect of lowering the surface area of that surface as the tissue is pulled together. As the air inside the lungs is moist, there is considerable surface tension within the tissue of the lungs. Because the alveoli of the lungs are highly elastic, they do not resist surface tension on their own, which allows the force of that surface tension to deflate the alveoli as air is forced out during exhalation by the contraction of the pleural cavity.