1. Minute Respiratory Volume (MRV) Definition: it is total volume of new air that enters respiratory passages per minute Formula: Minute Resp. Volume= V T x Resp. rate Value: 500x12= 6000ml/min or 6L/min

2. Alveolar Ventilation Definition :The rate at which new air reaches alveoli and other gas exchange areas is called alveolar ventilation Alveolar ventilation per minute is Rate of alveolar ventilation Formula: V A =Freq× (V T - V D ) V A is the volume of alveolar ventilation per minute Freq. is the frequency of respiration per minute V T is the tidal volume V D is the physiologic dead space volume Calculation: V A = 12 × (500 - 150) V A = 12 × (350) V A = 4200 ml/ min

5. LUNG COMPLIANCE Expansibility of lungs per unit increase in Trans pulmonary pressure It is determined by elastic forces Formula: ∆V ____________ ∆P Combined compliance of thorax and lungs is 110ml/cm of H 2 O Compliance of lung alone = Average 200ml/cmH 2 O ELASTANCE: It is reciprocal of compliance. i.e. ∆P/∆V

6. Elastic forces of the lungs. (1) recoil forces of the lung’ elastic tissue (1/3 of total forces) (2) forces caused by surface tension of the fluid that lines the inside walls of the alveoli and other lung air spaces (2/3 of total forces). LUNG COMPLIANCE (Cont..)

7. Compliance diagram of lungs

8. Compliance diagram of saline filled lungs

11. High Compliance – – Emphysema, – old age. Decreased Compliance :It means lungs are difficult to expand. – Pulmonary edema, – fibrosis – pneumothorax, – scaring of lungs in T.B. – thickening of pleura, – absence of surfactant in new born

12. Work of Breathing Inspiration - active process, so work is done Energy consumed (work done) during inspiration – 3- 5% of total energy used by body During exertion - ↑ ventilation – both inspiration and expiration – active, energy utilized upto 50 times more than at rest

13. TYPES OF WORK OF BREATHING 1. COMPLAINCE WORK OR ELASTIC WORK (65%): that required to expand the lungs against the lung and chest elastic forces 1.Lung elastic tissue---1/3 2.Surface tension in alveloi---2/3 It increases in RDS. 2. AIRWAY RESISTANCE WORK (28%): – that required to overcome airway resistance to movement of air into the lungs. – Medium and large sized airways offer most of the airway resistance not terminal bronchioles. – It is increased in asthma and COPD. 3. TISSUE RESISTANCE WORK (7%): – that required to overcome the viscosity of the lung and chest wall structures – It is increased in restrictive lung diseases

14. Surfactant Lipoprotein mixture in thin fluid layer on the interior of alveoli Secreted by alveolar type II cells Surface tension inversely proportional to concentration of surfactant Functions of surfactant: – Prevents collapse of lungs – Stabilize size of alveoli – Surfactant increases lung compliance. – Surfactant helps to keep lungs expanded. – Surfactant also helps to keep the alveoli dry and prevent development of pulmonary edema.

15. Surfactant Composed of Surfactant apoproteins, Phospholipids e.g. Dipalmityollecithin Calcium ions During inspiration water molecules move apart & expiration close to each other

16. Law of LaPlace Pressure = 2×Surface tension __________ Radius of alveolus

17. respiratory distress syndrome (RDS) During intrauterine life surfactant formation begins at 30 th week and it can be detected in amniotic fluid. Pre-mature infants do not produce enough surfactant the pressure of -20 to -30 mm of Hg will be required to keep the lungs expanded Amnicentisis can be performed and in that fluid we can estimate the surfactant concentration. Surfactant secretion is stimulated by: – glucoorticoids, – epinephrine, – thyroxine Deficiency occurs in: – premature babies, – babies of hypothyroid, – diabetic mothers. – Smoking decreases surfactant.