Pressure Relationships in the

Thoracic Cavity

Intrapulmonary pressure
is the pressure in the
alveoli, which rises and
falls during respiration,
but always eventually
equalizes with
atmospheric pressure.

Intrapleural pressure is
the pressure in the
pleural cavity. It also
rises and falls during
respiration, but is always
about 4mm Hg less than
intrapulmonary pressure.

Relationships

Transpulmonary pressure (Palv Pip) keeps the airspaces of

the lungs open.

The negative pressure of the intrapleural space and the

tight coupling of the lungs to the thoracic walls is extremely
important.

If intrapleural pressure is equalized with intrapulmonary or

atmospheric pressure, lung collapse will occur immediately

Atelectasis (lung collapse) commonly occurs when air enters

the pleural cavity through a chest wound; it can also result
from ruptured visceral pleura (usually due to pneumonia)
allowing air to enter the pleural cavity from the respiratory
tract
Pneumothorax (air in the intrapleural space) is reversed by
closing the hole and drawing air out of the intrapleural space
with chest tubes, allowing lungs to reinflate and resume
normal function.

Pulmonary Ventilation

Mechanical process causing gas flow into and out of the

lungs according to volume changes in the thoracic cavity.
(A.K.A. Breathing)

Consists of two phases:

Important physics rule to remember for breathing

mechanics:

Inspiration: period of time when air flows into the lungs

Expiration: period of time when gases exit the lungs

Volume changes lead to pressure changes

Pressure changes lead to flow of gases to equalize pressure

Boyles Law: (when temp constant) P1V1 = P2V2

At a constant temperare, pressure varies inversely with

volume
P = pressure in mm Hg
V = volume in cubic mm

Pressure Relationships During

Pulmonary Ventilation

Gases, like liquids,

conform to the shape of
their container

Unlike liquids, gases

always fill their container

In a large volume, the

gas molecules will be far
apart and the pressure
will be low

If the volume is reduced,

the gas molecules will be
compressed and the
pressure will rise

Inspiration

Diaphragm and intercostals muscles contract

Diaphragm moves inferiorly and flattens during

contraction, causing height of thoracic cavity to increase

Intercostals contraction lifts the ribcage and thrusts

sternum forward, increasing anterioposterior and lateral
dimensions (circumference)

Lungs adhere tightly to the thorax walls (due to surface

tension of fluid between pleural membranes), they are
stretched to the new, larger size of the thorax.

As intrapulmonary volume increases, gases with in the lungs

spread out to fill the larger space.

Resulting decrease in the gas pressure in the lungs produces

a partial vacuum (pressure less than atmospheric pressure),
which sucks the air into the lungs.

Expiration

Passive process that depends mostly on natural elasticity of

the lungs than on muscle contraction.

As inspiratory muscles relax and resume normal resting

length, rib cage descends and lungs recoil.

As the thoracic and pulmonary volume to decrease, gases

inside the lungs are forced closer together and intrapulmonary
pressure rises to above atmospheric pressure.

This causes gases to flow out to equalize pressure inside and

outside of the lungs.

Normally this is a passive process, but if passageways are

narrowed due to spasms of bronchioles (asthma) or clogged
with mucus/fluid (bronchitis/pneumonia), it becomes an active
process, using intercostal muscles to help depress rib cage
and abdominal muscles to help squeeze air out of lungs.

Events of Inspiration

Steps of Expiration

Ventilation:
Airway Resistance

Friction in the respiratory passageways is the major non-elastic

source of resistance to gas flow
F = P/R

Gas flow in/out of the alveoli is directly proportional to the

difference in pressure between the atmosphere and the alveoli,
normally small changes in pressure cause large changes in
volume of gas flow (gradient ~2mmHg less, moves 500mL air
in/out per breath)

Gas flow inversely changes with resistance, which is

mainly determined by conducting tube diameter.
Resistance is usually insignificant because relatively speaking
they are huge at the initial part of the conducting zone and as the
diameter gets small diffusion takes over. Greatest resistance is in
the bronchi.

Inhaled irritants & inflammatory chemicals can cause constriction

of the bronchioles and reduce air passage, accumulation of
mucus or infectious material can also increase resistance

Ventilation:
Alveolar Surface Tension Forces

At a liquid-gas boundary, the molecules of liquid are more

strongly attracted to each other than to the gas.

This produces a surface tension at the liquid surface that draws

the liquid molecules even closer and reduces contact with gas
molecules and resists any force that tends to increase the area of
the surface.

The liquid film that coats the alveolar walls is always acting to
reduce the alveoli to their smallest size.

This film contains surfactant (as opposed to being pure water) to

reduce surface tension. When too little surfactant is present, the
excess surface tension can collapse the alveoli requiring
complete reinflation with each breath, requiring tremendous
energy
(IRDS infant respiratory distress syndrome)

Ventilation:
Lung Compliance

Healthy lungs are distensible (stretchy). The ease with which

they can be expanded is called lung compliance. CL

CL is a measure of the change of lung volume (VL) that occurs

with a given change in transpulmonary pressure ([Palv Pip)

Meaning, the higher the lung compliance, the easier it is to

expand the lungs at any transpulmonary pressure.

The two factors that determine lung compliance are distensibility

of lung tissue and the surrounding thoracic cage, and surface
tension in the alveoli (contributes to elastic recoil).

Excessive compliance indicates a loss of elastic recoil of the

lungs, as in old age or emphysema. Decreased compliance
means that a greater change in pressure is needed for a given
change in volume, as in atelectasis, edema, fibrosis, pneumonia,
or absence of surfactant.

Respiratory Adjustments:
Exercise

Ventilation can increase 10-20x during exercise

Breathing becomes deeper and more vigorous

(Hyperpnea), but respiratory rate may not be
significantly changed.

Any respiratory changes meet metablolic

demands so O2/CO2 levels in the blood are not
altered.

Change in breathing is prompted by rising CO 2

and declining O2, which causes drop in blood
pH.

Respiratory Adjustments: High

Altitude

At elevation above 8000ft, air density and

oxygen pressure are lower, which may cause
symptoms of acute mountain sickness (AMS)

Respiratory and hematopoietic adjustments

occur called acclimiatization.

Chemoreceptors become more responsive to

increases in CO2/decreases in O2, resulting in
increased ventilation.

Within a few days, respiratory volume stabilizes

at a level 2-3 L/min higher than at sea level.