the diffusion of pulmonary gases - lane community … · the diffusion of pulmonary gases. ......
TRANSCRIPT
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CHAPTER 3
The Diffusion of
Pulmonary Gases
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Gas Laws
• Ideal Gas Law
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Ideal Gas Law
• Where P is pressure, V is volume, and
T is temperature on the Kelvin scale
• N is the number of moles of gas
molecules present
• R is the gas constant
– Fixed value of 0.02821
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Ideal Gas Law
• If nR remains constant, then:
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Boyle’s Law: P1 x V1 = P2 x V2
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• If an air-tight container with a volume of
200 mL and a pressure or 10 cm H2O,
has its volume reduced by 100 mL, the
new pressure will be:
Boyle’s Law: P1 x V1 = P2 x V2
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Charles’ Law
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Charles’ Law
• If the temperature of the gas in a 3-liter
balloon is increased from 250 K° to
300 K°, the resulting volume of the
balloon would be:
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Gay Lussac’s Law
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Gay Lussac’s Law
• If the temperature of the gas in a closed
container, having a pressure of 50 cm
H2O, is increased from 275 K° to 375 K°,
the resulting pressure would be:
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Dalton’s Law
Figure 3-1. Dalton’s law.
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Partial Pressures of Atmosphere Pressure
• Barometric pressure
– The force of atmospheric gases surrounding
the earth exert this force on the earth’s
surface
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Gases that Compose the Barometric Pressure
Table 3-1
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Percent of Atmosphere and Partial Pressure Relationship
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Partial Pressure of Oxygen and Carbon Dioxide
• Partial pressure (mm Hg) of gases in the
air, alveoli, and blood
Gas Dry Alveolar Arterial Venous
Air Gas Blood Blood
PO2 159 100 95 40
PCO2 0.2 40 40 46
PH2O† 0.0 47 47 47
PN2* 600 573 573 573
Total 760 760 755 706
† water vapor
* and other gases in minute quantities
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Partial Pressure of Oxygen and Carbon Dioxide
• In Table 3-2, why is PO2 in the
atmosphere (159) so much higher
than the PO2 in the alveoli (100)?
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Water Vapor Pressure
• Water can exist as a liquid, gas, or solid
• Water in gaseous form is called water
vapor, or molecular water
• Alveolar gas is assumed to have an
absolute humidity of 44 mg/L, and a
water vapor pressure of 47 mm Hg
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Relationship Between Temperature, Absolute Humidity,
and Water Vapor Pressure
Table 3-3
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Ideal Alveolar Gas Equation
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Ideal Alveolar Gas Equation
• If a patient is receiving an FIO2 of .40 on
a day when the barometric pressure is
755 mm Hg
• And if the PaCO2 is 55
– Then the patient’s alveolar oxygen tension is:
(next slide)
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Ideal Alveolar Gas Equation
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Ideal Alveolar Gas Equation
• Clinically, when the PaCO2 is less than
60 mm Hg
• And when the patient is receiving oxygen
– The following simplified equation may
be used:
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Diffusion of Pulmonary Gases
Figure 3-2. The major
barriers of the alveolar-
capillary membrane through
which a gas molecule must
diffuse.
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Oxygen and Carbon Dioxide Diffusion Across Alveolar-Capillary Membrane
Figure 3-3. Normal gas
pressure for O2 and CO2 as
blood moves through the
alveolar capillary membrane.
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Diffusion Across Alveolar-Capillary Membrane Under Normal Conditions
Figure 3-4. Under normal
resting conditions, blood
moves through the alveolar
capillary membrane in about
0.75 seconds.
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Diffusion Across Alveolar-Capillary Membrane During Exercise
Figure 3-5. During exercise
or stress, the total transit time
for blood through the alveolar
capillary membrane is less
than normal.
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Diffusion Across Alveolar-Capillary Membrane with Alveolar Thickening
Figure 3-6. When the rate
of diffusion is decreased
because of alveolar
thickening, oxygen
equilibrium will likely
not occur.
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Gas Diffusion
• Fick’s Law
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Fick’s Law
Figure 3-7. Fick’s law.
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Henry’s Law
• Amount of a gas that dissolves in a liquid
at a given temperature is proportional to
the partial pressure of the gas.
• Amount that can be dissolved is known
as the gas’s:
– Solubility coefficient
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Henry’s Law
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Graham’s Law
• Rate of diffusion of a gas through a
liquid is:
– Directly proportional to the solubility coefficient
of the gas, and
– Inversely proportional to the square root of the
gram-molecular weight (GMW) of the gas
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In Comparing Rates of Diffusion of Oxygen (GMW: 32)
and Carbon Dioxide (GMW: 44)
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Graham’s and Henry’s Laws
• By combining Graham’s and Henry’s
laws, the rates of diffusion of two
gases are:
– Directly proportional to the ratio of their
solubility coefficients, and
– Inversely proportional to the ratio of their
gram-molecular weights
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Graham’s and Henry’s Laws
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Clinical Application of Fick’s Law
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Clinical Application of Fick’s Law
• Area (A) component of the law verified
when:
– Decreased alveolar surface area
• Caused by alveolar collapse or alveolar fluid,
which decreases ability of oxygen to enter the
pulmonary capillary blood
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Clinical Application of Fick’s Law
• P1-P2 portion of the law is confirmed when:
– Decreased alveolar oxygen pressure
(PAO2 or P1)
• Caused by high altitudes or alveolar
hypoventilation, which reduces diffusion
of oxygen into pulmonary capillary blood
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Clinical Application of Fick’s Law
• Thickness (T) factor is confirmed when:
– Increased alveolar tissue thickness caused
by alveolar fibrosis or alveolar edema reduces
movement of oxygen across alveolar-capillary
membranes
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Perfusion-Limited Gas Flow
• Perfusion limited
– Transfer of gas across the alveolar wall is
a function of the amount of blood that flows
past the alveoli.
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Diffusion of N2O
Figure 3-8. Nitrous oxide
(N2O) quickly equilibrates
with pulmonary blood. When
equilibrium occurs, the
diffusion of N2O stops.
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Diffusion-Limited Gas Flow
• Diffusion limited
– Movement of gas across the alveolar wall
is a function of the integrity of the alveolar-
capillary membrane itself
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Carbon Monoxide (CO) and Hemoglobin
Figure 3-9. Carbon
monoxide (CO) rapidly bonds
to hemoglobin and, thus,
does not generate an
appreciable partial pressure
in the plasma.
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Clinical Conditions that Cause Diffusion Problems
Figure 3-10. Clinical
conditions that decrease
the rate of gas diffusion –
diffusion-limited problems.
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Factors that Affect Measured DLCO
Table 3-4
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HOW OXYGEN CAN BE
EITHER PERFUSION OR
DIFFUSION LIMITED
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Diffusion of Oxygen Is Perfusion Limited
Figure 3-11. Under normal
resting conditions, the
diffusion of oxygen is
perfusion limited.
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Clinical Application 1 Discussion
• How did this case illustrate …
• Both the adverse and therapeutic effects
of factors presented in Fick’s law?
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Clinical Application of Fick’s Law
V gas = A. D. (P1 – P2)
T
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Alveoli with Pulmonary Edema
Figure 3-12. Cross-sectional
view of alveoli with pulmonary
edema. Pathology includes
(1) interstitial edema, (2) fluid
engorgement throughout the
alveolar wall interstitium, and
(3) frothy white secretions in
the alveoli.
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Clinical Application 2 Discussion
• How did this case illustrate …
• Both the acute and chronic effects of an
increased alveolar-capillary membrane?