Nunn's Applied Respiratory Physiology eBook

 
 
Elsevier (Verlag)
  • 9. Auflage
  • |
  • erschienen am 4. Juni 2020
  • |
  • 456 Seiten
 
E-Book | ePUB mit Adobe-DRM | Systemvoraussetzungen
978-0-7020-7933-7 (ISBN)
 
Nunn's Applied Respiratory Physiology eBook
  • Englisch
  • Philadelphia
  • |
  • Großbritannien
  • 25,05 MB
978-0-7020-7933-7 (9780702079337)
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  • Front Cover
  • Inside Front Cover
  • Fronit matter
  • Nunn and lumb's applied respiratory physiology
  • Copyright
  • Dedication
  • Foreword
  • Preface to the ninth edition
  • Table of Contents
  • Videos table of contents
  • Part I Basic Principles
  • 1 Functional anatomy of the respiratory tract
  • Keywords:
  • Key points
  • Mouth, nose and pharynx
  • The larynx
  • Speech
  • Effort closure
  • The tracheobronchial tree
  • Trachea (generation 0)
  • Main, lobar and segmental bronchi (generations 1-4)
  • Small bronchi (generations 5-11)
  • Bronchioles (generations 12-14)
  • Respiratory bronchioles (generations 15-18)
  • Alveolar ducts (generations 19-22)
  • Alveolar sacs (generation 23)
  • Pulmonary acinus
  • Respiratory epithelium
  • Ciliated epithelial cells5
  • Goblet cells
  • Airway glands6
  • Basal cells
  • Mast cells
  • Club cells (formerly clara cells)
  • Neuroepithelial cells
  • The alveoli
  • The alveolar septa
  • The fibre scaffold¹¹
  • Alveolar cell types
  • Capillary endothelial cells
  • Alveolar epithelial cells: Type I¹5
  • Alveolar epithelial cells: Type II
  • Alveolar macrophages
  • The pulmonary vasculature
  • Pulmonary arteries
  • Pulmonary arterioles
  • Pulmonary capillaries
  • Pulmonary venules and veins
  • Bronchial circulation²²
  • Pulmonary lymphatics
  • References
  • 2 Elastic forces and lung volumes
  • Keywords:
  • Key points
  • Elastic recoil of the lungs¹
  • The nature of the forces causing recoil of the lung
  • The alveolar surfactant
  • Synthesis of surfactant
  • Action of surfactant
  • Other effects of surfactant
  • Alternative models to explain lung recoil
  • Transmural pressure gradient and intrathoracic pressure
  • Time dependence of pulmonary elastic behaviour
  • Hysteresis
  • Causes of time dependence of pulmonary elastic behaviour
  • Factors affecting lung compliance
  • Elastic recoil of the thoracic cage
  • Factors influencing compliance of the thoracic cage
  • Pressure-volume relationships of the lung plus thoracic cage
  • Relationship between alveolar, intrathoracic and ambient pressures
  • Static lung volumes
  • Factors affecting static lung volumes
  • Functional residual capacity in relation to closing capacity
  • Principles of measurement of compliance
  • Static compliance
  • Dynamic compliance
  • Automated measurement of compliance
  • Principles of measurement of static lung volumes
  • Measurement of functional residual capacity
  • References
  • 3 Respiratory system resistance
  • Keywords:
  • Key points
  • Physical principles of gas flow and resistance
  • Laminar flow
  • Quantitative relationships
  • Turbulent flow
  • Quantitative relationships
  • Reynolds number
  • Respiratory system resistance
  • Airway resistance
  • Tissue resistance
  • Inertance as a component of respiratory system resistance
  • Factors affecting respiratory resistance
  • Volume-related airway collapse
  • Effect of lung volume on resistance to breathing
  • Gas trapping
  • Closing capacity4'5
  • Flow-related airway collapse
  • Muscular control of airway diameter
  • Neural pathways7
  • Parasympathetic system9
  • Sympathetic system
  • Noncholinergic parasympathetic nerves7
  • Humoral control
  • Physical and chemical effects
  • Local cellular mechanisms
  • Drug effects on airway smooth muscle
  • ß²-agonists
  • The ß²-receptor
  • Phosphodiesterase inhibitors¹6'¹7
  • Anticholinergic drugs
  • Acetylcholine receptor
  • Leukotriene antagonists¹9
  • Compensation for increased resistance to breathing
  • Inspiratory resistance
  • Expiratory resistance
  • Principles of measurement of respiratory resistance and closing capacity
  • Respiratory system resistance
  • Pressure-flow technique
  • Oscillating air flow
  • Body plethysmograph
  • Interrupter technique
  • End-inspiratory interruption
  • Measurement of closing capacity4'²¹
  • References
  • 4 Control of breathing
  • Keywords:
  • Key points
  • The origin of the respiratory rhythm¹
  • Anatomical location of the 'respiratory centre'
  • Central pattern generator¹
  • Cellular mechanisms of central pattern generation
  • Neurotransmitters involved in central pattern generator and respiratory control³
  • Efferent pathways from the respiratory centre
  • Central nervous system connections to the respiratory centre
  • The pons
  • Cerebral cortex4
  • Ondine's curse (primary alveolar hypoventilation syndrome)
  • Peripheral input to the respiratory centre and nonchemical reflexes
  • Reflexes arising from the upper respiratory tract¹³
  • Nose
  • Pharynx
  • Larynx
  • Cough reflex¹4'¹5
  • Expiration reflex¹4'¹6
  • Reflexes arising in the lung
  • Pulmonary stretch receptors and their associated reflexes¹6
  • Head's paradoxical reflex
  • Other pulmonary afferents
  • Reflexes arising from outside the airway and lungs
  • Phrenic nerve afferents
  • Baroreceptor reflexes²7
  • Afferents from the musculoskeletal system
  • The influence of carbon dioxide on respiratory control
  • Localization of the central chemoreceptors
  • Mechanism of action
  • Compensatory bicarbonate shift in the csf
  • The Pco²/ventilation response curve
  • Time course of Pco²/ventilation response
  • The influence of oxygen on respiratory control
  • Peripheral chemoreceptors³6
  • Mechanism of action of peripheral chemoreceptors³6'³?
  • Other effects of stimulation
  • Time course of the ventilatory response to hypoxia47
  • Acute hypoxic ventilatory response
  • Hypoxic ventilatory decline
  • Response to sustained hypoxia
  • Ventilatory response to progressive hypoxia
  • Iatrogenic loss of peripheral chemoreceptor sensitivity5²
  • Central hypoxic depression of breathing
  • Integration of the chemical control of breathing
  • Effects of Pco² and ph on the hypoxic ventilatory response
  • Effects of Po² and ph on central chemoreceptor response³³'59
  • Periodic breathing
  • Breath holding
  • Influence of Pco² and Po²
  • Effect of lung volume
  • Drug effects on the control of breathing
  • Respiratory depressants
  • Opioids64
  • Benzodiazepines
  • Respiratory stimulants70
  • Methods for assessment of breathing control
  • Sensitivity to carbon dioxide
  • Steady-state method
  • Rebreathing method
  • Sensitivity to hypoxia74
  • Steady-state method
  • Rebreathing method
  • Intermittent inhalation of high oxygen concentration
  • References
  • 5 Pulmonary ventilation
  • Keywords:
  • Key points
  • Upper airway muscles
  • Laryngeal control of airway resistance
  • Respiratory muscles of the trunk
  • Diaphragm
  • Mechanics of diaphragmatic function
  • Rib cage muscles¹0
  • Accessory muscles
  • Abdominal muscles
  • Integration of respiratory muscle activity
  • Breathing
  • Separation of volume contribution of rib cage and abdomen
  • Effect of posture on respiratory muscles
  • Supine position
  • Lateral position
  • Chemoreceptor activation
  • Neuronal control of respiratory muscles
  • Muscle fibre subtypes¹?
  • Respiratory muscle fatigue and disuse¹?
  • Effect of disuse²³
  • The work of breathing
  • Units of measurement of work
  • Dissipation of the work of breathing
  • Work against elastic recoil
  • Work against resistance to gas flow
  • The minimal work of breathing
  • Measurement of ventilation
  • Direct measurement of respired volumes²7
  • Impellers and turbines
  • Noninvasive measurement of ventilation
  • Measurement of ventilatory volumes by integration of instantaneous gas flow rate
  • Measurement of ventilatory capacity²7'³0
  • Maximal voluntary ventilation
  • Forced expiration
  • Peak expiratory flow rate
  • Assessment of the respiratory muscles
  • References
  • 6 The pulmonary circulation
  • Keywords:
  • Key points
  • Pulmonary blood flow
  • Pulmonary blood volume
  • Factors influencing pulmonary blood volume
  • Posture
  • Systemic vascular tone
  • Pulmonary vascular pressures
  • Effect of intraalveolar pressure
  • Pulmonary vascular resistance
  • Vascular resistance in the lung
  • Localization of the pulmonary vascular resistance
  • Passive changes in pulmonary vascular resistance
  • Effect of pulmonary blood flow (cardiac output)
  • Effect of lung inflation
  • Effect of gravity on alveolar and vascular pressures
  • Vascular weir
  • Active control of pulmonary vascular resistance
  • Cellular mechanisms controlling pulmonary vascular tone6
  • Receptors
  • Second messengers
  • Role of the endothelium and nitric oxide
  • Hypoxic pulmonary vasoconstriction6'9'?
  • Mechanism of hypoxic pulmonary vasoconstriction6'?'¹5'¹6
  • Oxygen sensing in pulmonary artery smooth muscle cells
  • Modulation by the endothelial cell of the pulmonary artery smooth muscle cells¹7
  • Iron and hypoxic pulmonary vasoconstriction²0'²²
  • Effects of Pco² and pH on pulmonary vascular resistance
  • Neural control
  • Humoral control
  • Drug effects on the pulmonary circulation
  • Inhaled drugs
  • Nitric oxide
  • Prostacyclin (pgi²)²7
  • Systemic drugs²9
  • Principles of measurement of the pulmonary circulation
  • Pulmonary vascular pressures
  • Pulmonary blood flow
  • Dye or thermal dilution
  • References
  • 7 Distribution of pulmonary ventilation and perfusion
  • Keywords:
  • Key points
  • Distribution of ventilation
  • Spatial and anatomical distribution of inspired gas
  • Distribution of inspired gas in relation to the rate of alveolar filling
  • Effect of maldistribution on the alveolar 'plateau'
  • Distribution of perfusion
  • Distribution between the two lungs
  • Gravitational effects on regional pulmonary blood flow
  • Gravity-independent regional blood flow5
  • Ventilation in relation to perfusion
  • Body position and ventilation and perfusion ratios
  • Multiple inert gas elimination technique¹9
  • Quantification of spread of v?/q? ratios using three-compartment model
  • Dead space
  • Components of dead space
  • Anatomical dead space
  • Factors influencing the anatomical dead space
  • Alveolar dead space
  • Physiological dead space
  • The bohr equation
  • Factors influencing physiological dead space
  • Effects of an increased physiological dead space
  • Venous admixture or shunt
  • Nomenclature of venous admixture
  • Forms of venous admixture
  • Effect of venous admixture on arterial pco2 and po2
  • Effect of cardiac output on shunt
  • The iso-shunt diagram
  • The effect of scatter of v?/q? ratios on arterial po2
  • Modification of the iso-shunt diagram to include v?/q? scatter
  • Principles of assessment of distribution of ventilation and pulmonary blood flow
  • Regional distribution of ventilation and perfusion
  • Radioactive tracers
  • Scanning techniques
  • Noninvasive techniques
  • Measurement of ventilation and perfusion as a function of v?/q? ratios
  • Measurement of venous admixture
  • Alveolar air equation
  • Distinction between shunt and the effect of v?/q? scatter
  • Measurement of dead space
  • References
  • 8 Diffusion of respiratory gases
  • Keywords:
  • Key points
  • Fundamentals of the diffusion process
  • Quantification of resistance to diffusion
  • Diffusion of gases in solution
  • Partial pressure versus concentration gradients
  • Diffusion of oxygen in the lungs
  • Components of the alveolar/capillary diffusion pathway
  • Gas space within the alveolus
  • Alveolar lining fluid
  • Tissue barrier
  • Plasma layer
  • Diffusion into and within the red blood cell5
  • Uptake of oxygen by haemoglobin
  • Quantification of the diffusing capacity for oxygen
  • Forward integration¹0
  • Capillary transit time
  • Diffusion of carbon dioxide in the lungs
  • Diffusion of carbon monoxide in the lungs
  • Diffusion path for carbon monoxide
  • Diffusion of co in plasma
  • Uptake of co by haemoglobin
  • Quantification of the components of the resistance to diffusion of co
  • Factors affecting diffusing capacity
  • Factors affecting the membrane surface area
  • Body size
  • Lung volume
  • Ventilation/perfusion mismatch
  • Posture
  • Pathology
  • Factors affecting the membrane diffusion barrier
  • Factors affecting uptake of gases by haemoglobin
  • Other determinants of diffusing capacity
  • Diffusion of oxygen in the tissues¹³'¹4
  • Principles of measurement of diffusing capacity¹9
  • Steady-state method
  • Single-breath method1
  • Rebreathing method
  • References
  • 9 Carbon dioxide
  • Keywords:
  • Key points
  • Carriage of carbon dioxide in blood
  • In physical solution
  • As carbonic acid
  • Carbonic anhydrase¹
  • As bicarbonate ion
  • As carbamino compounds
  • Carbamino carriage and haemoglobin
  • Haldane effect4
  • Effect of buffering power of proteins on carbon dioxide carriage
  • Distribution of carbon dioxide within the blood
  • Haemoglobin buffering
  • Hamburger shift
  • Dissociation curves of carbon dioxide
  • Factors influencing the pco2 in the steady state
  • Alveolar Pco² (paco2)
  • End-expiratory Pco² (pe'co2)
  • Alveolar/arterial Pco² gradient
  • Arterial Pco² (paco2)
  • Carbon dioxide stores and the unsteady state
  • Apnoea
  • Carbon dioxide carriage during hypothermia
  • Outline of methods of measurement of carbon dioxide
  • Blood partial pressure
  • Fractional concentration in gas mixtures¹7
  • Infrared analysis
  • Capnography¹7'¹9
  • Arterial to end-expiratory pco2 gradient
  • References
  • 10 Oxygen
  • Keywords:
  • Key points
  • Oxygen cascade
  • Dilution of inspired oxygen by water vapour
  • Primary factors influencing alveolar oxygen partial pressure
  • Dry barometric pressure
  • Inspired oxygen concentration
  • Oxygen consumption
  • Alveolar ventilation
  • Secondary factors influencing alveolar oxygen partial pressure
  • Cardiac output
  • 'concentration', third gas or fink effect
  • Alveolar/arterial po 2 difference
  • Factors influencing the magnitude of the alveolar/arterial po 2 difference
  • Compensation for increased alveolar/arterial po 2 difference by raising the inspired oxygen concentration
  • Carriage of oxygen in the blood
  • Physical solution of oxygen in blood
  • Haemoglobin
  • Molecular mechanisms of oxygen binding²
  • Oxygen-binding capacity of haemoglobin (bo 2) or hüfner constant
  • Kinetics of the reaction of oxygen with haemoglobin
  • Oxyhaemoglobin dissociation curve
  • Factors causing displacement of the dissociation curve
  • Quantifying displacement of the haemoglobin dissociation curve
  • Clinical significance of displacement of the haemoglobin dissociation curve
  • 2,3-diphosphoglycerate
  • Normal arterial po 2
  • Nitric oxide and haemoglobin¹5
  • Abnormal forms of haemoglobin
  • Abnormal ligands
  • Carboxyhaemoglobin
  • Blood substitutes
  • Perfluorocarbons²7
  • Haemoglobin-based oxygen carriers³0'³¹
  • Role of oxygen in the cell
  • Energy production
  • Glycolysis and anaerobic energy production
  • Aerobic energy production
  • Significance of aerobic metabolism
  • Critical oxygen partial pressure for aerobic metabolism
  • Tissue po 2
  • Transport of oxygen from the lungs to the cell
  • The concept of oxygen delivery
  • Quantification of oxygen delivery
  • Interaction of the factors governing oxygen delivery
  • Relationship between oxygen delivery and consumption
  • Oxygen stores
  • Cyanosis
  • Central and peripheral cyanosis
  • Sensitivity of cyanosis as an indication of hypoxaemia
  • Principles of measurement of oxygen levels
  • Oxygen concentration in gas samples
  • Blood po 2
  • Errors in measuring oxygen levels
  • Transcutaneous po 2
  • Oxygen saturation³'49
  • Pulse oximetry
  • Tissue po 2
  • Tissue surface electrodes
  • Near-infrared spectroscopy56
  • Indirect assessment of tissue oxygenation
  • Measurement of oxygen consumption and delivery
  • Oxygen consumption
  • Oxygen loss from a closed breathing system
  • Subtraction of expired from inspired volume of oxygen
  • Multiplication of cardiac output by arterial/mixed venous oxygen content difference
  • Oxygen delivery
  • References
  • 11 Nonrespiratory functions of the lung
  • Keywords:
  • Key points
  • Filtration
  • Defence against inhaled substances
  • Airway lining fluid
  • Mucous layer5
  • Ciliary function7'9
  • Periciliary layer
  • Humidification
  • Inhaled particles
  • Defence against inhaled pathogens¹5
  • Direct removal of pathogens
  • Chemical inactivation of pathogens
  • Protease-antiprotease system
  • Immune systems
  • Chemical hazards
  • Processing of endogenous compounds by the pulmonary vasculature
  • Catecholamines and acetylcholine
  • Noradrenaline (norepinephrine)
  • Peptides
  • Angiotensin
  • Bradykinin
  • Atrial natriuretic peptide
  • Endothelins
  • Arachidonic acid derivatives
  • Purine derivatives
  • Pharmacokinetics and the lung
  • Drug delivery²6'²7
  • Drug elimination
  • Pulmonary circulation²?
  • Pulmonary toxicity of drugs
  • The endocrine lung
  • References
  • Part II Applied Physiology
  • 12 Pregnancy, neonates and children
  • Keywords:
  • Key points
  • Respiratory function in pregnancy
  • The lungs before birth
  • Embryology
  • Lung liquid
  • Lung development and lung function later in life
  • Fetal circulation
  • Events at birth
  • Factors in the initiation of breathing
  • Fate of the fetal lung liquid
  • Changes in the circulation
  • Mechanism of reduced pulmonary vascular resistance at birth
  • Neonatal lung function
  • Mechanics of breathing
  • Ventilation and gas exchange
  • Control of breathing
  • Haemoglobin
  • Premature birth and the lungs
  • Respiratory distress syndrome
  • Bronchopulmonary dysplasia²¹
  • Sudden infant death syndrome²³
  • Development of lung function during childhood
  • References
  • 13 Exercise
  • Keywords:
  • Key points
  • Oxygen consumption during exercise
  • Time course of the increase in oxygen consumption
  • Maximal oxygen uptake
  • Response of the oxygen delivery system
  • Oxygen delivery
  • Oxygen extraction
  • Anaerobic metabolism
  • Oxygen debt
  • Excess post-exercise oxygen consumption
  • Ventilatory response to exercise
  • Time course7
  • Ventilation equivalent for oxygen
  • Minute volume and dyspnoea
  • Control of ventilation
  • Neural factors
  • Arterial blood gas partial pressures and the chemoreceptors
  • Humoral mechanisms
  • Fitness and training
  • Minute volume of ventilation
  • Ventilation equivalent for oxygen
  • Exercise-induced arterial hypoxaemia
  • Cardiorespiratory disease
  • Exercise testing
  • References
  • 14 Sleep
  • Keywords:
  • Key points
  • Normal sleep
  • Respiratory changes
  • Ventilation¹
  • Chemosensitivity
  • Effect of age
  • Pharyngeal airway resistance
  • Snoring
  • Sleep-disordered breathing
  • The mechanism of airway obstruction?
  • Anatomically narrow airway
  • Inadequate control of respiratory muscles
  • Arousal
  • Respiratory instability
  • Drug effects in sleep apnoea/hypopnoea syndrome
  • Effects of sleep apnoea/hypopnoea syndrome
  • Principles of therapy¹²'³9'³?
  • Conservative treatment
  • Surgical relief of obstruction
  • Upper airway stimulation
  • References
  • 15 Obesity
  • Keywords:
  • Key points
  • Respiratory physiology of obesity
  • Lung volumes and respiratory mechanics
  • Static lung volumes
  • Dynamic lung volumes
  • Respiratory muscles
  • Ventilation perfusion relationships
  • Respiratory control
  • Impact of obesity on lung disease
  • Lung development in childhood
  • Dysanapsis
  • Asthma obesity phenotype
  • Chronic obstructive pulmonary disease
  • The obesity paradox
  • Obesity hypoventilation syndrome
  • References
  • 16 High altitude and flying
  • Keywords:
  • Key points
  • Equivalent oxygen concentration
  • Respiratory system responses to altitude
  • Physiological effects of exposure to altitude
  • Ventilatory changes
  • Signs and symptoms
  • Acclimatization to altitude
  • Ventilatory control
  • Blood gases
  • Haemoglobin concentration and oxygen affinity
  • Adaptation to altitude¹4
  • Physiological adaptations
  • Epigenetic adaptations
  • Genetic adaptations
  • Chronic mountain sickness (monge disease)¹
  • Exercise at high altitude²²
  • Capacity for work performed
  • Ventilation equivalent of oxygen consumption
  • Pco2 and po2
  • Altitude illness²5'²6
  • Acute mountain sickness
  • High-altitude pulmonary oedema²9
  • Other medical problems at altitude
  • Therapy for altitude-induced illness²5
  • Flying
  • Altitude exposure
  • Depressurization
  • Air travel in patients with respiratory disease46
  • Cabin air quality
  • References
  • 17 High pressure and diving
  • Keywords:
  • Key points
  • Exchange of oxygen and carbon dioxide
  • Effect of pressure on alveolar pco2 and po2
  • Effect on mechanics of breathing¹­­¯³
  • Effect on gas exchange¹'²'4
  • Oxygen consumption
  • Exercise
  • Effects attributable to the composition of the inspired gas
  • Air
  • Oxygen
  • Nitrogen
  • Helium/oxygen mixtures
  • Helium/oxygen/nitrogen mixtures
  • Types of diving activity and their respiratory effects
  • Breath-hold diving6
  • Lung volume
  • Alveolar po2
  • Alveolar pco2
  • Limited duration dives
  • Saturation dives
  • Respiratory aspects of decompression illness¹²'¹³
  • Barotrauma
  • Decompression sickness
  • Altitude decompression sickness¹?'²0
  • References
  • 18 Respiration in closed environments and space
  • Keywords:
  • Key points
  • Closed-system anaesthesia
  • Accumulation of other gases in closed circuits
  • Submarines
  • Physiological effects of prolonged hypercapnia4
  • Respiratory changes7
  • Calcium metabolism9
  • Space?
  • Atmosphere composition
  • Oxygen supply
  • Carbon dioxide removal
  • Atmospheric contamination
  • Long-term space travel
  • Microgravity¹5
  • Biospheres?
  • Small-scale biological atmospheric regeneration
  • Biosphere 29
  • Outcome from the 2-year closure
  • References
  • 19 Drowning
  • Keywords:
  • Key points
  • Physiology of immersion²
  • Physiological mechanisms of drowning
  • Drowning without aspiration of water
  • Drowning with aspiration of water
  • Freshwater
  • Seawater
  • The role of hypothermia²
  • Principles of therapy for near-drowning
  • Immediate treatment
  • Hospital treatment
  • References
  • 20 Smoking and air pollution
  • Keywords:
  • Key points
  • Tobacco smoke
  • Constituents of tobacco smoke
  • Gaseous phase
  • Particulate phase
  • Individual smoke exposure
  • Quantifying cigarettes smoked
  • Pattern of inhalation
  • Respiratory effects of smoking
  • Airway mucosa
  • Airway diameter
  • Ventilatory capacity
  • Passive smoking
  • Maternal smoking
  • Smoking and perioperative complications
  • Smoking cessation
  • E-cigarettes
  • Mechanisms of smoking-related lung damage
  • Oxidative injury
  • Direct oxidative damage
  • Cell-mediated oxidative damage
  • Carcinogenesis
  • Immunological activation
  • Air pollution²²
  • Sources of pollutants
  • Primary pollutants
  • Secondary pollutants
  • Meteorological conditions
  • Respiratory effects of pollutants
  • Indoor air pollution44
  • Allergens
  • Carbon monoxide
  • Nitrogen dioxide
  • References
  • 21 Anaesthesia
  • Keywords:
  • Key points
  • Control of breathing
  • Unstimulated ventilation
  • Effect on pco2/ventilation response curve
  • Effect on po2/ventilation response curve³'4
  • Implications of the depression of acute hypoxic ventilatory response by anaesthetic agents
  • Pattern of contraction of respiratory muscles
  • Pharynx
  • Maintenance of pharyngeal airway patency
  • Inspiratory muscles
  • Expiratory muscles¹³
  • Change in functional residual capacity
  • Cause of the reduction in frc¹9
  • Atelectasis during anaesthesia¹9
  • Causes of atelectasis
  • Prevention of atelectasis³0
  • Inspired oxygen concentration
  • Nitrous oxide
  • Positive airway pressures
  • Reexpansion of atelectasis
  • Continuous positive airway pressure manoeuvres
  • Positive end-expiratory pressure
  • Respiratory mechanics47
  • Calibre of the lower airways
  • Effect of reduced functional residual capacity
  • Inhalational anaesthetics
  • Other sites of increased airway resistance
  • Compliance
  • Gas exchange
  • Dead space
  • Shunt
  • Magnitude of the change during anaesthesia
  • Cause of venous admixture during anaesthesia
  • Ventilation/perfusion relationships
  • Effect of age on v?/q? ratios during anaesthesia
  • Effect of positive end-expiratory pressure
  • Other factors affecting ventilation/perfusion relationships during anaesthesia
  • Summary
  • Other effects of general anaesthesia on the respiratory system
  • Response to added resistance
  • Hypoxic pulmonary vasoconstriction6²
  • Anaesthesia in specific patient groups
  • Paediatrics6³
  • Obesity66
  • Special circumstances relevant during anaesthesia
  • Patient position
  • Lateral
  • Prone
  • Laparoscopic surgery
  • Respiratory mechanics
  • Carbon dioxide absorption77
  • Regional anaesthesia
  • Control of breathing
  • Respiratory function in the postoperative period
  • Reversal of intraoperative physiological changes
  • Postoperative pulmonary complications
  • Preoperative interventions to avoid postoperative pulmonary complications
  • Intraoperative considerations
  • Postoperative considerations
  • References
  • 22 Changes in the carbon dioxide partial pressure
  • Keywords:
  • Key points
  • Causes of hypocapnia¹
  • Causes of hypercapnia
  • Effects of carbon dioxide on the nervous system
  • Effects on consciousness
  • Cerebral blood flow²
  • Mechanisms
  • Anaesthesia
  • Effects on the autonomic and endocrine systems
  • Effects on other body systems
  • Respiratory system
  • Pulmonary circulation
  • Oxygenation of the blood
  • Cardiovascular system
  • Myocardial contractility and heart rate
  • Arrhythmias
  • Blood pressure
  • Effect on the kidney
  • Effect on blood electrolyte levels
  • Hypercapnia in clinical practice
  • Clinical signs
  • Severe hypercapnia
  • References
  • 23 Hypoxia
  • Keywords:
  • Key points
  • Biochemical changes in hypoxia
  • Depletion of high-energy compounds
  • End products of metabolism
  • Initiation of glycolysis
  • Mechanisms of hypoxic cell damage
  • Immediate cellular responses to hypoxia³
  • Potassium and sodium flux
  • Calcium
  • Glutamate release
  • Nonglutamate mechanisms
  • Delayed cellular responses to hypoxia
  • Hypoxia-inducible factor ¹7'9
  • Ischaemic preconditioning¹¹
  • Early protection
  • Late protection
  • Remote ischaemic preconditioning¹²'¹³
  • Agents used for preconditioning
  • Po2 level at which hypoxia occurs
  • Critical arterial po2 for tissue function
  • Effects of hypoxia
  • References
  • 24 Anaemia
  • Keywords:
  • Key points
  • Pulmonary function
  • Gas exchange
  • Haemoglobin dissociation curve
  • Arterial oxygen content
  • Oxygen delivery
  • Effect of anaemia on cardiac output
  • Acute anaemia
  • Chronic anaemia
  • The influence of cardiac output on oxygen delivery
  • Relationship between oxygen delivery and consumption
  • Anaemia and exercise
  • Anaemia in the clinical setting?5
  • References
  • 25 Oxygen toxicity and hyperoxia
  • Keywords:
  • Key points
  • Hyperoxia
  • Oxygen toxicity
  • The oxygen molecule and reactive derivatives²
  • Singlet oxygen
  • Superoxide anion
  • Hydroperoxyl radical
  • Hydrogen peroxide
  • Three-stage reduction of oxygen
  • Secondary derivatives of the products of dioxygen reduction
  • Sources of electrons for the reduction of oxygen to superoxide anion
  • Mitochondrial enzymes
  • Nadph oxidase system
  • Xanthine oxidoreductase and reperfusion injury6
  • Ferrous iron
  • High po2
  • Exogenous compounds
  • Biological effects of reactive oxygen species
  • Defences against reactive oxygen species
  • Antioxidant enzymes
  • Superoxide dismutase¹¹
  • Endogenous antioxidants
  • Exogenous antioxidants
  • Normobaric hyperoxia
  • Increasing the inspired oxygen concentration¹6
  • Fixed performance devices
  • Variable performance devices
  • High-flow nasal therapy
  • Clinical effects of normobaric hyperoxia
  • Retinopathy of prematurity²7
  • Pulmonary oxygen toxicity
  • Symptoms³0
  • Cellular changes³¹
  • Limits of survival
  • Pulmonary absorption collapse
  • Bleomycin lung toxicity
  • Hyperoxia in the perioperative period
  • Hyperoxia in acute medicine
  • Hyperoxia in critical care
  • Hyperbaric hyperoxia
  • Oxygen convulsions (the paul bert effect)
  • Incidence
  • Therapeutic effects of hyperbaric oxygen
  • Clinical applications of hyperbaric oxygenation therapy
  • References
  • 26 Comparative respiratory physiology
  • Keywords:
  • Key points
  • Designs of respiratory system
  • Structural designs for gas-exchange apparatus
  • Factors affecting respiratory system design
  • Respiratory medium for breathing
  • Body temperature
  • Metabolic rate
  • Respiratory systems of major phyla
  • Aquatic respiration
  • Diffusion respiration in small species
  • Echinodermata
  • Mollusca
  • Crustacea
  • Fish
  • Amphibia
  • Air respiration
  • Annelida
  • Arthropoda
  • Reptilia
  • Mammalia
  • Aves (birds)¹0'¹¹
  • Carriage of gases in blood
  • Circulation configurations
  • Fish
  • Amphibians
  • Reptiles
  • Birds and mammals
  • Oxygen-carrying molecules
  • Haemerythrin
  • Haemocyanin
  • Haemoglobin
  • Animals at physiological extremes
  • Mammals at altitude
  • Oxygen carriage¹6'¹7
  • Pulmonary vasculature
  • Collateral ventilation
  • Exercising horses²0
  • Diving mammals
  • Pathophysiology of animal respiratory diseases in veterinary practice
  • Ruminants
  • Bovine respiratory disease²7
  • Acute interstitial pneumonia
  • Vena caval thrombosis
  • Parasitic bronchitis (lungworm or husk)
  • Equine respiratory disease
  • References
  • Part III Physiology of Pulmonary Disease
  • 27 Ventilatory failure
  • Keywords:
  • Key points
  • Definitions
  • Pattern of changes in arterial blood gases
  • Time course of changes in blood gases in acute ventilatory failure
  • Causes of ventilatory failure¹
  • Increased dead space
  • Relationship between ventilatory capacity and ventilatory failure
  • Metabolic demand and ventilatory failure
  • Breathlessness5
  • The origin of the sensation
  • Treatment of breathlessness
  • Principles of therapy for ventilatory failure
  • Treatment of hypoxaemia caused by hypoventilation by administration of oxygen
  • Improvement of alveolar ventilation
  • References
  • 28 Airways disease
  • Keywords:
  • Key points
  • Asthma
  • Clinical features
  • Asthma phenotypes?
  • Cellular mechanisms of asthma¹0
  • Causes of airway obstruction in asthma
  • Airway smooth muscle
  • Inflammation
  • Airway remodelling¹?
  • Aetiology of asthma²³
  • Genetics
  • Allergy
  • Infection
  • Hygiene hypothesis
  • Smoking and air pollution
  • Obesity
  • Paracetamol (acetaminophen)
  • Aspirin and asthma³5
  • Mechanism of aspirin sensitivity
  • Principles of therapy¹
  • Chronic obstructive pulmonary disease
  • Aetiology of chronic obstructive pulmonary disease
  • Emphysema
  • Airway obstruction
  • Hyperinflation
  • Respiratory muscles in chronic obstructive pulmonary disease
  • Principles of therapy44
  • Smoking cessation (page 239)
  • Medical treatment69
  • Long-term supplemental oxygen7¹
  • Pulmonary rehabilitation7²
  • Oxygen therapy in chronic obstructive pulmonary disease75
  • Cystic fibrosis7?
  • Aetiology of cystic fibrosis
  • Biochemical abnormality
  • Causes of lung disease
  • Principles of therapy?0
  • Correcting the abnormal cystic fibrosis transmembrane conductance regulator
  • References
  • 29 Pulmonary vascular disease
  • Keywords:
  • Key points
  • Pulmonary oedema
  • Anatomical factors
  • Pulmonary fluid dynamics
  • Fluid exchange across the endothelium4
  • Fluid dynamics within the interstitial space
  • Fluid exchange across the alveolar epithelium6
  • Stages of pulmonary oedema
  • Stage I: Interstitial pulmonary oedema
  • Stage II: Crescentic filling of the alveoli
  • Stage III: Alveolar flooding
  • Stage IV: Froth in the air passages
  • Aetiology of pulmonary oedema
  • Increased capillary pressure (haemodynamic pulmonary oedema)
  • Increased permeability of the capillary/endothelial glycocalyx/alveolar barrier (permeability oedema)
  • Decreased osmotic pressure of the plasma proteins
  • Other causes of pulmonary oedema
  • Principles of therapy
  • Haemodynamic pulmonary oedema
  • Permeability pulmonary oedema
  • Artificial ventilation and positive end-expiratory pressure
  • Measurement of extravascular lung water
  • Pulmonary embolism
  • Thromboembolism
  • Diagnosis of pulmonary thromboembolus¹³
  • Pathophysiology
  • Principles of therapy¹³
  • Air embolism
  • Detection of air embolism
  • Pathophysiology of air embolus
  • Paradoxical air embolism
  • Fat embolism
  • Amniotic fluid embolism¹9'¹?
  • Pulmonary hypertension
  • Secondary pulmonary arterial hypertension
  • Primary pulmonary arterial hypertension
  • Pathophysiology of vascular remodelling
  • Treatment²0'²¹
  • Hepatopulmonary syndrome
  • References
  • 30 Diseases of the lung parenchyma and pleura
  • Keywords:
  • Key points
  • Pulmonary collapse
  • Loss of forces opposing retraction of the lung
  • Absorption of trapped gas
  • The effect of respired gases
  • Magnitude of the pressure gradients
  • Effect of reduced ventilation/perfusion ratio
  • Diagnosis of pulmonary collapse
  • Principles of therapy
  • Pulmonary consolidation (pneumonia)
  • Pathophysiology9¯¹0
  • Margination of neutrophils¹¹
  • Interstitial lung disease and pulmonary fibrosis
  • Causes of pulmonary fibrosis
  • Cellular mechanisms of pulmonary fibrosis¹?¯²¹
  • Principles of therapy¹9'²4'²5
  • Lung cancer
  • Epidemiology
  • Tobacco
  • Radon
  • Carcinogenesis of lung cancer
  • Radiation
  • Tobacco smoke carcinogens
  • Molecular mechanisms of carcinogenesis
  • Target genes for pulmonary carcinogenesis
  • Clinical aspects
  • Pathology
  • Clinical features³?
  • Principles of therapy
  • Pleural disease
  • Physiology of the pleural space4³
  • Pleural effusion
  • Pneumothorax
  • Tension pneumothorax
  • Principles of therapy for spontaneous pneumothorax
  • Absorption of air from the pleural space
  • Empyema
  • References
  • 31 Acute lung injury
  • Keywords:
  • Key points
  • Clinical aspects of acute lung injury¹'²
  • Definition
  • Predisposing conditions and risk factors for acute lung injury
  • Pulmonary and extrapulmonary acute lung injury
  • Incidence and mortality
  • Clinical course
  • Pathophysiology²
  • Alveolar/capillary permeability
  • Maldistribution of ventilation and perfusion¹5
  • Lung mechanics
  • Mechanisms of acute lung injury
  • Histopathology
  • Acute stage
  • Fibroproliferative stage
  • Cellular mechanisms¹?
  • Principles of therapy²'¹0'²³'²4
  • Artificial ventilation in acute respiratory distress syndrome
  • Tidal volume
  • Ventilation mode
  • Positive end-expiratory pressure³5
  • Protective ventilation strategy
  • Recruitment manouevres46
  • Prone positioning50
  • Alternative respiratory support strategies5³
  • Other therapeutic options59
  • Future directions
  • References
  • 32 Respiratory support and artificial ventilation
  • Keywords:
  • Key points
  • Respiratory physiotherapy
  • Physiology of respiratory interventions
  • To increase lung volume
  • To decrease the work of breathing
  • To clear secretions
  • Noninvasive ventilation
  • Negative pressure ventilation
  • Noninvasive positive pressure ventilation
  • Clinical applications
  • Intermittent positive pressure ventilation
  • Phases of the respiratory cycle
  • Inspiration
  • Expiration
  • Time course of inflation and deflation
  • Effect of changes in inflation pressure, resistance and compliance
  • Effect of changes in compliance and resistance
  • Overpressure
  • Deviations from true exponential character of expiration
  • Alternative patterns of application of inflation pressure
  • Control of duration of inspiration
  • The inspiratory to expiratory ratio
  • Clinical use of intermittent positive pressure ventilation
  • Interactions between patient and ventilator
  • Pressure sensing
  • Flow sensing
  • Neurally adjusted ventilatory assist
  • Ventilatory modes in common use
  • Mandatory minute volume
  • Airway pressure release ventilation
  • Synchronized intermittent mandatory ventilation
  • Pressure support ventilation
  • High-frequency ventilation
  • Weaning²³
  • Predicting successful weaning
  • Techniques for weaning
  • Positive end-expiratory pressure
  • Intrinsic positive end-expiratory pressure
  • Physiological effects of positive pressure ventilation
  • Respiratory effects³³
  • Distribution of ventilation
  • Apparatus dead space
  • Physiological dead space
  • Lung volume
  • Arterial po2
  • Pulmonary neutrophil retention
  • Valsalva effect
  • Cardiovascular effects of positive pressure ventilation³5
  • Cardiac output
  • Oxygen delivery
  • Arterial blood pressure
  • Interpretation of vascular pressures
  • Transmission of airway pressure to other intrathoracic structures
  • Haemodynamic response in heart failure
  • Renal effects40
  • Ventilator-induced lung injury4¹'4²
  • Barotrauma
  • Volutrauma
  • Atelectrauma
  • Biotrauma
  • Prevention of ventilator-induced lung injury4¹
  • Artificial ventilation for resuscitation
  • Expired air ventilation
  • Extrapulmonary gas exchange
  • Factors in design
  • Factors favouring performance
  • Unfavourable factors
  • Bubble oxygenators
  • Membrane oxygenators
  • Damage to blood
  • Systems for extrapulmonary gas exchange
  • Extracorporeal membrane oxygenation56
  • Extracorporeal carbon dioxide removal57
  • Intravascular oxygenators
  • Clinical applications5?
  • Neonates and infants
  • Adults
  • References
  • 33 Pulmonary surgery
  • Keywords:
  • Key points
  • Physiological aspects of common interventions
  • Bronchoscopy
  • Flexible bronchoscopy¹
  • Rigid bronchoscopy
  • Thoracoscopy
  • Thoracotomy
  • Lung resection
  • Assessing patient fitness for lung resection?
  • Partial lung resection
  • Pneumonectomy
  • Surgery for emphysema
  • Pleurodesis
  • One-lung ventilation
  • Lung isolation techniques
  • Physiology of one-lung ventilation
  • Patient position
  • Open chest
  • Perfusion of the nonventilated lung
  • Management of one-lung ventilation
  • Ventilation
  • Management of the nonventilated lung
  • Summary of the clinical management of one-lung ventilation
  • Lung injury following one-lung ventilation40
  • Lung transplantation
  • Clinical aspects4²'4³
  • Indications
  • Types of transplant
  • Outcome following transplant
  • Rejection
  • Physiological effects of lung transplant
  • Denervated lung
  • Ventilation/perfusion relationships
  • Mucociliary clearance
  • References
  • 34 The atmosphere
  • Keywords:
  • Key points
  • Evolution of the atmosphere
  • Formation of the earth and the prebiotic atmosphere
  • Significance of the mass of earth and its distance from sun
  • Origin of life and the development of photosynthesis
  • The appearance of oxygen in the atmosphere
  • Biological consequences of an oxidizing environment
  • Changes in carbon dioxide levels
  • Carbon dioxide and the ice ages
  • Recent changes in carbon dioxide levels
  • The greenhouse effect
  • Other greenhouse gases
  • Turnover rates of atmospheric gases
  • Oxygen, ozone and ultraviolet screening
  • Evolution and adaptation
  • References
  • 35 The history of respiratory physiology
  • Keywords:
  • Key points
  • Ancient civilizations
  • Egyptian physiology7
  • Medical papyri
  • Ancient greece
  • Roman medicine and galen (129-199 bce)
  • Galen's system of physiology and anatomy
  • Experiments on respiration
  • The functions of breathing
  • Galen's legacy
  • After galen
  • The renaissance
  • Leonardo da vinci (1452-1519)4'¹4
  • Da vinci and the bronchial circulation
  • Anatomy in the renaissance
  • Pulmonary circulation²¹
  • Experimental physiology in the 17th century
  • Discoveries to assist the respiratory physiologists
  • Circulation
  • Atmospheric pressure4
  • The microscope
  • The oxford physiologists and the 'use of breathing'¹'5'6
  • Robert boyle (1627-1691)³0
  • Robert hooke (1635-1702)³¹
  • Richard lower (1631-1691)
  • John mayow (1641-1679)4
  • Physiology hibernates
  • Chemistry and respiration
  • Different types of air
  • Phlogiston6
  • Fixed air and vitiated air
  • Dephlogisticated air
  • Fire air
  • Oxygen
  • Early development of current ideas of respiratory physiology
  • Tissue respiration
  • Blood gases40'4¹
  • Partial pressure
  • Haemoglobin and its dissociation curve
  • The oxygen secretion controversy¹'4¹'50
  • Lung mechanics5?
  • Elasticity and surfactant
  • Lung volumes
  • Control of ventilation
  • Chemical control of breathing6³
  • References
  • Appendix A Physical quantities and units of measurement
  • International system of units
  • Volume (dimensions: L³)
  • Fluid flow rate (dimensions: L³/T, or L³.T¯¹)
  • Force (dimensions: MLT¯²)
  • Pressure (dimensions: MLT¯²/L², Or ML¯¹T¯²)
  • Compliance (dimensions: M¯¹L4T²)
  • Resistance to fluid flow (dimensions: ML¯4T¯¹)
  • Work (Dimensions: ML²T¯², Derived from MLT¯² × L OR ML¯¹T¯² × L³)
  • Power (dimensions: ML²T-²/T OR ML²T¯³)
  • Appendix B The gas laws
  • Appendix C Conversion factors for gas volumes
  • Conversion of gas volume-atps to btps
  • Derivation of conversion factors
  • Conversion of gas volume-atps to stpd
  • Appendix D Symbols and abbreviations
  • Reference
  • Appendix E Mathematical functions relevant to respiratory physiology
  • Linear function
  • Examples
  • Mathematical statement
  • Graphical representation
  • The rectangular hyperbola or inverse function
  • Examples
  • Mathematical statement
  • Graphical representation
  • The parabola or squared function
  • Example
  • Mathematical statement
  • Graphical representation
  • Exponential functions
  • General statement
  • The tear-away exponential function
  • Simple statement
  • Examples
  • Mathematical statement
  • Graphical representation
  • The wash-out or die-away exponential function
  • Simple statement
  • Examples
  • Mathematical statement
  • Half-life
  • Graphical representation
  • The wash-in exponential function
  • Simple statement
  • Examples
  • Mathematical statement
  • Graphical representation
  • Index
  • A
  • B
  • C
  • D
  • E
  • F
  • G
  • H
  • I
  • J
  • K
  • L
  • M
  • N
  • O
  • P
  • R
  • S
  • T
  • W
  • X
  • Z
  • Inside back cover

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