The Respiratory System

Every cell in the body must obtain energy to maintain its life, growth, and function. Cells obtain their energy from oxidation, which is a slow, controlled burning of food materials. Oxidation requires fuel and oxygen. Respiration is the process of exchanging oxygen and carbon dioxide during oxidation and releasing energy and water.

3-4.1 Gas Exchange. Few body cells are close enough to the surface to have any chance of obtaining oxygen and expelling carbon dioxide by direct air diffusion. Instead, the gas exchange takes place via the circulating blood. The blood is exposed to air over a large diffusing surface as it passes through the lungs. When the blood reaches the tissues, the small capillary vessels provide another large surface where the blood and tissue fluids are in close contact. Gases diffuse readily at both ends of the circuit and the blood has the remarkable ability to carry both oxygen and carbon dioxide. This system normally works so well that even the deepest cells of the body can obtain oxygen and get rid of excess carbon dioxide almost as readily as if they were completely surrounded by air.

If the membrane surface in the lung, where blood and air come close together, were just an exposed sheet of tissue like the skin, natural air currents would keep fresh air in contact with it. Actually, this lung membrane surface is many times larger than the skin area and is folded and compressed into the small space of the lungs that are protected inside the bony cage of the chest. This makes it necessary to continually move air in and out of the space. The process of breathing and the exchange of gases in the lungs is referred to as ventilation and pulmonarygas exchange, respectively.

3-4.2 Respiration Phases. The complete process of respiration includes six important phases:

1. Ventilation of the lungs with fresh air

2. Exchange of gases between blood and air in lungs

3. Transport of gases by blood

4. Exchange of gases between blood and tissue fluids

5. Exchange of gases between the tissue fluids and cells

6. Use and production of gases by cells

If any one of the processes stops or is seriously hindered, the affected cells cannot function normally or survive for any length of time. Brain tissue cells, for example, stop working almost immediately and will either die or be permanently injured in a few minutes if their oxygen supply is completely cut off.

The respiratory system is a complex of organs and structures that performs the pulmonary ventilation of the body and the exchange of oxygen and carbon dioxide between the ambient air and the blood circulating through the lungs. It also warms the air passing into the body and assists in speech production by providing air to the larynx and the vocal chords. The respiratory tract is divided into upper and lower tracts.

3-4.3 Upper and Lower Respiratory Tract. The upper respiratory tract consists of the nose, nasal cavity, frontal sinuses, maxillary sinuses, larynx, and trachea. The upper respiratory tract carries air to and from the lungs and filters, moistens and warms air during each inhalation.

The lower respiratory tract consists of the left and right bronchi and the lungs, where the exchange of oxygen and carbon dioxide occurs during the respiratory cycle. The bronchi divide into smaller bronchioles in the lungs, the bronchioles divide into alveolar ducts, the ducts into alveolar sacs, and the sacs into alveoli. The alveolar sacs and the alveoli present about 850 square feet of space for the exchange of oxygen and carbon dioxide that occurs between the internal alveolar surface and the tiny capillaries surrounding the external alveolar wall.

3-4.4 The Respiratory Apparatus. The mechanics of taking fresh air into the lungs

(inspiration or inhalation) and expelling used air from the lungs (expiration or exhalation) is diagrammed in Figure 3-3. By elevating the ribs and lowering the diaphragm, the volume of the lung is increased. Thus, according to Boyle's Law, a lower pressure is created within the lungs and fresh air rushes in to equalize this lowered pressure. When the ribs are lowered again and the diaphragm rises to its original position, a higher pressure is created within the lungs, expelling the used air.

3-4.4.1 The Chest Cavity. The chest cavity does not have space between the outer lung surfaces and the surrounding chest wall and diaphragm. Both surfaces are covered by membranes; the visceral pleura covers the lung and the parietal pleura lines the chest wall. These pleurae are separated from each other by a small amount of fluid that acts as a lubricant to allow the membranes to slide freely over themselves as the lungs expand and contract during respiration.

3-4.4.2 The Lungs. The lungs are a pair of light, spongy organs in the chest and are the main component of the respiratory system (see Figure 3-4). The highly elastic lungs are the main mechanism in the body for inspiring air from which oxygen is extracted for the arterial blood system and for exhaling carbon dioxide dispersed from the venous system. The lungs are composed of lobes that are smooth and shiny on their surface. The lungs contain millions of small expandable air sacs (alveoli) connected to air passages. These passages branch and rebranch like the twigs of a tree. Air entering the main airways of the lungs gains access to the

Figure 3-3. Inspiration Process. Inspiration involves both raising the rib cage (left panel) and lowering the diaphragm (right panel). Both movements enlarge the volume of the thoracic cavity and draw air into the lung.
Figure 3-4. Lungs Viewed from Medial Aspect.

entire surface of these alveoli. Each alveolus is lined with a thin membrane and is surrounded by a network of very small vessels that make up the capillary bed of the lungs. Most of the lung membrane has air on one side of it and blood on the other; diffusion of gases takes place freely in either direction.

3-4.5 Respiratory Tract Ventilation Definitions. Ventilation of the respiratory system establishes the proper composition of gases in the alveoli for exchange with the blood. The following definitions help in understanding respiration (Figure 3-5).

3-4.5.1 Respiratory Cycle. The respiratory cycle is one complete breath consisting of an inspiration and exhalation, including any pause between the movements.

Figure 3-5. Lung Volumes. The heavy line is a tracing, derived from a subject breathing to and from a sealed recording bellows. Following several normal tidal breaths, the subject inhales maximally, then exhales maximally. The volume of air moved during this maximal effort is called the vital capacity. During exercise, the tidal volume increases, using part of the inspiratory and expiratory reserve volumes. The tidal volume, however, can never exceed the vital capacity. The residual volume is the amount of air remaining in the lung after the most forceful expiration. The sum of the vital capacity and the residual volume is the total lung capacity.

Figure 3-5. Lung Volumes. The heavy line is a tracing, derived from a subject breathing to and from a sealed recording bellows. Following several normal tidal breaths, the subject inhales maximally, then exhales maximally. The volume of air moved during this maximal effort is called the vital capacity. During exercise, the tidal volume increases, using part of the inspiratory and expiratory reserve volumes. The tidal volume, however, can never exceed the vital capacity. The residual volume is the amount of air remaining in the lung after the most forceful expiration. The sum of the vital capacity and the residual volume is the total lung capacity.

3-4.5.2 Respiratory Rate. The number of complete respiratory cycles that take place in 1 minute is the respiratory rate. An adult at rest normally has a respiratory rate of approximately 12 to 16 breaths per minute.

3-4.5.3 Total Lung Capacity. The total lung capacity (TLC) is the total volume of air that the lungs can hold when filled to capacity. TLC is normally between five and six liters.

3-4.5.4 Vital Capacity. Vital capacity is the volume of air that can be expelled from the lungs after a full inspiration. The average vital capacity is between four and five liters.

3-4.5.5 Tidal Volume. Tidal volume is the volume of air moved in or out of the lungs during a single normal respiratory cycle. The tidal volume generally averages about one-half liter for an adult at rest. Tidal volume increases considerably during physical exertion, and cannot exceed the vital capacity.

3-4.5.6 Respiratory Minute Volume. The respiratory minute volume (RMV) is the total amount of air moved in or out of the lungs in a minute. The respiratory minute volume is calculated by multiplying the tidal volume by the rate. RMV varies greatly with the body's activity. It is about 6 to 10 liters per minute at complete rest and may be over 100 liters per minute during severe work.

3-4.5.7 Maximal Breathing Capacity and Maximum Ventilatory Volume. The maximal breathing capacity (MBC) and maximum ventilatory volume (MVV) are the greatest respiratory minute volumes that a person can produce during a short period of extremely forceful breathing. In a healthy young man, they may average as much as 180 liters per minute (the range is 140 to 240 liters per minute).

3-4.5.8 Maximum Inspiratory Flow Rate and Maximum Expiratory Flow Rate. The maximum inspiratory flow rate (MIFR) and maximum expiratory flow rate (MEFR) are the fastest rates at which the body can move gases in and out of the lungs. These rates are important in designing breathing equipment and computing gas use under various workloads. Flow rates are usually expressed in liters per second.

3-4.5.9 Respiratory Quotient. Respiratory quotient (RQ) is the ratio of the amount of carbon dioxide produced to the amount of oxygen consumed during cellular processes per unit time. This value ranges from 0.7 to 1.0 depending on diet and physical exertion and is usually assumed to be 0.9 for calculations. This ratio is significant when calculating the amount of carbon dioxide produced as oxygen is used at various workloads while using a closed-circuit breathing apparatus. The duration of the carbon dioxide absorbent canister can then be compared to the duration of the oxygen supply.

3-4.5.10 Respiratory Dead Space. Respiratory dead space refers to the part of the respiratory system that has no alveoli, and in which little or no exchange of gas between air and blood takes place. It normally amounts to less than 0.2 liter. Air occupying the dead space at the end of expiration is rebreathed in the following inspiration. Parts of a diver's breathing apparatus can add to the volume of the dead space and thus reduce the proportion of the tidal volume that serves the purpose of respiration. To compensate, the diver must increase his tidal volume. The problem can best be visualized by using a breathing tube as an example. If the tube contains one liter of air, a normal exhalation of about one liter will leave the tube filled with used air from the lungs. At inhalation, the used air will be drawn right back into the lungs. The tidal volume must be increased by more than a liter to draw in the needed fresh supply, because any fresh air is diluted by the air in the dead space. Thus, the air that is taken into the lungs (inspired air) is a mixture of fresh and dead space gases.

3-4.6 Alveolar/Capillary Gas Exchange. Within the alveolar air spaces, the composition of the air (alveolar air) is changed by the elimination of carbon dioxide from the blood, the absorption of oxygen by the blood, and the addition of water vapor. The air that is exhaled is a mixture of alveolar air and the inspired air that remained in the dead space.

The blood in the capillary bed of the lungs is exposed to the gas pressures of alveolar air through the thin membranes of the air sacs and the capillary walls. With this exposure taking place over a vast surface area, the gas pressure of the blood leaving the lungs is approximately equal to that present in alveolar air.

When arterial blood passes through the capillary network surrounding the cells in the body tissues it is exposed to and equalizes with the gas pressure of the tissues.

Some of the blood's oxygen is absorbed by the cells and carbon dioxide is picked up from these cells. When the blood returns to the pulmonary capillaries and is exposed to the alveolar air, the partial pressures of gases between the blood and the alveolar air is again equalized.

Carbon dioxide diffuses from the blood into the alveolar air, lowering its pressure, and oxygen is absorbed by the blood from the alveolar air, increasing its pressure. With each complete round of circulation, the blood is the medium through which this process of gas exchange occurs. Each cycle normally requires approximately 20 seconds.

3-4.7 Breathing Control. The amount of oxygen consumed and carbon dioxide produced increases markedly when a diver is working. The amount of blood pumped through the tissues and the lungs per minute increases in proportion to the rate at which these gases must be transported. As a result, more oxygen is taken up from the alveolar air and more carbon dioxide is delivered to the lungs for disposal. To maintain proper blood levels, the respiratory minute volume must also change in proportion to oxygen consumption and carbon dioxide output.

Changes in the partial pressure (concentration) of oxygen and carbon dioxide (ppO2 and ppCO2) in the arterial circulation activate central and peripheral chemoreceptors. These chemoreceptors are attached to important arteries. The most important are the carotid bodies in the neck and aortic bodies near the heart. The chemoreceptor in the carotid artery is activated by the ppCO2 in the blood and signals the respiratory center in the brain stem to increase or decrease respiration. The chemoreceptor in the aorta causes the aortic body reflex. This is a normal chemical reflex initiated by decreased oxygen concentration and increased carbon dioxide concentration in the blood. These changes result in nerve impulses that increase respiratory activity. Low oxygen tension alone does not increase breathing markedly until dangerous levels are reached. The part played by chemoreceptors is evident in normal processes such as breathholding.

As a result of the regulatory process and the adjustments they cause, the blood leaving the lungs usually has about the same oxygen and carbon dioxide levels during work that it did at rest. The maximum pumping capacity of the heart (blood circulation) and respiratory system (ventilation) largely determines the amount of work a person can do.

3-4.8 Oxygen Consumption. A diver's oxygen consumption is an important factor when determining how long breathing gas will last, the ventilation rates required to maintain proper helmet oxygen level, and the length of time a canister will absorb carbon dioxide. Oxygen consumption is a measure of energy expenditure and is closely linked to the respiratory processes of ventilation and carbon dioxide production.

Oxygen consumption is measured in liters per minute (l/min) at Standard Temperature (0°C, 32°F) and Pressure (14.7 psia, 1 ata), Dry Gas (STPD). These rates of oxygen consumption are not depth dependent. This means that a fully charged MK

16 oxygen bottle containing 360 standard liters (3.96 scf) of usable gas will last 225 minutes at an oxygen consumption rate of 1.6 liters per minute at any depth, provided no gas leaks from the rig.

Minute ventilation, or respiratory minute volume (RMV), is measured at BTPS (body temperature 37°C/98.6°F, ambient barometric pressure, saturated with water vapor at body temperature) and varies depending on a person's activity level, as shown in Figure 3-6. Surface RMV can be approximated by multiplying the oxygen consumption rate by 25. Although this 25:1 ratio decreases with increasing gas density and high inhaled oxygen concentrations, it is a good rule-of-thumb approximation for computing how long the breathing gas will last.

Unlike oxygen consumption, the amount of gas exhaled by the lungs is depth dependent. At the surface, a diver swimming at 0.5 knot exhales 20 l/min of gas. A scuba cylinder containing 71.2 standard cubic feet (scf) of air (approximately 2,000 standard liters) lasts approximately 100 minutes. At 33 fsw, the diver still exhales 20 l/min at BTPS, but the gas is twice as dense; thus, the exhalation would be approximately 40 standard l/min and the cylinder would last only half as long, or 50 minutes. At three atmospheres, the same cylinder would last only one-third as long as at the surface.

Carbon dioxide production depends only on the level of exertion and can be assumed to be independent of depth. Carbon dioxide production and RQ are used to compute ventilation rates for chambers and free-flow diving helmets. These factors may also be used to determine whether the oxygen supply or the duration of the CO2 absorbent will limit a diver's time in a closed or semi-closed system.

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