Applied Respiratory Physiology

Applied Respiratory Physiology

3rd Edition - January 1, 1987

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  • Author: J. F. Nunn
  • eBook ISBN: 9781483162331

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Applied Respiratory Physiology, Third Edition focuses on the applications of respiratory physiology and is designed to bridge the gap between applied respiratory physiology and the treatment of patients. This book is divided into two parts; the first of which is confined to general principles and the second deals with the various applied situations. This text is comprised of 29 chapters. After giving a general introduction to human respiratory physiology, including the functional anatomy of the respiratory tract, this book turns to the topic of the elastic resistance afforded by lungs and chest wall, along with its effect on the resting end-expiratory lung volume or functional residual capacity. The role of anesthesia in the control of breathing and the relative distribution of ventilation and perfusion are then examined. The section on artificial ventilation covers the techniques of ventilation and extracorporeal gas exchange. The reader is also introduced to special forms of lung pathology that have a major effect on lung function, including the adult respiratory distress syndrome, pulmonary oedema, embolus, and collapse. Sleep, smoking, diving, and drowning are also examined in this book. In addition, this text provides substantial coverage of exercise, high altitude, children, and neonates. This book will be of interest to clinicians and practitioners of applied respiratory physiology.

Table of Contents

  • Foreword to the First Edition

    Preface to the First Edition

    Preface to the Third Edition

    Part I Basic Principles

    1 Functional Anatomy of the Respiratory Tract

    Mouth and Pharynx

    The Larynx

    The Trachobronchial Tree

    The Alveoli

    The Pulmonary Vasculature

    2 Elastic Forces and Lung Volumes

    Elastic Recoil of the Lungs

    Elastic Recoil of the Thoracic Cage

    Pressure/Volume Relationships of the Lung plus Thoracic Cage

    Lung Volumes

    Principles of Measurement of Compliance

    Principles of Measurement of Lung Volumes

    3 Resistance to Gas Flow and Airway Closure

    Laminar Flow

    Turbulent Flow

    Threshold Resistors

    Minor Sources of Resistance to Gas Flow

    Increased Airway Resistance

    Causes of Increased Airway Resistance

    Compensation for Increased Resistance to Breathing

    Principles of Measurement of Flow Resistance

    4 Control of Breathing

    The origin of the Respiratory Rhythm

    Motor Pathways Concerned in Breathing

    Chemical Control of Breathing

    Reflex Control of Breathing

    Breath Holding

    Ventilatory Response to Loaded Breathing

    Outline of Methods of Assessment of Factors in Control of Breathing

    5 Pulmonary Ventilation

    Mechanisms of Breathing

    The Work of Breathing

    The Minute Volume of Pulmonary Ventilation

    Measurement of Ventilation

    Measurement of Ventilatory Capacity

    6 The Pulmonary Circulation

    Pulmonary Blood Volume

    Pulmonary Vascular Pressures

    Pulmonary Blood Flow

    Pulmonary Vascular Resistance

    Principles of Measurement of the Pulmonary Circulation

    7 Distribution of Pulmonary Ventilation and Perfusion

    Distribution of Ventilation

    Distribution of Perfusion

    Ventilation in Relation to Perfusion

    Dead Space

    The Concept of Venous Admixture

    Principles of Assessment of Distribution of Ventilation and Pulmonary Blood Flow

    8 Diffusion and Alveolar/Capillary Permeability

    Fundamentals of the Diffusion Process

    Diffusion of Oxygen within the Lungs

    Diffusion of Carbon Monoxide within the Lungs

    Diffusion of Carbon Dioxide within the Lungs

    Diffusion of 'Inert' Gases within the Lungs

    Diffusion of Gases in the Tissues

    Alveolar/Capillary Permeability

    Principles of Methods of Measurement of Carbon Monoxide Diffusing Capacity

    9 Carbon Dioxide

    Carriage of Carbon Dioxide in Blood

    Transfer of Carbon Dioxide Across Cell Membranes

    Factors Influencing the Carbon Dioxide Tension in the Steady State

    Causes of Hypocapnia (Respiratory Alkalosis)

    Causes of Hypercapnia (Respiratory Acidosis)

    Carbon Dioxide Stores and the Unsteady State

    Apnoeic Mass-Movement Oxygenation (Formerly Known as Diffusion Respiration)

    Therapeutic Uses of Carbon Dioxide

    Outline of Methods of Measurement of Carbon Dioxide

    10 Oxygen

    The Role of Oxygen in the Cell

    The Oxygen Cascade

    The Carriage of Oxygen in the Blood

    The 'Normal' Arterial Oxygen Tension

    Oxygen Stores and the Steady State

    Control of the Inspired Oxygen Concentration


    Principles of Measurement of Oxygen Levels

    11 Non-Respiratory Functions of the Lung


    Oxidative Metabolism of the Lung

    Protease Transport System

    Synthesis of Surfactant

    Processing of Hormones and Other Vasoactive Compounds

    Handling of Foreign Substances by the Lungs


    Part II The Applications

    12 Respiratory Aspects of Exercise

    Levels of Exercise

    Oxygen Consumption

    Anaerobic Metabolism

    Response of the Oxygen Delivery System

    Control of Ventilation

    13 Respiratory Aspects of Sleep

    Normal Sleep

    The Sleep Apnoea Syndrome

    The Postoperative Period

    Relationship to Sudden Infant Death Syndrome (SIDS)

    14 Respiratory Aspects of High Altitude

    Acute Exposure to Altitude

    Acute Mountain Sickness

    Adaptation to Altitude

    Exercise at High Altitude

    15 Respiratory Aspects of High Pressure and Diving

    Exchange of Oxygen and Carbon Dioxide

    Effects Attributable to the Composition of the Inspired Gas

    Special Circumstances of Exposure to Pressure

    Avoidance of Exposure of Man to Pressure

    16 Drowning

    Drowning without Aspiration

    Aspiration of Fresh Water

    Sea Water Drowning

    Other Material Contaminating the Lungs

    Tests of Drowning

    The Role of Hypothermia

    Principles of Treatment of Near-Drowning

    17 Smoking

    Smoking and Lung Function

    Constituents of Tobacco Smoke

    Individual Smoke Exposure

    Respiratory Effects of Smoking

    18 Respiration in Neonates and Children

    The Lungs Before Birth

    Events at Birth

    Neonatal Lung Function

    Development of Lung Function during Childhood

    Respiratory Distress Syndrome

    Artificial Ventilation of the Neonate and Young Child

    19 Respiratory Aspects of Anesthesia

    Control of Breathing

    Pattern of Contraction of Respiratory Muscles

    Changes in Lung and Trunk Volumes

    Consequences of the Change in FRC

    Metabolic Rate

    Gas Exchange

    Minute Volume of Ventilation

    The Three-Compartment Model of Gas Exchange

    Effect of Hypoxic Pulmonary Vasoconstriction

    Special Conditions Arising during Anaesthesia

    20 Ventilatory Failure

    Pattern of Changes in Arterial Blood Gas Tensions

    Causes of Failure of Ventilation

    Relationship between Rentilatory Capacity and Ventilatory Failure


    Treatment of Ventilatory Failure

    21 Artificial Ventilation

    Methods Used for Resuscitation

    Intermittent Positive Pressure Ventilation (IPPV)

    Special Techniques for IPPV

    Interaction Between Patient and Ventilator

    Positive EndEexpiratory Pressure (PEEP)

    Negative (Subatmospheric) End-Expiratory Pressure (NEEP)


    22 Extracorporeal Gas Exchange

    Factors in Design

    Types of Extracorporeal Gas Exchangers

    Damage to Blood

    Prolonged Extracorporeal Oxygenation for Respiratory Failure

    Extracorporeal Removal of Carbon Dioxide

    23 Pulmonary Oedema

    Anatomical Factors

    Stages of Pulmonary Oedema

    The Mechanism of Pulmonary Oedema



    Physiological Principles of Treatment

    Clinical Measurement

    24 Pulmonary Collapse and Atelectasis

    Loss of Forces Opposing Retraction of the Lung

    Absorption of Trapped Gas

    The Effect of Collapse

    Diagnosis of Pulmonary Collapse


    25 Pulmonary Embolism

    Air Embolism


    Fat Embolism

    26 Adult Respiratory Distress Syndrome


    Clinical Course

    Predisposing Conditions and Risk Factors

    Incidence and Mortality



    Mechanisms of Causation of ARDS

    Principles of Management

    Problems of Research into ARDS

    27 The Effects of Changes in the Carbon Dioxide Tension

    Effects upon the Nervous System

    Effects upon the Respiratory System

    Effects upon the Circulatory System

    Effect upon the Kidney

    Effect on Blood Electrolyte Levels

    Effect upon Drug Action

    Bedside Recognition of Hypercapnia

    28 Hypoxia

    Biochemical Changes in Hypoxia

    PO2 Levels and Hypoxia

    Compensatory Mechanisms in Hypoxia

    Organ Survival Times

    29 Hyperoxia and Oxygen Toxicity


    Hyperbaric Oxygenation

    Oxygen Toxicity

    Clinical Oxygen Toxicity

    Other Hazards of Oxygen

    Appendix A

    Physical Quantities and Units of Measurement

    Appendix B

    The Gas Laws

    Appendix C

    Conversion Factors for Gas Volumes

    Appendix D

    Symbols, Abbreviations and Definitions

    Appendix E

    Nomograms and Correction Charts

    Appendix F

    The Exponential Function

    The Tear-Away Exponential Function

    The Wash-out or Die-Away Exponential Function

    The Wash-in Exponential Function

    References and Further Reading


Product details

  • No. of pages: 600
  • Language: English
  • Copyright: © Butterworth-Heinemann 1987
  • Published: January 1, 1987
  • Imprint: Butterworth-Heinemann
  • eBook ISBN: 9781483162331

About the Author

J. F. Nunn

Affiliations and Expertise

Formerly Head of Division of Anaesthesia, MRC Clinical Research Centre; Honorary Consultant Anaesthetist, Northwick Park Hospital, UK; Previously Professor of Anaesthesia, University of Leeds; Dean of Faculty of Anaesthetists, 1979 - 1982, Royal College of Surgeons of England, UK

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