Respiratory system

Physics relevant to respiratory physiology

Fundamental gas laws relevant to critical care medicine

Partial pressure and the solubility of gases in biological systems

Physics of humidity and evaporation

Heating and humidification in the normal respiratory tract

Anatomy of the Respiratory System

Structure and function of the upper airways

Differences in upper airways of neonates, children and adults

Structure and function of the lower airways

Anatomy of the pulmonary and bronchial circulation

Structure and function of the alveolus

Properties, production and regulation of lung surfactant

Roles of the chest wall and diaphragm in respiratory mechanics

Non-respiratory functions of the lungs

Control of Ventilation

Control of ventilation and oxygenation

Relationship of arterial carbon dioxide and alveolar ventilation

Relationship of arterial oxygen and alveolar ventilation

Factors which influence the respiratory rate and tidal volume

Pathways and importance of the cough reflex

Mechanics of Breathing

The expiratory and inspiratory process

Static, dynamic and specific compliance

Measurement of respiratory compliance

Elastic properties of the respiratory system

Time constants

Resistance of the respiratory system

Factors that affect airway resistance

Measurement of respiratory resistance

Vertical gradient of pleural pressure

The effects of positioning on the mechanics of breathing

Work of breathing and its components

Pulmonary Capacities and Volumes

Lung volumes and capacities

Measurement of lung volumes and capacities

Functional residual capacity

Clinical significance and measurement of closing capacity

Pulmonary circulation

Physiological characteristics of pulmonary blood vessels

Differences between the pulmonary and systemic circulations

Factors which affect pulmonary vascular resistance

Ventilation-Perfusion Relationships

Global and regional ventilation and perfusion

West's zones of the lung

Ventilation-perfusion matching and mismatching

Methods of measuring ventilation-perfusion mismatch

Effects of ventilation-perfusion mismatch on gas exchange

Dead space and its components

Measurement of dead space

Physiological consequences of increased dead space

The concepts of venous admixture and shunt

Measurement and estimation of shunt

Physiological consequences of increased shunt

Diffusive Transfer of Respiratory Gases

The oxygen cascade

Movement of carbon dioxide from the cell to the atmosphere

Diffusion of gases through the alveolar membrane

Diffusing capacity and its measurement

Perfusion-limited and diffusion-limited transfer of gases

Gas Transport in the Blood

Oxygen carrying capacity of whole blood

Fraction of oxygenated haemoglobin

Measurement of oxygen saturation by the blood gas analyser

The oxyhaemoglobin dissociation curve

Factors which influence the affinity of haemoglobin for oxygen

The p50 value of a blood gas sample

The idealised p50 value for a standard set of conditions

Transport of carbon dioxide in the blood

The carbon dioxide dissociation curve

The Haldane Effect

The Bohr Effect

The erythrocyte chloride shift (Hamburger effect)

Carbon dioxide storage in the human body

Oxygen storage in the human body

Measurement and Properties of Haemoglobin Species

Absorption spectroscopy of haemoglobin species

Concentration of total haemoglobin in the ABG sample

Haematocrit: erythrocyte volume as fraction of total volume

Methaemoglobin measurement by the blood gas analyser

Physiology and consequences of foetal haemoglobin

Biological properties of methaemoglobin

Causes and mechanisms of methaemoglobinaemia

Spectrophotometry of carboxyhaemoglobin

Properties of myoglobin

Pulmonary function tests and equations

Common respiratory equations

The alveolar gas equation

Oxygen tension - based indices of oxygenation

Interpretation of lung function tests

Carbon dioxide and oxygen response curves

Respiratory Pharmacology and Therapeutic Gases

Pharmacology of oxygen

Physiological effects of hyperoxia

Causes and physiological effects of hypoxaemia

Pharmacology of carbon dioxide

Pharmacology of nitric oxide

Pharmacology of pulmonary vasodilators

Pharmacology of drugs used to treat asthma

Measurement and Monitoring of Respiratory Function

Arterial blood gas interpretation

Principles of pulse oximetry

End-tidal capnometry

Difference between end tidal and arterial PCO₂

Measurement of oxygen tension by electrolysis of dissolved oxygen

Principles of oxygen measurement with the Clark electrode

Principles of measuring PCO₂ with the Severinghaus electrode

Mechanical Ventilator Design and Function

Basic components of a mechanical ventilator

Power and gas supply requirements for mechanical ventilators

Methods of generating gas flow for mechanical ventilation

Control of gas concentration and flow delivery

Breathing circuits for manual and mechanical ventilation

Active circuit humidification equipment

Passive heat and moisture exchangers

Methods of generating positive ventilator circuit pressure

Sensors for monitoring mechanical ventilation

Filters in the mechanical ventilator circuit

Alarms and safety features in mechanical ventilation

Physiology of Positive Pressure Ventilation

Positive pressure and positive end-expiratory pressure (PEEP)

Intrinsic PEEP and positive pressure ventilation

Physiological effects of positive pressure ventilation in summary

Effects of positive pressure ventilation on pulmonary physiology

Effects of positive pressure ventilation on cardiovascular physiology

Haemodynamic changes during a mechanical breath

Effects of positive pressure ventilation on extrathoracic organ systems

Advantages and limitations of non-invasive ventilation

Power of mechanical ventilation

Settings on the Ventilator

Flow, volume, pressure, resistance and compliance

Phases of the mechanical breath

Phase variables: triggering, limits, cycling and PEEP

Control variables: volume and pressure

Triggering of a mechanically supported breath

Limit (target) variables in mechanical ventilation

Cycling from inspiration to expiration

Tidal volume and respiratory rate

Selecting and adjusting PEEP

Inspiratory pause, I:E ratio and inspiratory rise time

Modes of Mechanical Ventilation

Modes and targeting schemes of mechanical ventilation

Practical differences between pressure and volume controlled ventilation

Mandatory and spontaneous modes of ventilation

Ventilator Waveform Analysis

An introduction to the ventilator waveform

Interpreting the shape of the pressure waveform

Interpreting the shape of the ventilator flow waveform

Interpreting the shape of the pressure-volume loop

Pressure-volume loops in the presence of lung pathology

Interpreting the shape of the flow-volume loop

Intrinsic PEEP and the expiratory hold manoeuvre

Alveolar pressure and the inspiratory hold manoeuvre

The normal capnograph waveform

Abnormal capnography waveforms and their interpretation

Deranged Respiratory Physiology

Age-related changes in respiratory physiology

Physiological effects of high and low barometric pressure

Influence of morbid obesity on respiratory function

Influence of pregnancy on respiratory function

Neonatal respiratory physiology