, Essential Equations
Chapter 2 Ventilation
Pr4
Transairway pressure: Pta Pm Palv Poiseuille’s law for flow: V
8l
V 8l
Transpulmonary pressure: Ptp Palv Ppl Poiseuille’s law for pressure: P 4
r
P
Transthoracic pressure: Ptt Palv Pbs Airway resistance: Raw
V
V P (cm H2O) V (L)
Lung compliance: CL Time constants: TC (sec)
P V (L/sec) P (cm H2O)
P (Raw) (CL)
Elastance:
V
ST
Laplace’s law: P Minute alveolar ventilation: VA (VT VD) breaths/min
r
Chapter 3 The Diffusion of Pulmonary Gases
Boyle’s law (solving for volume): Gay-Lussac’s law: P1/T1 P2/T2
T1 V1
V2
P2
Boyle’s law (solving for pressure): Gay-Lussac’s law (solving for pressure):
T1 V1 T1 T2
P2 P2
V2 T1
Charles’ law: V1/T1 V2/T2 Dalton’s law: Gas A Gas B Gas A B
A.D. (P1 P2)
Charles’ law (solving for volume): Fick’s law: V gas
T
V1 T2
V2 Graham’s law: 1 2GMW
T1
Ideal alveolar gas equation:
PAO2 [BP PH2O] FIO2 PaCO2 (1.25)
Chapter 5 The Anatomy and Physiology of the Circulatory System
Cardiac output: CO SV HR
Blood pressure: P CO SVR
BP
Vascular resistance:
CO (continues on inside back cover)
, Essential Equations (continued)
Chapter 6 Oxygen Transport
O2 bound to Hb: 1.34 g% Hb SaO2 Total O2 delivery: DO2 QT (CaO2 10)
Dissolved O2: PaO2 0.003 Arterial-venous oxygen content difference:
C (a v)O2 CaO2 CvO2
Oxygen content of arterial blood:
CaO2 (Hb 1.34 SaO2) (PaO2 0.003) Oxygen consumption: VO2 QT [C(a v)O2 10]
Oxygen content of mixed venous blood: CaO2 CvO2
CvO2 (Hb 1.34 SvO2) PvO2 0.003) Oxygen extraction ratio: O2 ER
CaO2
Oxygen content of pulmonary capillary blood: CCO2 CaO2
QS
CCO2 (Hb 1.34) (PAO2 0.003) Shunt equation: CC Cv
QT O2 O2
Chapter 7 Carbon Dioxide Transport and Acid-Base Balance
[HCO3 ]
Henderson-Hasselbalch equation: pH pK log
[H2CO3]
Chapter 8 Ventilation-Perfusion Relationships
VCO2
Respiratory quotient: RQ
VO2
Chapter 15 Hemodynamic Measurements
CO Right ventricular stroke work index:
Stroke volume: SV
HR RVSWI SVI (PA CVP) 0.0136 g/mL
SV Left ventricular stroke work index:
Stroke volume index: SVI LVSWI SVI (MAP PCWP) 0.0136 g/mL
BSA
CO Pulmonary vascular resistance:
Cardiac index: CI PA PCWP
BSA PVR 80
CO
MAP CVP
Systemic vascular resistance: SVR 80
CO
Chapter 17 Exercise and Its Effects on the Cardiopulmonary System
Maximum heart rate: 220 age
, Cardiopulmonary
Anatomy & Physiology
Essentials for
Respiratory Care
FOURTH EDITION
,DEDICATION
To Ken and Esther
, Cardiopulmonary
Anatomy & Physiology
Essentials for
Respiratory Care
FOURTH EDITION
Terry Des Jardins, MEd, RRT
Department of Respiratory Care
Parkland College
Champaign, Illinois
Australia Canada Mexico Singapore Spain United Kingdom United States
, Cardiopulmonary Anatomy & Physiology
Essentials for Respiratory Care, 4th Edition
Terry Des Jardins
Health Care Publishing Director: Editorial Assistant: Project Editor:
William Brottmiller Maria D’Angelico Mary Ellen Cox
Executive Editor: Executive Marketing Manager: Production Editor:
Cathy L. Esperti Dawn F. Gerrain James Zayicek
Acquisitions Editor: Channel Manager: Art/Design Coordinator:
Candice Janco Jennifer McAvey Jay Purcell
Developmental Editor: Marketing Coordinator:
Marjorie A. Bruce Kimberly Lourinia
COPYRIGHT © 2002 by Delmar, a division of Thomson For permission to use material from this text or product, con-
Learning, Inc. Thomson Learning™ is a trademark used tact us by
herein under license. Tel (800) 730-2214
Printed in the United States of America Fax (800) 730-2215
1 2 3 4 5 XXX 05 04 03 02 01 www.thomsonrights.com
For more information, contact Delmar, Library of Congress Cataloging-in-Publication Data
3 Columbia Circle, PO Box 15015, Des Jardins, Terry R.
Albany, NY 12212-0515 Cardiopulmonary anatomy & physiology : essentials for
Or you can visit our Internet site at http://www.delmar.com respiratory care / Terry Des Jardins—4th ed.
ALL RIGHTS RESERVED. Certain portions of this work © p. cm.
1998, 1993, and 1988. No part of this work covered by the Includes bibliographical references and index.
copyright hereon may be reproduced or used in any form or ISBN 0-7668-2533-7 (alk. paper)
by any means—graphics, electronic, or mechanical, including 1. Cardiopulmonary system—Physiology.
photocopying, recording, taping, Web distribution or informa- 2. Cardiopulmonary system—Anatomy. 3. Respiratory
tion storage and retrieval system—without written permis- therapy.
sion of the publisher. [DNLM: 1. Cardiovascular System—anatomy &
histology. 2. Cardiovascular System—physiology.
3. Respiratory System—physiology.]
I. Title: Cardiopulmonary anatomy & physiology.
II. Title.
QP121 .D47 2001
612.1—dc21 2001047593
NOTICE TO THE READER
Publisher does not warrant or guarantee any of the products described herein or perform any independent analysis in connec-
tion with any of the product information contained herein. Publisher does not assume, and expressly disclaims, any obligation
to obtain and include information other than that provided to it by the manufacturer.
The reader is expressly warned to consider and adopt all safety precautions that might be indicated by the activities herein and
to avoid all potential hazards. By following the instructions contained herein, the reader willingly assumes all risks in connection
with such instructions.
The Publisher makes no representation or warranties of any kind, including but not limited to, the warranties of fitness for par-
ticular purpose or merchantability, nor are any such representations implied with respect to the material set forth herein, and the
publisher takes no responsibility with respect to such material. The publisher shall not be liable for any special, consequential, or
exemplary damages resulting, in whole or part, from the readers’ use of, or reliance upon, this material.
, CONTENTS
List of Tables xiii
Foreword xv
Preface xvii
Acknowledgments xx
I Section One
The Cardiopulmonary System—The Essentials 1
Chapter 1
The Anatomy and Physiology of the Respiratory System 3
The Airways 7
The Upper Airway 7
The Lower Airways 22
The Sites of Gas Exchange 34
The Pulmonary Vascular System 37
The Lymphatic System 41
Neural Control of the Lungs 43
The Lungs 44
The Mediastinum 46
The Pleural Membranes 48
The Thorax 49
The Diaphragm 50
Chapter Summary 58
Review Questions 59
Chapter 2
Ventilation 63
Pressure Differences Across the Lungs 64
Role of the Diaphragm in Ventilation 67
v
,vi CONTENTS
Positive Pressure Ventilation 69
Static Characteristics of the Lungs 71
Dynamic Characteristics of the Lungs 86
Ventilatory Patterns 94
How Normal Intrapleural Pressure Differences Cause Regional
Differences in Normal Lung Ventilation 100
The Effect of Airway Resistance and Lung Compliance on
Ventilatory Patterns 101
Overview of Specific Ventilatory Patterns 102
Chapter Summary 106
Clinical Applications 109
Review Questions 112
Clinical Application Questions 115
Chapter 3
The Diffusion of Pulmonary Gases 117
Gas Laws 118
The Partial Pressures of Atmospheric Gases 120
The Ideal Alveolar Gas Equation 122
The Diffusion of Pulmonary Gases 123
Oxygen and Carbon Dioxide Diffusion Across the Alveolar-
Capillary Membrane 124
Gas Diffusion 128
Perfusion-Limited Gas Flow 130
Diffusion-Limited Gas Flow 131
How Oxygen Can Be Either Perfusion or Diffusion Limited 134
Chapter Summary 136
Clinical Applications 136
Review Questions 139
Clinical Application Questions 141
Chapter 4
Pulmonary Function Measurements 143
Lung Volumes and Capacities 144
Pulmonary Mechanics 148
How the Effects of Dynamic Compression Decrease Expiratory
Flow Rates 157
, CONTENTS vii
Chapter Summary 161
Clinical Applications 162
Review Questions 166
Clinical Application Questions 168
Chapter 5
The Anatomy and Physiology of the Circulatory System 169
The Blood 170
The Heart 175
The Pulmonary and Systemic Vascular Systems 183
Pressures in the Pulmonary and Systemic Vascular
Systems 187
The Cardiac Cycle and Its Effect on Blood Pressure 188
The Distribution of Pulmonary Blood Flow 192
Chapter Summary 203
Clinical Applications 205
Review Questions 208
Clinical Application Questions 210
Chapter 6
Oxygen Transport 211
Oxygen Transport 213
Oxygen Dissociation Curve 216
Oxygen Transport Studies 229
Tissue Hypoxia 240
Cyanosis 242
Polycythemia 243
Chapter Summary 244
Clinical Applications 244
Review Questions 248
Clinical Application Questions 250
Chapter 7
Carbon Dioxide Transport and Acid-Base Balance 251
Carbon Dioxide Transport 252
Carbon Dioxide Elimination at the Lungs 254
Chapter 2 Ventilation
Pr4
Transairway pressure: Pta Pm Palv Poiseuille’s law for flow: V
8l
V 8l
Transpulmonary pressure: Ptp Palv Ppl Poiseuille’s law for pressure: P 4
r
P
Transthoracic pressure: Ptt Palv Pbs Airway resistance: Raw
V
V P (cm H2O) V (L)
Lung compliance: CL Time constants: TC (sec)
P V (L/sec) P (cm H2O)
P (Raw) (CL)
Elastance:
V
ST
Laplace’s law: P Minute alveolar ventilation: VA (VT VD) breaths/min
r
Chapter 3 The Diffusion of Pulmonary Gases
Boyle’s law (solving for volume): Gay-Lussac’s law: P1/T1 P2/T2
T1 V1
V2
P2
Boyle’s law (solving for pressure): Gay-Lussac’s law (solving for pressure):
T1 V1 T1 T2
P2 P2
V2 T1
Charles’ law: V1/T1 V2/T2 Dalton’s law: Gas A Gas B Gas A B
A.D. (P1 P2)
Charles’ law (solving for volume): Fick’s law: V gas
T
V1 T2
V2 Graham’s law: 1 2GMW
T1
Ideal alveolar gas equation:
PAO2 [BP PH2O] FIO2 PaCO2 (1.25)
Chapter 5 The Anatomy and Physiology of the Circulatory System
Cardiac output: CO SV HR
Blood pressure: P CO SVR
BP
Vascular resistance:
CO (continues on inside back cover)
, Essential Equations (continued)
Chapter 6 Oxygen Transport
O2 bound to Hb: 1.34 g% Hb SaO2 Total O2 delivery: DO2 QT (CaO2 10)
Dissolved O2: PaO2 0.003 Arterial-venous oxygen content difference:
C (a v)O2 CaO2 CvO2
Oxygen content of arterial blood:
CaO2 (Hb 1.34 SaO2) (PaO2 0.003) Oxygen consumption: VO2 QT [C(a v)O2 10]
Oxygen content of mixed venous blood: CaO2 CvO2
CvO2 (Hb 1.34 SvO2) PvO2 0.003) Oxygen extraction ratio: O2 ER
CaO2
Oxygen content of pulmonary capillary blood: CCO2 CaO2
QS
CCO2 (Hb 1.34) (PAO2 0.003) Shunt equation: CC Cv
QT O2 O2
Chapter 7 Carbon Dioxide Transport and Acid-Base Balance
[HCO3 ]
Henderson-Hasselbalch equation: pH pK log
[H2CO3]
Chapter 8 Ventilation-Perfusion Relationships
VCO2
Respiratory quotient: RQ
VO2
Chapter 15 Hemodynamic Measurements
CO Right ventricular stroke work index:
Stroke volume: SV
HR RVSWI SVI (PA CVP) 0.0136 g/mL
SV Left ventricular stroke work index:
Stroke volume index: SVI LVSWI SVI (MAP PCWP) 0.0136 g/mL
BSA
CO Pulmonary vascular resistance:
Cardiac index: CI PA PCWP
BSA PVR 80
CO
MAP CVP
Systemic vascular resistance: SVR 80
CO
Chapter 17 Exercise and Its Effects on the Cardiopulmonary System
Maximum heart rate: 220 age
, Cardiopulmonary
Anatomy & Physiology
Essentials for
Respiratory Care
FOURTH EDITION
,DEDICATION
To Ken and Esther
, Cardiopulmonary
Anatomy & Physiology
Essentials for
Respiratory Care
FOURTH EDITION
Terry Des Jardins, MEd, RRT
Department of Respiratory Care
Parkland College
Champaign, Illinois
Australia Canada Mexico Singapore Spain United Kingdom United States
, Cardiopulmonary Anatomy & Physiology
Essentials for Respiratory Care, 4th Edition
Terry Des Jardins
Health Care Publishing Director: Editorial Assistant: Project Editor:
William Brottmiller Maria D’Angelico Mary Ellen Cox
Executive Editor: Executive Marketing Manager: Production Editor:
Cathy L. Esperti Dawn F. Gerrain James Zayicek
Acquisitions Editor: Channel Manager: Art/Design Coordinator:
Candice Janco Jennifer McAvey Jay Purcell
Developmental Editor: Marketing Coordinator:
Marjorie A. Bruce Kimberly Lourinia
COPYRIGHT © 2002 by Delmar, a division of Thomson For permission to use material from this text or product, con-
Learning, Inc. Thomson Learning™ is a trademark used tact us by
herein under license. Tel (800) 730-2214
Printed in the United States of America Fax (800) 730-2215
1 2 3 4 5 XXX 05 04 03 02 01 www.thomsonrights.com
For more information, contact Delmar, Library of Congress Cataloging-in-Publication Data
3 Columbia Circle, PO Box 15015, Des Jardins, Terry R.
Albany, NY 12212-0515 Cardiopulmonary anatomy & physiology : essentials for
Or you can visit our Internet site at http://www.delmar.com respiratory care / Terry Des Jardins—4th ed.
ALL RIGHTS RESERVED. Certain portions of this work © p. cm.
1998, 1993, and 1988. No part of this work covered by the Includes bibliographical references and index.
copyright hereon may be reproduced or used in any form or ISBN 0-7668-2533-7 (alk. paper)
by any means—graphics, electronic, or mechanical, including 1. Cardiopulmonary system—Physiology.
photocopying, recording, taping, Web distribution or informa- 2. Cardiopulmonary system—Anatomy. 3. Respiratory
tion storage and retrieval system—without written permis- therapy.
sion of the publisher. [DNLM: 1. Cardiovascular System—anatomy &
histology. 2. Cardiovascular System—physiology.
3. Respiratory System—physiology.]
I. Title: Cardiopulmonary anatomy & physiology.
II. Title.
QP121 .D47 2001
612.1—dc21 2001047593
NOTICE TO THE READER
Publisher does not warrant or guarantee any of the products described herein or perform any independent analysis in connec-
tion with any of the product information contained herein. Publisher does not assume, and expressly disclaims, any obligation
to obtain and include information other than that provided to it by the manufacturer.
The reader is expressly warned to consider and adopt all safety precautions that might be indicated by the activities herein and
to avoid all potential hazards. By following the instructions contained herein, the reader willingly assumes all risks in connection
with such instructions.
The Publisher makes no representation or warranties of any kind, including but not limited to, the warranties of fitness for par-
ticular purpose or merchantability, nor are any such representations implied with respect to the material set forth herein, and the
publisher takes no responsibility with respect to such material. The publisher shall not be liable for any special, consequential, or
exemplary damages resulting, in whole or part, from the readers’ use of, or reliance upon, this material.
, CONTENTS
List of Tables xiii
Foreword xv
Preface xvii
Acknowledgments xx
I Section One
The Cardiopulmonary System—The Essentials 1
Chapter 1
The Anatomy and Physiology of the Respiratory System 3
The Airways 7
The Upper Airway 7
The Lower Airways 22
The Sites of Gas Exchange 34
The Pulmonary Vascular System 37
The Lymphatic System 41
Neural Control of the Lungs 43
The Lungs 44
The Mediastinum 46
The Pleural Membranes 48
The Thorax 49
The Diaphragm 50
Chapter Summary 58
Review Questions 59
Chapter 2
Ventilation 63
Pressure Differences Across the Lungs 64
Role of the Diaphragm in Ventilation 67
v
,vi CONTENTS
Positive Pressure Ventilation 69
Static Characteristics of the Lungs 71
Dynamic Characteristics of the Lungs 86
Ventilatory Patterns 94
How Normal Intrapleural Pressure Differences Cause Regional
Differences in Normal Lung Ventilation 100
The Effect of Airway Resistance and Lung Compliance on
Ventilatory Patterns 101
Overview of Specific Ventilatory Patterns 102
Chapter Summary 106
Clinical Applications 109
Review Questions 112
Clinical Application Questions 115
Chapter 3
The Diffusion of Pulmonary Gases 117
Gas Laws 118
The Partial Pressures of Atmospheric Gases 120
The Ideal Alveolar Gas Equation 122
The Diffusion of Pulmonary Gases 123
Oxygen and Carbon Dioxide Diffusion Across the Alveolar-
Capillary Membrane 124
Gas Diffusion 128
Perfusion-Limited Gas Flow 130
Diffusion-Limited Gas Flow 131
How Oxygen Can Be Either Perfusion or Diffusion Limited 134
Chapter Summary 136
Clinical Applications 136
Review Questions 139
Clinical Application Questions 141
Chapter 4
Pulmonary Function Measurements 143
Lung Volumes and Capacities 144
Pulmonary Mechanics 148
How the Effects of Dynamic Compression Decrease Expiratory
Flow Rates 157
, CONTENTS vii
Chapter Summary 161
Clinical Applications 162
Review Questions 166
Clinical Application Questions 168
Chapter 5
The Anatomy and Physiology of the Circulatory System 169
The Blood 170
The Heart 175
The Pulmonary and Systemic Vascular Systems 183
Pressures in the Pulmonary and Systemic Vascular
Systems 187
The Cardiac Cycle and Its Effect on Blood Pressure 188
The Distribution of Pulmonary Blood Flow 192
Chapter Summary 203
Clinical Applications 205
Review Questions 208
Clinical Application Questions 210
Chapter 6
Oxygen Transport 211
Oxygen Transport 213
Oxygen Dissociation Curve 216
Oxygen Transport Studies 229
Tissue Hypoxia 240
Cyanosis 242
Polycythemia 243
Chapter Summary 244
Clinical Applications 244
Review Questions 248
Clinical Application Questions 250
Chapter 7
Carbon Dioxide Transport and Acid-Base Balance 251
Carbon Dioxide Transport 252
Carbon Dioxide Elimination at the Lungs 254
