Respiratory Insufficiency Pathophysiology Diagnosis Oxygen Therapy

Diagnosis and treatment of most respiratory disorders depend heavily on understanding the basic physiologic principles of respiration and gas exchange. Some respiratory diseases result from inadequate ventilation. Others result from abnormalities of diffusion through the pulmonary membrane or abnormal blood transport of gases between the lungs and tissues. Therapy is often entirely different for these diseases, so it is no longer satisfactory simply to make a diagnosis of "respiratory insufficiency."

Useful Methods for Studying Respiratory Abnormalities

In the previous few chapters, we have discussed a number of methods for studying respiratory abnormalities, including measuring vital capacity, tidal air, functional residual capacity, dead space, physiologic shunt, and physiologic dead space. This array of measurements is only part of the armamentarium of the clinical pulmonary physiologist. Some other interesting tools are described here.

Study of Blood Gases and Blood pH

Among the most fundamental of all tests of pulmonary performance are determinations of the blood Po2, CO2, and pH. It is often important to make these measurements rapidly as an aid in determining appropriate therapy for acute respiratory distress or acute abnormalities of acid-base balance. Several simple and rapid methods have been developed to make these measurements within minutes, using no more than a few drops of blood. They are the following.

Determination of Blood pH. Blood pH is measured using a glass pH electrode of the type used in all chemical laboratories. However, the electrodes used for this purpose are miniaturized. The voltage generated by the glass electrode is a direct measure of pH, and this is generally read directly from a voltmeter scale, or it is recorded on a chart.

Determination of Blood CO2. A glass electrode pH meter can also be used to determine blood CO2 in the following way: When a weak solution of sodium bicarbonate is exposed to carbon dioxide gas, the carbon dioxide dissolves in the solution until an equilibrium state is established. In this equilibrium state, the pH of the solution is a function of the carbon dioxide and bicarbonate ion concentrations in accordance with the Henderson-Hasselbalch equation that is explained in Chapter 30; that is,

When the glass electrode is used to measure CO2 in blood, a miniature glass electrode is surrounded by a thin plastic membrane. In the space between the electrode and plastic membrane is a solution of sodium bicarbonate of known concentration. Blood is then superfused onto the outer surface of the plastic membrane, allowing carbon dioxide to diffuse from the blood into the bicarbonate solution. Only a drop or so of blood is required. Next, the pH is measured by the glass electrode, and the CO2 is calculated by use of the above formula.

Determination of Blood PO2. The concentration of oxygen in a fluid can be measured by a technique called polarography. Electric current is made to flow between a small negative electrode and the solution. If the voltage of the electrode is more than -0.6 volt different from the voltage of the solution, oxygen will deposit on the electrode. Furthermore, the rate of current flow through the electrode will be directly proportional to the concentration of oxygen (and therefore to P02 as well). In practice, a negative platinum electrode with a surface area of about 1 square millimeter is used, and this is separated from the blood by a thin plastic membrane that allows diffusion of oxygen but not diffusion of proteins or other substances that will "poison" the electrode.

Often all three of the measuring devices for pH, CO2, and Po2 are built into the same apparatus, and all these measurements can be made within a minute or so using a single, droplet-size sample of blood. Thus, changes in the blood gases and pH can be followed almost moment by moment at the bedside.

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Essentials of Human Physiology

Essentials of Human Physiology

This ebook provides an introductory explanation of the workings of the human body, with an effort to draw connections between the body systems and explain their interdependencies. A framework for the book is homeostasis and how the body maintains balance within each system. This is intended as a first introduction to physiology for a college-level course.

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