dr Salim S Thalib

Respiration is controlled by areas of the brain

that stimulate the contraction of the diaphragm
and the intercostal muscles.
These areas, collectively called
RESPIRATORY CENTERS

 Clustered neurons in the brain, located

bilaterally in the reticular formation of the brain
stem and from which nerve impulses are sent to
respiratory muscles.
Pons Respiratory Centers

Medullary Respiratory Centers

MEDULLARY RESPIRATORY CENTERS

Dorsal Respiratory Group
Inspiratory area

 INSPIRATORY CENTER
When fired they generates
rhythmic nerve impulses that
travel along the phrenic nerve
to diaphragm and intercostal
nerves to excite external
intercostal muscles
As a result, these muscles will
contract and the thorax
expand,
Volume increase
Pressure decrease
Air pushes into lungs

 DRG then becomes dormant,

and expiration occurs passively
as the inspiratory muscle relax
and the lungs recoil.
This cyclic activity of the
inspiratory neurons repeats and
produce respiratory rate of 12
15 breaths per minute

MEDULLARY RESPIRATORY CENTERS

Ventral Respiratory Group
Expiratory area

 VRG contain mix of neurons

Inspiratory
Expiratory (mainly)

Inactive during normal

respiration

Pontine respiratory group

A collection of neurons in the
reticular formation within the
pons

Transmit inhibitory impulses to

the inspiratory centers in
medulla

Factors influencing the respiratory center of the

brain
Pulmonary irritant reflexes
Receptors in the lung that respond to irritants
Activation of irritant receptors

Send signals to respiratory centers through vagal nerve

Modify respiratory rate and depth

Factors influencing the respiratory center of the

brain
The inflation reflexes
Stretch Receptors (baroreceptors) in visceral
pleurae that stimulated when lung are inflated
Activation of stretch receptors

Send inhibitory signals to medullary respiratory

centers through vagus nerve

End inspiration and allow expiration

Factors influencing the respiratory center of the

brain
Influence of higher brain centers
Hypothalamic controls
Activation of sympathetic centers in hypothalamus

Send signals to respiratory centers

Modify respiratory rate and depth

Factors influencing the respiratory center of the

brain
Influence of higher brain centers
Cortical controls - voluntary controls
Cerebral motor cortex

Send signals to motor neurons

Stimulate respiratory muscles

(Bypassing the medullary center)

Factors influencing the respiratory center of the

brain
Chemical factors:
Oxygen (O2)
Carbon dioxide (CO2)
Hydrogen ion (H+)

Sensed by CHEMORECEPTORS

Factors influencing the respiratory center of the

brain
CHEMORECEPTORS
Central chemoreceptors
Located in bilaterally in medulla
Sensitive to the pH ECF

Peripheral chemoreceptors
Located in great vessels of neck
sensitive to PO2, PCO2 and pH

Influence of PCO2 and H+

Most potent and
most closely
controlled
Sensed by central
chemoreceptors

Influence of PCO2 and H+

Influence of PO2
Cells sensitive to arterial
PO2 are found in:
Peripheral
chemoreceptors:
Aortic bodies
In arch of aorta

Carotid bodies
In common carotid artery

Influence of PO2
Under normal condition the
decline in arterial PO2 has a
slight effect on ventilation.
Arterial PO2 must decrease
to less than 60 mm Hg
before O2 level become
major stimulus for increased
ventilation.

Influence of arterial pH
changes in arterial pH can
modify respiratory rate
and depth even when CO2
and O2 are normal
Act on peripheral
chemoreceptors.

INTRUDUCTION

DEFINITION
DYSPNEA

OF

MECHANISM
DYSPNEA

DYSPNEA

OF

RESEPTOR PADA SISTEM RESPIRASI

Kapasitas residu paru

obstruksi paru

Composed of four general categories

Pulmonary
Cardiac
Mixed cardiac or pulmonary
non-cardiac or non-pulmonary

Cardiac Etiology

CHF Congestive heart failure

CAD Coronary artery disease
MI (recent or past history)
Miocard infarct
Cardiomyopathy
Valvular dysfunction
Left ventricular hypertrophy
Pericarditis
Arrhythmias

 COPD with pulmonary HTN and/or cor

pulmonale
Deconditioning
Chronic pulmonary emboli
Pleural effusion

Metabolic conditions (e.g. acidosis)

Pain
Trauma
Neuromuscular disorders
Functional (anxiety,panic disorders, hyperventilation)
Chemical exposure

Airway

VENTILASI

Alveol

DIFUSI

Kapiler darah

PERFUSI

Pulmonary Etiology

Airway

Sumbatan

No VENTILASI

Alveol

PERFUSI
Bood flow

Kapiler darah

SHUNT UNIT

PERFUSION WITHOUT VENTILATION

SHUNT UNIT

Akibat alveoli yang kolaps, darah yang

mengaliri tidak mengalami oksigenasi
Perfusion without ventilation shunt
(direct right-to-left shunt)
Ratio ventilasi-perfusi terganggu

hipoksemia

AIR FLUID LEVEL

Barking cough, stridor, hoarseness

Difficul breathing worsen at night

Steeple sign

Pengisian alveoli oleh eksudat /cairan

Ventilasi berkurang / tidak ada

Unit shunt

Hipoksemia

Questions ?