Control of ventilation
- Douglas C Johnson, MD
Douglas C Johnson, MD
- Associate Professor, Department of Medicine
- Tufts University School of Medicine
- Section Editors
- Kevin R Flaherty, MD, MS
Kevin R Flaherty, MD, MS
- Section Editor — Interstitial Lung Disease
- Associate Professor of Medicine
- University of Michigan Health System
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
The respiratory system is dependent upon adequate ventilation to supply oxygen, remove carbon dioxide, and help maintain acid-base homeostasis. Ventilation responds to changes in the arterial carbon dioxide tension (PaCO2), arterial oxygen tension (PaO2), and pH (figure 1), and may be modified in response to a number of mechanical and irritant stimuli arising from various structures within the thoracic cage, and probably from within muscles and joints during exercise.
Broadly viewed, the respiratory control mechanisms respond to input from neural and chemical receptors. Respiratory centers in the brain integrate these inputs and provide neuronal drive to the respiratory muscles, which maintain upper airway patency and drive the thoracic bellows to determine the level of ventilation [1,2].
The physiologic aspects of the control of ventilation and the evaluation of patients with disorders of ventilation will be reviewed here. The deleterious effects of various disease states on the control of ventilation are discussed separately. (See "Disorders of ventilatory control".)
THORACIC NEURAL RECEPTORS
Several different neural receptors are present in the upper airways, trachea, lungs, chest wall, and pulmonary vessels .
●Slowly adapting pulmonary stretch receptors and muscle spindles respond primarily to changes in lung volume.
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- THORACIC NEURAL RECEPTORS
- PERIPHERAL CHEMORECEPTORS
- CENTRAL CHEMORECEPTORS
- Ventral medullary pH and alpha-imidazole receptors
- Brain extracellular fluid composition
- RESPONSES TO METABOLIC ACIDOSIS AND ALKALOSIS
- INTEGRATION OF NEURAL AND CHEMORECEPTOR INPUT
- EVALUATION OF RESPIRATORY DRIVE AND CONTROL
- Respiratory muscle forces
- Hypoxic challenge
- Hypercapnic challenge
- Alterations in ventilatory response to CO2 and O2
- Elastic and resistive loading
- Breathing pattern
- OTHER MEASUREMENTS OF RESPIRATORY EFFORT
- Mouth occlusion pressure