UPDATED PUNCTUAL SYNTHESIS OF ADVANCES IN KNOWLEDGE DEVELOPED FROM ANALYSIS AND INTERPRETATION OF THE RESPIRATORY PULSE AND DERIVED PARAMETERS IN CONTRAST TO TRADITIONAL BELIEFS
The structural and functional design of the Lung is a conception of Nature for autonomic-automatic dynamic integration of the Living Being's vital functions, in itself as with conditions of the Atmosphere at the level of the species adaptation. Therefore, this is condition for the species geographical distribution.
All the physiological and pathological vital parameters of each individual are correlative to the Respiratory Pulse
Living Beings, integrated with Atmosphere, are autonomous Systems of Fluid Mechanics for maintenance of Life.
Foetus are integrated Viscero-Somatic System of Fluid Mechanics for potential integration with Atmosphere, condition for autonomic Life as a Living Being
Lung and airways. Heart, blood vessels and other passageways for organic liquids circulation, constitute a partial, visceral System of Fluid Mechanics which needs to be integrated, by means of viscero-somatic reflexes, with somatic structures of the Trunk to achieve their commitments.
While Heart and blood vessels complete one circuit for blood circulation, leading to cell metabolism, Lung is composed by five lobar bronchial-circuits for air circulation leading to air renovation from the Atmosphere and gas exchange with the blood.
Each pulmonary lobe is a Mechanical-functional Unit of the Lung for renovation and distribution of a fifth of the inspired mass of air, leading to gas exchange with the blood.
Each lobe is a complex System of pneumatic pumps: The main lobar bronchial tree and its multiple lobular bronchiolar trees.
Each lobar lobule is a bronchiolar mechanical unit for balanced distribution of air to be immediately delivered to the alveoli. They also constitute a System of floodgates and presses allowing blood-balanced circulation throughout the alveolo-capillary units for simultaneous blood and air arrival, thus enabling uniform gas exchange.
Each alveolo-capillary membrane is a surface-unit for gas exchange with the blood.
Extra-pulmonary airways and the naso-pharynx are active specific air passages between Lung and Atmosphere, integrated to lobar mechanics.
The Vagus-Sympathetic is a complementary Autonomic Nerve System for Lung and Heart Dynamic performance in balanced integration. The Vagus is mainly concerned with air renovation from Atmosphere and visceral tonus, while Sympathetic is mainly concerned with gas exchange with the blood and parallel distribution to the cells.
Phrenic nerve and from the seventh to the lowest Intercostal nerves respond to Vagus nerve impulses, via reflex, for a linked viscero-somatic cyclic integration of the Organic System of Fluid Mechanics, leading to the vital functions dynamic balance.
Respiration is the main organic function resultant from the Lung-Heart, air and blood passageways and Thoraco-abdominal walls integrated dynamics.
Atmosphere is the Physic-Natural factor that primarily defines conditions for organic life adaptation, leading to a permanent integration. Organism adapts itself or suffers and dies.
The Respiratory Pulse is the Resultant of the Lung's autonomic mechanics, on its surface, in the pleural space. The Respiratory Pulse is to pulmonary mechanics what arterial pulse is to cardio-circulatory mechanics.
Each pulmonary lobe is a unitary complex autonomic system of pneumatic pumps, each one generating a similar pulse.
Right and left bronchia. Trachea and Larynx, closed by the Glottis, constitute an active unitary airway sector designed to receive and store the air used by the lobes during the cyclic period just finishing, to then eject them towards the exterior. This ejection is followed by a renewal of a similar volume-mass of air stored in the naso-pharynx, to be later delivered to the lobes after adding a degree of acclimatisation and pressurisation.
Airflow throughout the pulmonary and extra-pulmonary airways and throughout the naso-pharyx, have five equal range protagonists: the five lobes. Each one of the named segments of the whole airways accomplishes their proper role in the integration of functional parts to achieve eupneic respiration.
Lung, as a whole in its ensemble, also integrates the Heart's Dynamics and general blood circulation into the Organic System of Fluid Mechanics.
The Lung accomplishes its widest functional integrating role, by means of the Respiratory Mechanics, while also integrating the vital organic dynamics with universal Dynamics, by means of the atmospheric air mass per volume unit. Therefore, Living Beings only become functional units in their integration with the Atmosphere.
Respiration, as it is known, shows a different rhythm to that of the Heart, thus evidencing a lack of knowledge concerning gas exchange with the blood.
The Graphs of the Respiratory Pulse show two different kinds of cyclic inflexions with own rhythms: A longer wave, lasting the whole period of a "respiratory cycle" as it is known, and a series of minor waves with parallel rhythm to that of the Heart.
This fact led me to one of my most striking discoveries:
1. The main lobar bronchial trees are responsible for the longer, higher and slower waves of pressures, which I have proved, are mainly concerned with atmospheric air cyclic renovation and distribution among the lobuli, under vagal discharge.
2. The small structures known as lobuli, with their lobular bronchiolar trees are responsible for the faster and lower pressure waves, which I have concluded, correspond to the dynamics for gas exchange with the circulating blood, under Sympathetic discharge.
The first named dynamics implies dynamic integration with the Atmosphere, while the latter implies integration with the Heart, both necessary conditions for Pulmonary Respiration, since this comprises two well differentiated mechanics: one for air renovation and the other for gas exchange.
The mathematical relationship between these two kinds of rhythms is:
Cardiac rhythm/ Ventilatory (breathing) rhythm
This formula expresses the relationship between the circulating fraction of the blood volume-mass that exchanges gases and the proportional fraction of the inspired air volume-mass
The Pleura attach, by physical adhesion, the lobes among them and the Lung as a whole with the Thorax walls.
The main role of the pleurae is to attach, by physical adhesion, the surfaces lined by them, in intimate contact, that is to say, the pulmonary lobes between them and the lobes at each side, as a whole, with the thorax walls. This physical adhesion makes the multi-lobar organ a physical working unit in its ensemble with the thorax walls.
The pleural space is the site where the two different Resultants of the pulmonary lobes cyclic mechanics is directly detected:
1. The Resultant of cyclic ejection of the air masses filling the bronchi, towards their finest branches in the Lung's periphery and the alveoli, followed by their ejection, as far as the main bronchia and air renovation from there: Respiratory Pulse.
2. The Resultant of simultaneous cyclic pressure variations in the pleural capacity content (pleural vapour): Pleural pressure
Similar and simultaneous dynamics of the pulmonary lobes show their Resultants on any site of their surfaces, causing the cyclic "Respiratory Pulse", main parameter of the lobar and pulmonary Dynamics
The same lobar (pulmonary) dynamics pulling from their adhesion to the thorax walls, by bronchoconstriction-retraction try to detach themselves, but only within physiological limits, consequently, this traction only manages to widen the pleural lumen, with proportional decrease in the pleural pressure.
During bronchorelaxation, the Lung expands due to the expansion of its pressurised air content, diminishing the pleural lumen with proportional decrease in pressure in the pleural content (pleural vapour). The pleural pressure variation becomes the second main parameter for interpretation of the pulmonary mechanics.
Expansion-retraction of the rib-cage, monitored as "pneumograph" is believed to be caused by contraction-relaxation of the intercostal muscles. This mechanics, jointly with contraction-relaxation of the Diaphragm, has also been thought the cause of inflation-deflation of the Lung, by means of produced increase decrease in the pleural capacity and consequent decrease increase in the pleural vacuum, but truth is quite different and complex:
Costal retraction is due to Diaphragm contraction during intercostal muscle relaxation.
Costal expansion is due to intercostal muscle contraction during Diaphragm relaxation.
Furthermore, as the pulmonary lobes are physically attached to the costal walls, these displace the Lung with them, the consequence being a cyclic widening narrowing of the inferior part of the Mediastinum, which is important to balance blood flow from the abdomen.
The Diaphragm is the base-support of the Lung, to which it responds by contraction via reflex, in order to achieve multiple objectives.
Phrenic-Diaphragm and the muscles innervated by the six lower intercostal nerves (six lower intercostal muscles and antero-lateral muscles of the abdomen) constitute a working somatic unit under the leadership of the Lung via reflex, first a viscero-somatic Vagus-Phrenic reflex, followed by a somato-somatic Diaphragm-intercostal innervated muscles reflex.
Diaphragm accomplishes an important function in respiration, although not in the role of protagonist as the motor of the Lung, as is believed in traditional theory:
Diaphragm contraction diminishes resistance to expansion of the intra-pulmonary air previously ejected towards the pulmonary periphery by bronchoconstriction.
The common reflex role of the above named striated muscles is in the balance of the blood flow, before arriving into the right auricle, all under the primary leadership of the Lung.
The Diaphragm "recruits", via reflex, the costal wall and antero-lateral muscles of the Abdomen, for an alternating belt-press action between the two thoracic cavities.
This cyclic working belt-press evidences alternating effects:
Contraction of the Diaphragm, presses down the abdominal content while gases in the Lung, expand.
When Lung retracts, it also pulls the Diaphragm with it, gradually diminishing its abdominal press effects.
Diaphragm relaxation is followed by inter-costal muscle contraction to expand the rib-walls, widening the peri-cardiac space, while simultaneous abdominal muscle contraction presses the abdominal liquid streams towards the Heart.
Diaphragm joins the lower part of the rib-cage and the antero-lateral muscles of the abdomen, as integrated parts of a diaphragmatic belt-press system, for balanced liquid circulation between the abdominal and thoracic cavities.
Diaphragm is a somatic reflex-leader for functional balance between the two cavities of the Trunk.
CONTROLL AND INTEGRATION
Central Nervous System is the great controller of Respiration as a whole: Tissue and pulmonary Respiration.
Vagus and thoracic Sympathetic nerves command Lung and Heart for their integrated dynamic performance.
Lung, as visceral effector of the Vagus nerve also integrates the walls of the Trunk, via Vagus-Phrenic viscero-somatic reflex, for a working viscero-somatic Unit.
Living Being and Atmosphere are the two factors constituting the whole Organo-Physical-Unit to define Life in the World.
Pulmonary Respiration is a Life lasting continuous cyclic process of autonomic-automatic performance by Lung and Heart in their ensemble, under Central Nervous System control and Vagus-Sympathetic command, where the Vagus is Chief commander and the Sympathetic response is proportional to Vagus discharge.
The Vagus commands the respiratory macro-dynamics, mainly concerned with air renovation and tonus.
The Sympathetic commands the micro-dynamics, leading to Lung-Heart Dynamic integration, allowing balanced air-blood cyclic distribution among the mixed alveolo-capillary units, for gas exchange.
Pulmonary lobuli and Heart share a common Sympathetic command on Vagus tonus, in order to co-ordinate parallel and simultaneous pulmonary and tissue respiration.
Lobular structure, under Sympathetic command and vagal tonus, also work as a System of floodgates and presses for capillary blood circulation throughout their own alveolar capillary units, this contradicting traditional attribution of this area of blood circulation to the Heart dynamics.
Living Organisms and surrounding Atmosphere are the two complementary unitary factors integrated for Respiration, as condition for Life in the World.
Composition-mass per volume-unit of air is the Atmosphere's physic-chemical and mathematical factor for Respiration.
Living Organism in its anatomo-functional integration as a System of Fluid Mechanics is the organic physic-chemical and mathematical factor for Respiration.
Therefore, these organic factors merit further analysis:
Visceral components: Lung. Heart. Blood vessels. Blood as a tissue. Extra-pulmonary air passages.
Somatic components: Diaphragm. Costo-sternal wall. Antero-lateral muscles of the abdomen
Viscero-Somatic reflex integration: Lung-Thorax walls-antero-lateral muscles of the Abdomen.
Lung-Thorax walls physical integrator: Pleural serous.
Nervous control: Central Nervous System.
Nerve Command: Vagus-Sympathetic.
Chief Nerve Commander: Vagus.
Nervous reflex command for somatic integration to visceral demand: Vagus-Phrenic nerves, followed by the six lower pairs of intercostals.
Chief Commander's orders for each Ventilo-Respiratory cycle: Vagus nerve discharge with pre-ganglionic Sympathetic stimulation.
Effectors of the Vagus discharge: Smooth muscles of the airways up to the Glottis.
Effector of the Sympathetic discharges: muscular fibres of the pulmonary airways, mainly concentrated in the lobular bronchioli.
Visceral Effector Units for Pulmonary Mechanics leading to Respiration: The five lobes.
Total Visceral Effector-Unit for performing Ventilo-Respiratory Cycles: The Lung as ensemble of the five lobes.
Co-ordinator of the lobar air-stream's alternating directions: Bronchial and bronchiolar sphincters (Sphincter-like of Muller) and Glottis's sphincter.
Mechanical co-ordinator of the capillary blood circulation throughout the alveolo-capillary units: The lobular units as floodgates and presses
Mechanical co-ordinator of the Lung-Heart Cyclic Dynamic integration: The lobular units.
Nerve Commander of the Lung-Heart dynamic integration leading to Pulmonary Respiration: Sympathetic on Vagal tonus.
Rhythm for gas exchange with the blood. Sympathetic rhythm.
Rhythm for air renovation from Atmosphere: Vagus rhythm.
Fractions of the inspired air mass subject to gas exchange during each Ventilo-Respiratory Cycle: Inspired air-mass/Sympathetic rhythm.
Proposed vocabulary concerning Pulmonary Respiration
1. I propose to reserve the name of Pulmonary Respiratory Cycle and Rhythm to the small cycles for gas exchange with the blood, since these are parallel to complementary integrated Heart dynamics and Tissue Respiration.
2.The name of Ventilatory Cycle and Rhythm for the cycles leading to air renovation from the Atmosphere.
3. The name of Ventilo-Respiratory Cycle and Rhythm for the whole complex cycle for air renovation and use by parallel series of cycles for gas exchange with the blood.
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