Pulmonology Book

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Lung Volume

Aka: Lung Volume, Inspiratory Reserve Volume, Tidal Volume, Inspiratory Capacity, Expiratory Reserve Volume, Residual Volume, Total Lung Capacity, Minute Ventilation, Respiratory Minute Volume, Respiratory Dead Space, Anatomic Dead Space, Physiologic Dead Space
  1. See Also
    1. Pulmonary Function Test
    2. Diffusing Capacity
    3. Inhalation Challenge Test
    4. Exercise Spirometry
    5. Functional Residual Capacity
    6. Vital Capacity
    7. Peak Expiratory Flow Rate (PEFR)
    8. Spirometry Lower Limit of Normal (PFT LLN)
    9. Obstructive Lung Disease
    10. Restrictive Lung Disease
  2. Background
    1. At rest
      1. Tidal Volume (TV) represents basal respiratory flow, in and out (similar to gentle ocean tides)
    2. With exertion
      1. Vital Capacity (IRV and ERV, in addition to TV) is recruited to allow for deeper breaths
        1. Analogous to Cardiac Stroke Volume, which increases with exertion
        2. May increase with Exercise from 500 ml to 4200 ml per breath (TV+IRV +ERV) in 70 kg adult
        3. In Obstructive Lung Disease (Asthma, COPD), taking deep breaths is primary compensation
          1. Increasing Tidal Volume with deep breaths is less work than increasing Respiratory Rate
      2. When Vital Capacity is insufficient to support exertion, Respiratory Rate (RR) increases
        1. Respiratory Rate is analogous to Heart Rate in compensation for exertion
        2. May increase with Exercise, from 12 to 36 breaths per minute with strenuous Exercise
        3. Increased Respiratory Rate is primary compensation in high lung elastic rebound
          1. Increasing Respiratory Rate is less energy for these patients, then taking deep breaths
      3. Minute Ventilation may increase with Exercise from 6 L/min to over 150 L/min
    3. Images
      1. lungVolumes.png
  3. Interpretation: Overall Lung Volumes
    1. Vital Capacity (VC)
      1. Maximal volume expelled after maximal inspiration
      2. VC = ERV + TV + IRV
      3. VC = TLC - RV
      4. Decreased with low Lung Compliance, high elastic rebound (e.g. Restrictive Lung Disease, pulmonary fibrosis)
      5. Also low in Obstructive Lung Disease (e.g. Asthma, COPD), due to limited expiration (high Residual Volume)
    2. Total Lung Capacity (TLC)
      1. Volume in lungs at end of maximal inspiration
      2. Calculation: VC + RV
      3. Normal adult: 4-6 Liters
    3. Minute Ventilation (MV, Respiratory Minute Volume)
      1. Volume of breath inspired (and expired) per minute
      2. MV = TidalVolume x RespiratoryRate
      3. Typical resting Minute Ventilation in a 70 kg male is 6 liters/min = 500 ml TV x 12 breaths/min
    4. Alveolar Ventilation
      1. Volume of inspired air entering the alveoli per minute
      2. Similar to Minute Ventilation but subtracts alveolar dead space
        1. Aveolar dead space is 30-33% of Minute Ventilation in normal lungs (primarily Anatomic Dead Space)
        2. In a healthy lung, alveolar ventilation is typically two thirds of Minute Ventilation
        3. In very severe, end-stage COPD, alveolar ventilation may be as low as 20% of Minute Ventilation
      3. AV = (TidalVolume - AnatomicDeadSpace) x RespiratoryRate
        1. Normal adult example = (500-150) * 16 = 5600 ml
  4. Interpretation: Inspiratory Volumes
    1. Inspiratory Reserve Volume (IRV)
      1. Additional volume that could be inspired above normal inspiration (or Tidal Volume)
      2. Maximal inspired volume from end-tidal inspiration
      3. IRV may be as high as 40-43 ml/kg or 2800 ml in a 70 kg adult)
    2. Tidal Volume (Vt)
      1. Volume inspired and expired with each normal breath
      2. Tidal Volume is approximately one third of Vital Capacity
      3. Analogous to Cardiac Stroke Volume at Rest
      4. Minimum volume: 3 ml/kg
      5. Normal volume: 6-7 ml/kg (e.g. 500 ml in a 70 kg adult at rest)
      6. Typical ventilator Tidal Volume settings: 6-8 ml/kg
    3. Inspiratory Capacity (IC)
      1. Maximal volume inspired from resting expiratory level
      2. Calculation: IRV + Vt
  5. Interpretation: Expiratory Volumes
    1. Expiratory Reserve Volume (ERV)
      1. Additional volume that could be expired in addition to normal exhalation (or Tidal Volume)
      2. Maximal expired volume from end-tidal inspiration
      3. Normal: 25% of Vital Capacity (up to 15 ml/kg or 1050 ml in a 70 kg adult)
    2. Functional Residual Capacity (FRC)
      1. Volume remaining in lungs at resting expiratory level
      2. Resting position of the respiratory muscles
        1. Balance between the opposing recoil forces of lung and chest wall
      3. Functional Residual Capacity (FRC) is a key point from which other Lung Volumes are measured
        1. Inspiratory Capacity (IC) is measured from FRC to Total Lung Capacity (TLC)
        2. Expiratory Reserve Volume (ERV) is measured from FRC to Residual Volume (RV)
      4. FRC Measurements
        1. Body Plethysmography or body box
          1. Based on Boyle's law (Product of Pressure and Volume is constant, at constant Temperature)
          2. Technique
            1. Initial pressures are measured at mouth and in airtight box at rest (volume = FRC)
            2. Patient pants against a closed shutter and pressures are re-measured
              1. Volume has decreased from FRC to Residual Volume
              2. Pressure has increased
          3. FRC = Patm x dPb/dPm
            1. Where Patm = atmospheric or barometric pressure
            2. Where dPb = change in airtight box pressure
            3. Where dPm = change in mouth pressure
        2. Nitrogen Washout
          1. Start by rest breathing with normal Tidal Volumes
          2. At, end expiration, inhaled gas changed from room air to 100% oxygen
          3. Total exhaled nitrogen is measured over subsequent exhalations
          4. Volume of gas required to contain expired nitrogen is calculated (air is 78% nitrogen)
        3. Helium Dilution in Closed Circuit
          1. Start by rest breathing with normal Tidal Volumes
          2. At, end expiration, inhaled gas changed from room air to 10% helium in air
          3. Breathing and measurements continue until measured helium concentration reaches steady state
          4. Expired Carbon dioxide is absorbed by soda lime
          5. Used oxygen is replaced in the inspired air
          6. Helium concentration before and after steady state are used to calculate volume of replaced gas
    3. Forced Expiratory Volume in One Second (FEV1)
      1. Expiratory rate (FEV1) slowed by Obstructive Lung Disease (Asthma, COPD, chest masses)
    4. Residual Volume (RV)
      1. Volume remaining in lungs after maximal expiration
      2. Normal adult: 1.0 to 2.4 Liters
      3. Includes Respiratory Dead Space (anatomic and physiologic)
      4. Also includes healthy respiratory zone (alveoli to Bronchioles) that contribute to gas exchange
        1. Allows for passive CO2 and O2 diffusion in gas remaining in aveoli and Bronchioles between breaths
        2. Contrast with Physiologic Dead Space in diseased respiratory zone that cannot gas exchange
      5. RV is not measureable with standard Spirometry/PFTs
        1. Requires advanced testing (e.g. nitrogen washout, helium dilution, body plethysmography)
        2. Increased Residual Volume may also be suggested by barrel chest, hyperexpansion on CXR
  6. Interpretation: Dead Space
    1. Total Dead Space (Physiologic Dead Space)
      1. PhysiologicDeadSpace = AnatomicDeadSpace + AlveolarDeadSpace
    2. Anatomic Dead Space
      1. Volume of air within the nose, trachea and Bronchi that does not contribute to gas exchange
      2. Present in all patients regardless of health, representing 30-33% of Tidal Volume (e.g. 150 ml in 70 kg adult)
    3. Alveolar Dead Space
      1. Volume of air within the respiratory zone (alveoli to Bronchioles) that does not contribute to gas exchange
      2. In healthy patients, alveolar dead space is minimal (<5 ml)
      3. In diseased lung (e.g. COPD) or edematous lung (e.g. CHF, ARDS), alveolar dead space may be large
        1. Severe disease total dead space may be as large as 50-80% of Tidal Volume
      4. Ventilation-Perfusion mismatch results in some regions of lung that are over-ventilated and other underventilated
        1. Over-ventilated alveoli (V/Q>1) waste ventilation as blood is saturated with oxygen at a fixed maximum
        2. Alveolar dead space is the total excess ventilation to over-ventilated alveoli (V/Q>1)
    4. Measured Dead Space
      1. Vd/Vt = (PaCO2 - PeCO2)/PaCO2
      2. Where
        1. Vd = Physiologic Dead Space Volume
        2. Vt = Tidal Volume
        3. PaCO2 = arterial pCO2
        4. PeCO2 = expired CO2 (collected gas from several expired breaths)
          1. Expired CO2 is diluted by Ambient air and regions of excessive ventilation (V/Q>1)
            1. In these cases, PeCO2 will be much lower than PaCO2
      3. Interpretation
        1. Vd/Vt = 0.33 in normal lungs (resulting in ~150 ml in a 70 kg adult with TV 450-500 ml)
        2. Vd/Vt may increase to high fractions (0.6 to 0.8) in severe lung disease with V/Q>>1
  7. Resources
    1. Intagliata (2020) Lung Dead Space, StatPearls, Accessed 3/30/2021
      1. https://www.ncbi.nlm.nih.gov/books/NBK482501/
  8. References
    1. Rollings (1984) Facts and Formulas, McNaughton & Gunn
    2. Marini (1987) Respiratory Medicine, Williams & Wilkins

Expiratory Reserve Volume (C0015326)

Definition (NCI_CDISC) The maximum volume of air a subject can exhale from the lungs after a tidal exhalation.
Definition (NCI) The maximum volume of air a subject can exhale from the lungs after a tidal exhalation.
Definition (MSH) The extra volume of air that can be expired with maximum effort beyond the level reached at the end of a normal, quiet expiration. Common abbreviation is ERV.
Concepts Laboratory or Test Result (T034) , Organ or Tissue Function (T042)
MSH D005105
SnomedCT 55532004
English Expiratory Reserve Volumes, Reserve Volume, Expiratory, Reserve Volumes, Expiratory, Volume, Expiratory Reserve, Volumes, Expiratory Reserve, expiratory reserve volume, ERV-Expiratory reserve volume, erv, expiratory reserve volume (ERV) of lung, ERV, Expiratory reserve volume, ERV - Expiratory reserve volume, Expiratory reserve volume (observable entity), Expiratory Reserve Volume
Japanese 予備呼気量, ヨビコキリョウ
Swedish Utandningsreservvolym
Czech ERV, exspirační rezervní objem, Exspirační rezervní objem
Finnish Uloshengityksen varatila
French Volume de réserve expiratoire, VRE (Volume de Réserve Expiratoire)
Russian VYDOKHA REZERVNYI OB"EM, ВЫДОХА РЕЗЕРВНЫЙ ОБЪЕМ
Italian Volume di riserva espiratoria
Polish Objętość wydechowa zapasowa
Hungarian Kilégzési tartalék térfogat
Portuguese Volume de Reserva Expiratória, Volume Expiratório de Reserva, Volume de reserva expiratória
Spanish Volumen de Reserva Espiratoria, Volumen Espiratorio de Reserva, VRE, volumen de reserva espiratorio (entidad observable), volumen de reserva espiratorio, Volumen espiratorio de reserva
Norwegian Utåndingsreservevolum, Ekspiratorisk reservevolum, ERV
Dutch expiratoir reservevolume, Reservevolume, respiratoir
German expiratorisches Reservevolumen, Exspiratorisches Reservevolumen
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Inspiratory Capacity (C0021610)

Definition (CHV) The maximum volume of air that can be inspired after reaching the end of a normal, quiet expiration
Definition (NCI_CDISC) The maximum volume of air a subject can inhale into the lungs after a tidal exhalation (IRV plus TV).
Definition (NCI) The maximum volume of air a subject can inhale into the lungs after a tidal exhalation (IRV plus TV).
Definition (MSH) The maximum volume of air that can be inspired after reaching the end of a normal, quiet expiration. It is the sum of the TIDAL VOLUME and the INSPIRATORY RESERVE VOLUME. Common abbreviation is IC.
Concepts Organism Attribute (T032)
MSH D007320
SnomedCT 29533001
LNC MTHU008904
English Capacities, Inspiratory, Capacity, Inspiratory, Inspiratory Capacities, INSPIRATORY CAPAC, inspiratory capacity, Capacity.inspiratory, IC, Inspiratory capacity, IC - Inspiratory capacity, Inspiratory capacity (observable entity), Inspiratory Capacity
Japanese 深吸気量, シンキュウキリョウ
Swedish Inandningskapacitet
Czech inspirační kapacita, Inspirační kapacita
Finnish Sisäänhengityskapasiteetti
French Capacité vitale inspiratoire, CI (Capacité Inspiratoire), Capacité inspiratoire
Russian VDOKHA EMKOST', ВДОХА ЕМКОСТЬ
Polish Pojemność wdechowa, IC
Hungarian Belégzési kapacitás
Norwegian Inspiratorisk kapasitet
Spanish CI, capacidad inspiratoria (entidad observable), capacidad inspiratoria, Capacidad inspiratoria, Capacidad Inspiratoria
Portuguese Capacidade inspiratória, Capacidade Inspiratória
Dutch inspiratoire capaciteit, Capaciteit, inspiratoire, Inspiratoire capaciteit
German inspiratorische Kapazitaet, Inspirationskapazität, Kapazität, inspiratorische
Italian Capacità inspiratoria
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Inspiratory Reserve Volume (C0021613)

Definition (NCI) The maximum volume of air a subject can inhale into the lungs after a tidal inhalation.
Definition (NCI_CDISC) The maximum volume of air a subject can inhale into the lungs after a tidal inhalation.
Definition (MSH) The extra volume of air that can be inspired with maximal effort after reaching the end of a normal, quiet inspiration. Common abbreviation is IRV.
Concepts Laboratory or Test Result (T034) , Organ or Tissue Function (T042)
MSH D007321
SnomedCT 55562005
English Inspiratory Reserve Volume, Inspiratory Reserve Volumes, Reserve Volume, Inspiratory, Reserve Volumes, Inspiratory, Volume, Inspiratory Reserve, Volumes, Inspiratory Reserve, inspiratory reserve volume (IRV), inspiratory reserve volume, irv, IRV, Inspiratory reserve volume, IRV - Inspiratory reserve, Inspiratory reserve volume (observable entity)
Swedish Inandningsreservvolym
Czech inspirační rezervní objem, IRV
Finnish Sisäänhengityksen varatila
French Volume de réserve inspiratoire, VRI (Volume de Réserve Inspiratoire)
Russian VDOKHA REZERVNYI OB"EM, ВДОХА РЕЗЕРВНЫЙ ОБЪЕМ
Polish IRV, Objętość wdechowa zapasowa
Portuguese Volume de Reserva Inspiratória, Volume Inspiratório de Reserva
Spanish Volumen de Reserva Inspiratoria, Volumen Inspiratorio de Reserva, VRI, volumen de reserva inspiratoria (entidad observable), volumen de reserva inspiratoria
Norwegian Inspiratorisk reservevolum, IRV, Innåndingsreservevolum
German Inspiratorisches Reservevolumen
Italian Volume della riserva inspiratoria
Dutch Inspiratoir reservevolume, Reservevolume, inspiratoir
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Respiratory Dead Space (C0035218)

Definition (MSH) That part of the RESPIRATORY TRACT or the air within the respiratory tract that does not exchange OXYGEN and CARBON DIOXIDE with pulmonary capillary blood.
Concepts Organ or Tissue Function (T042)
MSH D012126
SnomedCT 251916001
English Dead Space, Respiratory, Dead Spaces, Respiratory, Respiratory Dead Space, Respiratory Dead Spaces, Space, Respiratory Dead, Spaces, Respiratory Dead, respiratory dead space, Respiratory dead space, VD - Dead space, Respiratory dead space (observable entity)
Swedish Andning, dead space
Czech dýchání - mrtvý prostor
Finnish Kuollut tila
Russian DYKHATEL'NOE MERTVOE PROSTRANSTVO, ДЫХАТЕЛЬНОЕ МЕРТВОЕ ПРОСТРАНСТВО
Polish Przestrzeń martwa
Norwegian Respiratorisk dødrom, Alveolært dødrom, Anatomisk dødrom, Fysiologisk alveolært dødrom
Spanish espacio muerto respiratorio (entidad observable), espacio muerto respiratorio, Espacio Muerto Respiratorio
French Espace mort respiratoire
German Respiratorischer Totraum
Italian Spazio morto respiratorio
Dutch Dode ruimte, Ruimte, dode
Portuguese Espaço Morto Respiratório
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Tidal Volume (C0040210)

Definition (NCI) The volume of air moved into and out of the lungs during breathing at rest.
Definition (NCI_CDISC) The volume of air moved into and out of the lungs during breathing at rest.
Definition (MSH) The volume of air inspired or expired during each normal, quiet respiratory cycle. Common abbreviations are TV or V with subscript T.
Definition (CSP) includes tidal volume, inspiratory and expiratory reserve volumes, residual volume, respiratory dead space, pulmonary ventilation, maximal voluntary ventilation, and vital capacity.
Concepts Finding (T033)
MSH D013990
SnomedCT 13621006, 142202008, 165029006
LNC LP75932-1
English Tidal Volume, Tidal Volumes, Volume, Tidal, Volumes, Tidal, respiratory airway volume, VT, tidal volume, Lung tidal volume, Vt - Tidal volume, V T, V<sub>T</sub>, lungs tidal volume, tidal volumes, vts, v t, tidal volume (vt), t v, vt, TV, Tidal volume, TV - Tidal volume, VT - Tidal volume, Tidal volume (observable entity), V>T<
Dutch VT, Ademvolume, Volume, adem-
French TV, VT (Volume Courant), Volume courant
German VT, Atemhubvolumen, Atemzugvolumen
Italian Tachicardia ventricolare, Volume corrente
Portuguese Taquicardia ventricular, Volume de Ventilação Pulmonar
Spanish TV, volumen corriente pulmonar (entidad observable), volumen corriente pulmonar, Volumen de Ventilación Pulmonar
Japanese 心室性頻脈, シンシツセイヒンミャク
Swedish Andetagsvolym
Czech dechový objem, Komorová tachykardie
Finnish Kertahengitystilavuus
Russian DYKHATEL'NYI OB"EM, ДЫХАТЕЛЬНЫЙ ОБЪЕМ
Polish Objętość oddechowa, TV
Hungarian Kamrai tachycardia
Norwegian Tidalvolum, Respirasjonsvolum, Tidevolum
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Total Lung Capacity (C0040509)

Definition (MSHCZE) Objem vzduchu obsažený v plicích na konci maximálního vdechu. Je to ekvivalent každého z následujících termínů: VITÁLNÍ KAPACITA plus REZIDUÁLNÍ OBJEM PLIC; INSPIRAČNÍ KAPACITA plus FUNKČNÍ REZIDUÁLNÍ KAPACITA; DECHOVÝ OBJEM plus INSPIRAČNÍ REZERVNÍ OBJEM plus funkční reziduální kapacita; nebo dechový objem plus inspirační rezervní objem plus EXPIRAČNÍ REZERVNÍ OBJEM plus reziduální objem.
Definition (NCI) The total volume of air in the lungs after maximum inhalation.
Definition (NCI_CDISC) The total volume of air in the lungs after maximum inhalation.
Definition (MSH) The volume of air contained in the lungs at the end of a maximal inspiration. It is the equivalent to each of the following sums: VITAL CAPACITY plus RESIDUAL VOLUME; INSPIRATORY CAPACITY plus FUNCTIONAL RESIDUAL CAPACITY; TIDAL VOLUME plus INSPIRATORY RESERVE VOLUME plus functional residual capacity; or tidal volume plus inspiratory reserve volume plus EXPIRATORY RESERVE VOLUME plus residual volume.
Concepts Finding (T033)
MSH D014109
SnomedCT 142205005, 57566009
English Capacities, Total Lung, Capacity, Total Lung, Lung Capacities, Total, Lung Capacity, Total, Total Lung Capacities, Total Lung Capacity, TLC, TOTAL LUNG CAPAC, LUNG CAPAC TOTAL, total lung capacity (TLC), total lung capacity, tlc, Total lung capacity, TLC - Total lung capacity, Total lung capacity (observable entity), Maximum inflation
Dutch TLC, totale longcapaciteit, Longcapaciteit, totale
French CPT (capacité pulmonaire totale), CPT (Capacité Pulmonaire Totale), Capacité pulmonaire totale
German TLC, Totalkapazitaet der Lunge, Lungenkapazität, totale, Totale Lungenkapazität
Japanese TLC, ソウハイキリョウ, TLC, 全肺気量, 総肺容量, 総肺気量, 肺容量-総, 肺気量-全
Swedish Total lungkapacitet
Czech plíce - celková kapacita, TLC, Celková plicní kapacita, celková kapacita plic
Finnish Keuhkojen kokonaistilavuus
Russian LEGKIKH EMKOST' OBSHCHAIA, ЛЕГКИХ ЕМКОСТЬ ОБЩАЯ
Croatian Not Translated[Total Lung Capacity]
Polish TLC, Pojemność płuc całkowita
Hungarian TLC, Teljes tüdő kapacitás
Norwegian Total lungekapasitet, Lungekapasitet, total
Spanish CPT, capacidad pulmonar total (entidad observable), capacidad pulmonar total, insuflación máxima, Capacidad pulmonar total, Capacidad Pulmonar Total
Portuguese Capacidade pulmonar total, Capacidade Pulmonar Total
Italian Capacità polmonare totale
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Lung volume (C0231953)

Concepts Organ or Tissue Function (T042)
SnomedCT 17785005
English Lung volume, function, volume lung, lungs volume, lungs volumes, lung volumes, lung volume, Lung volume, Lung volume, function (observable entity), Lung volume, NOS, Lung volume (function)
Spanish volumen pulmonar (entidad observable), volumen pulmonar (función), volumen pulmonar
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Anatomical dead space (C0231974)

Concepts Finding (T033)
SnomedCT 89315003
English VD(anat)-Anatomical dead space, Anatomic dead space, anatomical dead space, anatomic dead space, Anatomical dead space, VD(anat) - Anatomical dead space, Anatomical dead space (observable entity), Anatomic dead space, NOS, Conducting airways
Spanish espacio muerto anatómico (entidad observable), espacio muerto anatómico, vía aérea de conducción, vía aéreas conductoras
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Physiological dead space (C0231975)

Concepts Laboratory or Test Result (T034)
SnomedCT 88265002
English VD(physiol)-Physiol dead space, Physiological dead space, VD(physiol) - Physiological dead space, Physiological dead space (observable entity)
Spanish espacio muerto fisiológico (entidad observable), espacio muerto fisiológico
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Lung residual volume measurement (C0429713)

Concepts Laboratory Procedure (T059)
SnomedCT 127803005
English residual volume, residual (lung) volume, Lung residual volume measurement (procedure), Lung residual volume measurement
Spanish medición del volumen pulmonar residual (procedimiento), medición del volumen pulmonar residual
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Minute ventilation (C1301655)

Concepts Finding (T033)
SnomedCT 397802005
English minute ventilation, Minute ventilation (finding), Minute ventilation
Spanish ventilación minuto (hallazgo), ventilación minuto
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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