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Mechanics of the Pleural Space

Emilio Agostoni

10.1002/cphy.cp030330

Source: Supplement 12: Handbook of Physiology, The Respiratory System, Mechanics of Breathing

Originally published: 1986

Published online: January 2011

Full Article on Wiley Online Library



Abstract

The sections in this article are:

1 Mechanical Coupling Between Lung and Chest Wall
1.1 Factors Holding Lung Against Chest Wall
1.2 Definitions: Pleural Liquid Pressure and Pleural Surface Pressure
2 Pleural Liquid
2.1 Volume
2.2 Physicochemical Features and Pleural Permeability
2.3 Cells
2.4 Thickness
2.5 Pressure
2.6 Exchange
3 Pleural Surface Pressure
3.1 Topography
3.2 Nature of the Vertical Gradient
3.3 Special Conditions
4 Liquid Pressure, Surface Pressure, and Liquid Thickness at Various Lung Heights and Volumes
4.1 Hydrothorax
Figure 1. Figure 1.

Pressures in the pleural space. Vertical thick and thin lines, parietal and visceral pleura, respectively; springs, structures through which pleural membranes contact when lung and chest wall fit snugly (bumps, liquid cells, microvilli); broken arrows, tension along pleural membranes; Pdef liq, deformation pressure over liquid area; PmusI, pressure exerted by inspiratory muscles; Pcon, pleural contact pressure. Gravitational effects are omitted for simplicity. Left: resting volume of respiratory system with thin hydrothorax. Pleural membranes do not contact. Pleural liquid pressure (Pliq) equals pleural surface pressure (Ppl), which equals pressure of relaxed chest wall (Pw), or transpulmonary pressure with opposite sign (−PL). Outward flow of liquid exceeds inward flow. Hence volume and thickness of pleural liquid decrease. Center: resting volume of respiratory system under normal conditions. Pleural membranes contact and are deformed. At points of contact, walls push on each other. Average pressure produced by deformation does not add to Pw or PL because deformation force over contact area balances that over liquid area. Outward flow of liquid balances inward flow. Right: end of a deep inspiration under normal conditions. Thickness of pleural liquid is decreased; Ppl and Pliq decrease; overall surface of pleural space is increased; contact area relative to overall surface area is probably but not necessarily increased. Pleural liquid is not in equilibrium because phenomenon is transient; Pliq decrease tends to draw liquid into the space. Contact pressure is increased but not necessarily on bumps because they could have been smoothed by increase of membrane tension rather than squeezed by contact.
Figure 2. Figure 2.

Histograms of pleural liquid thickness in superior and inferior parts of costal region in cats in lateral posture at resting volume of respiratory system. Thickness at or near lobar margins was not measured. Measurements were pooled in groups at 5‐μm intervals. Measurements below 2.5 μm were so few that they do not appear.

Adapted from Agostoni et al. 11
Figure 3. Figure 3.

Percentage of lung height against pleural surface pressure in right intercostal region of dogs at resting volume of respiratory system in various postures. Symbols represent data from different studies: ▽ 6, □ 10, • 13, ○ 48, and × (unpublished data of G. Miserocchi obtained with counterpressure on exposed parietal pleura). Curves are best‐fit equations. Broken line in lateral posture separates upper and lower hemithorax.

Adapted from Agostoni 2
Figure 4. Figure 4.

Lung height against overall vertical gradient of pleural surface pressure in lateral posture. Overall pressure gradient is the difference in pressure between bottom and top divided by lung height. Data refer to resting volume of respiratory system except for human (∼50% total lung capacity). Value for human is taken from indirect data of Kaneko et al. 88 assuming 23 cm lung height.

Adapted from Agostoni and D'Angelo 6
Figure 5. Figure 5.

Lung height against overall vertical gradient of pleural surface pressure in head‐up posture at resting volume of respiratory system. Pleural surface pressure was measured 1–3 cm above bottom and below top. Overall vertical pressure gradient was obtained by dividing difference between these pressures by vertical distance between corresponding points. Values on ordinate refer to whole height of lung: only D'Angelo, et al. •, ▪ 48 and Agostoni and Miserocchi [•, ▪ 13] provided measurements of lung height; other data were obtained indirectly. Values for vertical pressure gradient and for lung height [× 111] are approximately corrected for lung height at functional residual capacity because only lung height at total lung capacity was given. Other values for lung height [○ 102, ○ 86, and ○ 162] have been calculated from a relationship between lung height (at functional residual capacity in head‐up posture) and body weight.

Adapted from Agostoni 2
Figure 6. Figure 6.

Percentage of lung height against pleural surface pressure in right intercostal regions at resting volume of respiratory system in eviscerated rabbits (symbols visually fitted by broken line) and in normal rabbits (continuous line). Right ordinates indicate average height of lung in eviscerated rabbits, which is essentially the same in normal rabbits.

Adapted from Agostoni et al. 9
Figure 7. Figure 7.

Effect of decreasing abdominal pressure on pleural surface pressure at midlung height in supine rabbit and dog. Small numbers on left, pressure applied on caudal part of abdomen; numbers in the middle, lung volume as % total lung capacity (TLC). Broken lines, relationship on midaxillary line in head‐up posture at functional residual capacity for comparison (lung volume ∼67% TLC in rabbits and ∼60% TLC in dogs). Dotted lines, extrapolation to cranial and caudal ends.

From Agostoni and D'Angelo 7
Figure 8. Figure 8.

Pleural surface pressure (Ppl) on 3rd and 6th intercostal space (i.c.s.) and on diaphragmatic surface of lung, esophageal pressure (Pes), and changes of lung volume (ΔV) during spontaneous breathing, weak and strong bilateral stimulation of phrenic nerves.

From D'Angelo, Sant'Ambrogio, and Agostoni 52
Figure 9. Figure 9.

Pleural surface pressure (Ppl) on 3rd and 6th intercostal space and diaphragmatic surface of lung, esophageal pressure (Pes), and changes of lung volume (ΔV) during spontaneous breathing before (left) and after (right) complete bilateral phrenicotomy.

From D'Angelo, Sant'Ambrogio, and Agostoni 52
Figure 10. Figure 10.

Left: pleural liquid pressure (Pliq) against pleural surface pressure (Ppl) at 70% (○) and 22% (•) lung height (△ height = 5.5 cm) in a supine dog on increasing lung volume from functional residual capacity to ∼80% total lung capacity (TLC). Alveolar pressure was atmospheric because lung volume was increased by lowering abdominal pressure. Right: deformation pressure over liquid area (Pdef liq) against Ppl obtained from data of left panel. Numbers, % TLC; broken lines join lung iso‐volume points of upper and lower region; arrow, point on lower region iso‐Pliq with 32% TLC in upper region.

From Miserocchi, Nakamura, and Agostoni 119
Figure 11. Figure 11.

Volume of isotonic saline solution introduced into right pleural space against change of pleural liquid pressure in supine cats at resting volume of respiratory system. Horizontal bars, standard errors; each point refers to 7–13 animals.

From Agostoni 2
Figure 12. Figure 12.

Height of pleural space against thickness of pleural liquid after 1, 2.5, 5, 10, and 20 ml of isotonic saline solution were introduced into pleural space of supine cats at resting volume of respiratory system.

From Agostoni and D'Angelo 5
Figure 13. Figure 13.

Pressure of pleural liquid at various heights of pleural space against corresponding thickness of pleural liquid in supine cats at resting volume of respiratory system with hydrothoraces of various size. Thin broken line connects points referring to lowest part of lung for each hydrothorax. With a vertical gradient of 1 cmH2O/cm, value of Pliq at various lung heights may be found.

From Agostoni 2


Figure 1.

Pressures in the pleural space. Vertical thick and thin lines, parietal and visceral pleura, respectively; springs, structures through which pleural membranes contact when lung and chest wall fit snugly (bumps, liquid cells, microvilli); broken arrows, tension along pleural membranes; Pdef liq, deformation pressure over liquid area; PmusI, pressure exerted by inspiratory muscles; Pcon, pleural contact pressure. Gravitational effects are omitted for simplicity. Left: resting volume of respiratory system with thin hydrothorax. Pleural membranes do not contact. Pleural liquid pressure (Pliq) equals pleural surface pressure (Ppl), which equals pressure of relaxed chest wall (Pw), or transpulmonary pressure with opposite sign (−PL). Outward flow of liquid exceeds inward flow. Hence volume and thickness of pleural liquid decrease. Center: resting volume of respiratory system under normal conditions. Pleural membranes contact and are deformed. At points of contact, walls push on each other. Average pressure produced by deformation does not add to Pw or PL because deformation force over contact area balances that over liquid area. Outward flow of liquid balances inward flow. Right: end of a deep inspiration under normal conditions. Thickness of pleural liquid is decreased; Ppl and Pliq decrease; overall surface of pleural space is increased; contact area relative to overall surface area is probably but not necessarily increased. Pleural liquid is not in equilibrium because phenomenon is transient; Pliq decrease tends to draw liquid into the space. Contact pressure is increased but not necessarily on bumps because they could have been smoothed by increase of membrane tension rather than squeezed by contact.



Figure 2.

Histograms of pleural liquid thickness in superior and inferior parts of costal region in cats in lateral posture at resting volume of respiratory system. Thickness at or near lobar margins was not measured. Measurements were pooled in groups at 5‐μm intervals. Measurements below 2.5 μm were so few that they do not appear.

Adapted from Agostoni et al. 11


Figure 3.

Percentage of lung height against pleural surface pressure in right intercostal region of dogs at resting volume of respiratory system in various postures. Symbols represent data from different studies: ▽ 6, □ 10, • 13, ○ 48, and × (unpublished data of G. Miserocchi obtained with counterpressure on exposed parietal pleura). Curves are best‐fit equations. Broken line in lateral posture separates upper and lower hemithorax.

Adapted from Agostoni 2


Figure 4.

Lung height against overall vertical gradient of pleural surface pressure in lateral posture. Overall pressure gradient is the difference in pressure between bottom and top divided by lung height. Data refer to resting volume of respiratory system except for human (∼50% total lung capacity). Value for human is taken from indirect data of Kaneko et al. 88 assuming 23 cm lung height.

Adapted from Agostoni and D'Angelo 6


Figure 5.

Lung height against overall vertical gradient of pleural surface pressure in head‐up posture at resting volume of respiratory system. Pleural surface pressure was measured 1–3 cm above bottom and below top. Overall vertical pressure gradient was obtained by dividing difference between these pressures by vertical distance between corresponding points. Values on ordinate refer to whole height of lung: only D'Angelo, et al. •, ▪ 48 and Agostoni and Miserocchi [•, ▪ 13] provided measurements of lung height; other data were obtained indirectly. Values for vertical pressure gradient and for lung height [× 111] are approximately corrected for lung height at functional residual capacity because only lung height at total lung capacity was given. Other values for lung height [○ 102, ○ 86, and ○ 162] have been calculated from a relationship between lung height (at functional residual capacity in head‐up posture) and body weight.

Adapted from Agostoni 2


Figure 6.

Percentage of lung height against pleural surface pressure in right intercostal regions at resting volume of respiratory system in eviscerated rabbits (symbols visually fitted by broken line) and in normal rabbits (continuous line). Right ordinates indicate average height of lung in eviscerated rabbits, which is essentially the same in normal rabbits.

Adapted from Agostoni et al. 9


Figure 7.

Effect of decreasing abdominal pressure on pleural surface pressure at midlung height in supine rabbit and dog. Small numbers on left, pressure applied on caudal part of abdomen; numbers in the middle, lung volume as % total lung capacity (TLC). Broken lines, relationship on midaxillary line in head‐up posture at functional residual capacity for comparison (lung volume ∼67% TLC in rabbits and ∼60% TLC in dogs). Dotted lines, extrapolation to cranial and caudal ends.

From Agostoni and D'Angelo 7


Figure 8.

Pleural surface pressure (Ppl) on 3rd and 6th intercostal space (i.c.s.) and on diaphragmatic surface of lung, esophageal pressure (Pes), and changes of lung volume (ΔV) during spontaneous breathing, weak and strong bilateral stimulation of phrenic nerves.

From D'Angelo, Sant'Ambrogio, and Agostoni 52


Figure 9.

Pleural surface pressure (Ppl) on 3rd and 6th intercostal space and diaphragmatic surface of lung, esophageal pressure (Pes), and changes of lung volume (ΔV) during spontaneous breathing before (left) and after (right) complete bilateral phrenicotomy.

From D'Angelo, Sant'Ambrogio, and Agostoni 52


Figure 10.

Left: pleural liquid pressure (Pliq) against pleural surface pressure (Ppl) at 70% (○) and 22% (•) lung height (△ height = 5.5 cm) in a supine dog on increasing lung volume from functional residual capacity to ∼80% total lung capacity (TLC). Alveolar pressure was atmospheric because lung volume was increased by lowering abdominal pressure. Right: deformation pressure over liquid area (Pdef liq) against Ppl obtained from data of left panel. Numbers, % TLC; broken lines join lung iso‐volume points of upper and lower region; arrow, point on lower region iso‐Pliq with 32% TLC in upper region.

From Miserocchi, Nakamura, and Agostoni 119


Figure 11.

Volume of isotonic saline solution introduced into right pleural space against change of pleural liquid pressure in supine cats at resting volume of respiratory system. Horizontal bars, standard errors; each point refers to 7–13 animals.

From Agostoni 2


Figure 12.

Height of pleural space against thickness of pleural liquid after 1, 2.5, 5, 10, and 20 ml of isotonic saline solution were introduced into pleural space of supine cats at resting volume of respiratory system.

From Agostoni and D'Angelo 5


Figure 13.

Pressure of pleural liquid at various heights of pleural space against corresponding thickness of pleural liquid in supine cats at resting volume of respiratory system with hydrothoraces of various size. Thin broken line connects points referring to lowest part of lung for each hydrothorax. With a vertical gradient of 1 cmH2O/cm, value of Pliq at various lung heights may be found.

From Agostoni 2
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Article Title: Mechanics of the Pleural Space
 

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Emilio Agostoni. Mechanics of the Pleural Space. Compr Physiol 2011, Supplement 12: Handbook of Physiology, The Respiratory System, Mechanics of Breathing: 531-559. First published in print 1986. doi: 10.1002/cphy.cp030330