RT Book, Section
A1 Suyderhoud, Johan P.
A2 Freeman, Brian S.
A2 Berger, Jeffrey S.
SR Print(0)
ID 1102569230
T1 Control of Ventilation
T2 Anesthesiology Core Review: Part One Basic Exam
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 9780071821377
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1102569230
RD 2023/03/20
AB The  anatomic  location  of  the  neural  elements  involved  in  the  control  of  breathing  and  ventilation  reside  primarily  in  medullary  and  pontine  structures  of  the  brainstem.  In  the  medulla,  two  groups  exist:  a  dorsal  respiratory  group  lying  in  close  proximity  to  the  nucleus  tractus  solitarius  and  the  fourth  ventricle,  and  a  ventral  respiratory  group  located  in  the  ventral  medullary  reticular  formation,  each  richly  cross-innervated.  The  dorsal  respiratory  group  is  involved  mainly  with  timing  and  initiation  of  the  respiratory  cycle  and  can  be  thought  of  as  the  pacemaker  for  breathing,  while  the  ventral  group  modulates  the  function  of  breathing,  such  as  modulating  and  inhibiting  pacemaker  signaling  to  allow  for  cessation  of  inspiratory  effort  and  eventual  exhalation,  controlling  the  force  of  contraction  of  inspiratory  muscles,  and  dilator  functions  of  the  larynx  and  pharynx.  Of  note,  generation  of  the  medullary  drive  requires  no  afferent  input  from  other  parts  of  the  body,  be  it  lungs  or  otherwise.  In  the  pons,  neural  activity  can  be  thought  of  as  processing  medullary  afferents  involved  in  both  inspiratory  and  expiratory  activities.  The  pneumotaxic  respiratory  center  of  the  rostral  pons  is  not,  as  was  earlier  thought,  involved  with  respiratory  rhythmicity  but  with  limiting  inspiratory  lung  volumes,  or  apneusis  (cessation  of  ventilation  effort  at  TLC).