How We Breathe – The Role Of Pressure Gradients

I figure as an anesthesiologist and intensivist, I should have a post on the basic mechanism of breathing. Here’s my attempt to simplify this complex process while maintaining some of the important details! 🙂

The atmospheric pressure (Patm) at sea level is approximately 760 mmHg. The alveolar pressure, go figure, is the pressure within the alveolus (Palv). The intrapleural space is the area between the visceral pleura (a serous membrane lining the lung itself) and the parietal pleura (the lining on the inner chest wall). The intrapleural pressure (Pip) is important in determining air flow through the tracheobronchial tree and is a consequence of balancing the chest wall’s tendency to recoil outward with the alveoli’s tendency to collapse inward. Esophageal balloon manometry is sometimes used as a surrogate for Pip. Finally, Pbr is the varying bronchial pressure at several points in the airway (which I’ve labeled A, B, C, and D) due to airway resistance.

By convention, pulmonary pressures are given with reference to a normal atmospheric pressure (760 mmHg). For example, Palv of 775 mmHg will be +15 whereas a Pip of 754 mmHg will be -6.

The transpulmonary pressure (TPP) is the difference between Palv and Pip. This pressure is responsible for maintaining alveolar inflation. In other words: TPP = Palv – Pip. In the case of a pneumothorax, the TPP = 0 since Palv = Pip. The lung will collapse on itself due to its elastic recoil.

Pressure gradients involved with breathing

In normal circumstances, the Pip is always negative (-4 to -6 mmHg), Palv is slightly negative during inspiration and slightly positive during expiration, and the TPP is always positive. See these descriptions reflected schematically on the diagram.

Fluids (liquids and gases) move from areas of higher pressure to those of lower pressure down a pressure gradient. When the diaphragm, the primary muscle of inspiration, contracts downward, the chest cavity’s volume increases. For a fixed temperature, increasing volume will decrease pressure. This is Boyle’s Law. This decreases Pip which, in turn, decreases Palv slightly. This creates a pressure gradient with the atmosphere subsequently drawing air into the lung. On expiration, intrapleural pressure becomes more positive to promote air movement out of the lungs.

Drop me a comment below with questions! 🙂

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  1. Hi Rishi
    At high altitude, atmospheric pressure is less than 760mm of Hg. So, will Palv will be motre than -1, say -2 or -3 during inspiration. In the same way, during expiration will Palv be +2 or +3.

  2. Is PiP same thing as intrathoracic pressure? When take and deep breath in, intrathoracic pressure becomes more negative and allows for greater expansion of lungs and more preload return to right side of heart?

    • During SPONTANEOUS ventilation, intrathoracic pressure becomes negative as the diaphragm is pulled downward creating an increase in intrathoracic volume. This also permits greater venous return to the right side of the heart. Intrapleural pressure (Pip) is often times used interchangeably for “intrathoracic pressure” when the latter is referring to pressure within the pleural cavity.


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