Bed side tests of Pulmonary function Vineet and ravi

Pulmonary function tests have been used traditionally in the preoperative assessment before any major surgery. INDICATION Determination of any significant impairment of lung function. Degree and severity of impairment Characterize any pulmonary dysfunction physiologically as obstructive or restrictive Identify the site of airway obstruction Evaluate the risk of procedures on lung To assess prognosis Evaluate airway hyper-reactivity .

Snider’s Match Blowing test Mouth wide open Match held at 15 cm distance Chin supported No head tilting Match stick and mouth at the same level

Can not blow out a match Able to blow out a match MBC < 60 L/min FEV1 < 1.6L Able to blow out a match MBC > 60 L/min FEV > 1.6L

Modified Snider’s test 3 inches MBC > 40 L/min 6 inches MBC > 60 L/min 9 inches MBC > 150 L/min FORCED EXPIRATORY TIME FET < 3 Sec (Restrictive lung ) FET > 6 sec (Obstructive lung )

SEBERESE’S SINGLE BREATH COUNT Patients is asked to take a deep breath followed by counting 1,2,3……….. till the time he cannot hold breath . Shows trend of deteriorating or improving pulmonary function in pre & op . post op patients

SEBARESE ‘S BREATH HOLDING TEST Subject is asked to take a normal tidal inspiration and hold breath (N) ≥ 40 Sec < 15 Sec is a C/I for elective surgery

COUGH TEST Observe for ability to cough, strength and effectiveness Wet productive cough candidate for pulm complications Inadequate cough FVC < 20 ml/kg FEV, < 15 ml / kg

WRIGHT’S PEAK FLOW METER. DE BONO’S WHISTLE TEST Wide more tube which has a whistle at the end and an adjustable leak hole in the side . The whistle shows when the rate of airflow through the whistle exceeds a certain value. WRIGHT’S PEAK FLOW METER. Values < 200 L/ min in surgical candidates suggest impaired cough efficiency (N) Males – 450 – 700 L/min Females – 300 – 500 L/min

SPIROMETRY WITH POCKET SIZED SPIROMETERS VC & FEV, Can be readily performed BED SIDE PULSE OXIMETRY Useful & rapid index of pulmonary gas exchange ABG Most commonly used measures of gas exchange are the partial pressures of 02 & co2 in arterial blood. These pressures do not measure the quantity of 02 & co2 in blood but the driving press. of the gas

BLOW AGAINST THE HAND. Place your hand against the patients month with slight resistance and ask the patient to blow I: E RATIO