1. 1 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use.

2. 2 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Chapter 5 Pulmonary Function Testing

3. 3 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. American Thoracic Society Indications Standardization of Spirometry Bedside monitoring

4. 4 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Equipment Used When Measuring Bedside Parameters Respirometer –A device used to measure ventilatory volumes Peak flow meter –A device that measures ventilatory flow rates Spirometer –A device that measures ventilatory volumes and air flow

5. 5 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Bedside Measurements Minute volume –The volume of air inhaled or exhaled during 1 minute –Normal adult at rest—minute volume ranges between 5 and 7 ‑ liters per minute –Increases = increased work of breathing –Decreases = hypoxemia and hypercapnea (continues)

6. 6 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Bedside Measurements (continued) Tidal volume –The amount of air moved into or out of a resting patient’s lungs with each normal breath –Calculated by dividing the minute volume by the respiratory rate –Anatomical dead space (continues)

7. 7 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Bedside Measurements (continued) Frequency –The number of breaths per minute –Normally, the adult rate is 12 to 20 breaths per minute –Increased respiratory rate may indicate increased hypoxemia, fear, pain, anxiety, or hypercapnia –A low respiratory rate may result from CNS depression caused by drugs, hypercapnia, or nervous system disorders (continues)

8. 8 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Bedside Measurements (continued) Vital capacity –The maximum volume of air that can be exhaled after a maximal inspiration –Made up of Expiratory reserve volume Tidal volume Inspiratory reserve volume –An indicator of ventilatory reserve (continues)

9. 9 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Bedside Measurements (continued) Peak Expiratory Flow Rate –The maximum flow rate attained during a forced expiration after a maximal inspiration –A good indicator of airway obstruction and muscle strength Maximal Inspiratory Pressure –The amount of negative pressure a patient is able to generate when trying to inhale –An indicator of muscle strength and ventilatory reserve

10. 10 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Basic Spirometry Volumes –Tidal volume The amount of air moved into or out of a resting patient’s lungs with each normal breath –Inspiratory reserve volume The maximum volume that can be inhaled after a normal inspiration (continues)

11. 11 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Basic Spirometry (continued) Volumes –Expiratory reserve volume The maximum amount of air that can be expired after a normal expiration –Residual volume The volume of gas left in the lungs following a maximal expiration

12. 12 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Capacities and their Significance Inspiratory capacity –The maximum volume that can be inspired from a resting expiratory level Vital capacity –The amount of air that can be exhaled following a maximal inspiration (continues)

13. 13 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Capacities and their Significance (continued) Functional Residual Capacity –A combination of the expiratory reserve volume and the residual volume Total Lung Capacity –A combination of all lung volumes

14. 14 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. The Forced Vital Capacity Tracing Measures –Timed forced expired volume (FEV t ) –Forced expired flow between 200 and 1200 ml (FEF 200–1200 ) –Mid-expiratory forced expired flow (FEF 25–75% ) –PEFR (continues)

15. 15 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. The Forced Vital Capacity Tracing (continued) Time Forced Expired Volume (FEV t) –The forced expired volume over a given time interval –Common intervals of measurement: 0.5, 1, and 3 seconds –Provides an indication of obstruction (continues)

16. 16 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. The Forced Vital Capacity Tracing (continued) Forced Expired Flow between 200 and 1200 (FEF 200–1200 ) –A measurement of the flow rate between 200 and 1200 ‑ ml on the FVC curve –Indicates the air flow characteristics of the large airways (continues)

17. 17 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. The Forced Vital Capacity Tracing (continued) Mid-expiratory Forced Expired Flow (FEF 25–75% ) –The flow rate over the middle portion of the FVC maneuver –Indicative of the flow characteristics of small-size airways (continues)

18. 18 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. The Forced Vital Capacity Tracing (continued) Peak Expiratory Flow Rate (PEFR) –Measured by extrapolating the steepest portion of the FVC tracing over a 1- second time interval –Little clinical significance

19. 19 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Maximum Voluntary Ventilation Measured by having the patient stand (if possible) and breathe as deeply and rapidly as possible over a 10-, 12-, or 15- second interval Volumes are then added Volume is then extrapolated and measured in liters per minute

20. 20 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. ATPS TO BTPS CONVERSION Ambient temperature and pressure, saturated (ATPS) Body temperature and pressure, saturated (BTPS) Difference between the two is generally 13°C ATPS must be converted to BTPS

21. 21 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Flow Volume Loops Plots the flow along the vertical axis and volume along the horizontal axis Expiratory portion of the curve is above the volume axis line—the iso flow line Inspiratory portion of the curve is below the iso flow line.

22. 22 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Measurement of Functional Residual Capacity and Residual Volume Helpful in the diagnosis of both obstructive and restrictive lung disease Two common techniques –Gas dilution –Body plethysmography (continues)

23. 23 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Measurement of Functional Residual Capacity and Residual Volume ( cont’d ) Gas dilution –Nitrogen washout –Helium dilution –C 1 V 1 = C 2 V 2 –The initial concentration and volume (C 1 and V 1 ) and the final concentration (C 2 ) are known and the final volume (lung volume V 2 ) is unknown (continues)

24. 24 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Measurement of Functional Residual Capacity and Residual Volume (cont’d) Body Plethysmography –A closed chamber utilizes the principle of Boyle’s law to measure lung volumes

25. 25 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Diffusion Single Breath Carbon Monoxide Test –The CO is used to measure diffusion, whereas the helium or neon is used to measure alveolar volume (total lung volume) using a dilutional (washout) method

26. 26 © 2013 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part, except for use as permitted in a license distributed with a certain product or service or otherwise on a password-protected website for classroom use. Hazards of Pulmonary Function Testing Hyperventilation Cardiac Stimulation from Bronchodilators Infection