Pulmonary Function Test

PULMONARYFUNCTIONTESTS
INTRODUCTION
Pulmonaryfunctiontestsisagenerictermusedto
indicateabatteryofstudiesormaneuversthatmay
beperformedusingstandardizedequipmentto
measurelungfunction.
Evaluatesoneormoreaspectsoftherespiratory
system
Respiratorymechanics
Lungparenchymalfunction/Gasexchange
Cardiopulmonaryinteraction
INDICATIONS
DIAGNOSTIC
PROGNOSTIC
Evaluationofsigns&symptoms
BLN,chronic cough,exertional
dyspnea
Assessseverity
Screeningatriskpts
Followresponsetotherapy
MeasuretheeffectofDs on
pulmonaryfunction
Determinefurthertreatmentgoals
To assesspreoperativerisk
Evaluatingdegreeofdisability
Monitorpulmonarydrugtoxicity
TISIGUIDELINES
Age>70
Obesepatients
Thoracicsurgery
Upperabdominalsurgery
Historyofcough/smoking
Anypulmonarydisease
AmericanCollegeofPhysicians
Guidelines
Lungresection
H/osmoking,dyspnoea
Cardiacsurgery
Upperabdominalsurgery
Lowerabdominalsurgery
Uncharacterizedpulmonarydisease(definedashistoryof
pulmonaryDiseaseorsymptomsandnoPFTinlast60days)
Contraindications
Recenteyesurgery
Thoracic,abdominalandcerebralaneurysms
Activehemoptysis
Pneumothorax
Unstableangina/recentMIwithin1month
INDEX
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
CategorizationofPFTs
Bedsidepulmonaryfunctiontests
Staticlungvolumesandcapacities
MeasurementofFRC,RV
Dynamiclungvolumes/forcedspirometry
Physiologicaldeterminantofspirometry
Flowvolumeloopsanddetectionofairwayobstruction
Flowvolumeloopandlungdiseases
Testsofgasexchangefunction
Testsforcardiopulmonaryreserve
Preoperativeassessmentofthoracotomypatients
CATEGORIZATIONOFPFT
MECHANICALVENTILATORY
FUNCTIONSOFLUNG/CHESTWALL:
BEDSIDEPULMONARYFUNCTIONTESTS
STATICLUNGVOLUMES&CAPACITIES VC,IC,IRV,
ERV,RV,FRC.
DYNAMICLUNGVOLUMESFVC,FEV1,FEF2575%,
PEFR,MVV,RESP.MUSCLESTRENGTH
GAS EXCHANGETESTS:
A)Alveolararterialpo2gradient
B)Diffusioncapacity
C)Gasdistributiontests 1)singlebreathN2
test.2)MultipleBreathN2 test3)Heliumdilution
method4)RadioXe scinitigram.
CARDIOPULMONARYINTERACTION:
Qualitativetests:
1)History,examination
2)ABG
Quantitativetests
1)6minwalktest
2)Stairclimbingtest
3)Shuttlewalk
4)CPET(cardiopulmonaryexercisetesting)
INDEX
1.
2.
3.
4.
5.
6.
7.
8.
9.
MeasurementofFRC,RV
Testsofgasfunction
Bed side pulmonary function tests

RESPIRATORY RATE
Essentialyetfrequentlyundervalued
componentofPFT
Impevaluatorinweaning&extubation
protocols
IncreaseRR musclefatigue workload weaningfails

1)
Sabrasezbreathholdingtest:
Askthepatienttotakeafullbutnottoodeepbreath&hold
itaslongaspossible.
>25SEC.NORMALCardiopulmonaryReserve(CPR)
1525SEC LIMITEDCPR
<15SEC VERYPOORCPR(Contraindicationfor
electivesurgery)
25 30SEC 3500mlVC
20 25SEC 3000mlVC
15 20SEC 2500mlVC
10 15SEC 2000mlVC
5 10SEC 1500mlVC

2)SCHNEIDERSMATCHBLOWINGTEST:MEASURESMaximum
BreathingCapacity.
Asktoblowamatchstickfromadistanceof6(15cms)
with
Mouthwideopen
Chinrested/supported
Nopurselipping
Noheadmovement
Noairmovementintheroom
Mouthandmatchatthesamelevel

Cannotblowoutamatch
MBC<60L/min
FEV1<1.6L
Abletoblowoutamatch
MBC>60L/min
FEV1>1.6L
MODIFIEDMATCHTEST:
DISTANCEMBC
9>150L/MIN.
6>60L/MIN.
3>40L/MIN

3)COUGHTEST:DEEPBREATHF/BYCOUGH
ABILITYTOCOUGH
STRENGTH
EFFECTIVENESS
INADEQUATECOUGHIF:FVC<20ML/KG
FEV1<15ML/KG
PEFR<200L/MIN.
*Awetproductivecough/selfpropagatedparaoxysmsof
coughing patientsusceptibleforpulmonaryComplication.

4)FORCEDEXPIRATORYTIME:
Afterdeepbreath,exhalemaximallyandforcefully&keep
stethoscopeovertrachea&listen.
NFET 35SECS.
OBS.LUNGDIS. >6SEC
RES.LUNGDIS. <3SEC

5)WRIGHTPEAKFLOWMETER:MeasuresPEFR(PeakExpiratory
FlowRate)
N MALES 450700L/MIN.
FEMALES 350500L/MIN.
<200L/MIN. INADEQUATECOUGHEFFICIENCY.
6)DEBONOWHISTLEBLOWINGTEST:MEASURESPEFR.
Patientblowsdownawideboretubeattheendofwhichisa
whistle,onthesideisaholewithadjustableknob.
Assubjectblowswhistleblows,leakholeisgradually
increasedtilltheintensityofwhistledisappears.
Atthelastpositionatwhichthewhistlecanbeblown,the
PEFRcanbereadoffthescale.
DEBONOSWHISTLE
MICROSPIROMETERS MEASUREVC.
BEDSIDEPULSEOXIMETRY
ABG.
INDEX
1.
2.
3.
4.
5.
6.
7.
8.
9.
MeasurementofFRC,RV
Testsofgasfunction
STATIC LUNG VOLUMES AND

CAPACITIES
SPIROMETRY:CORNERSTONEOFALLPFTs.
Johnhutchinson inventedspirometer.
Spirometryisamedicaltestthatmeasuresthe
volumeofairanindividualinhalesorexhalesasa
functionoftime.
CANTMEASURE FRC,RV,TLC
SPIROMETRYAcceptabilityCriteria
Goodstartoftest withoutanyhesitation
Nocoughing/glotticclosure
Novariableflow
Noearlytermination(>6sec)
Noairleak
Reproducibility Thetestiswithoutexcessivevariability
ThetwolargestvaluesforFVCandthetwolargestvaluesfor
FEV1 shouldvarybynomorethan0.2L.
SPIROMETRYAcceptabilityCriteria
SpirometryInterpretation:Sowhat
constitutesnormal?
Normalvaluesvaryanddependon:
I. Height Directlyproportional
II. Age Inverselyproportional
III. Gender
IV. Ethnicity
LUNGVOLUMESANDCAPACITIES
PFTtracingshave:
FourLungvolumes:tidal
volume,inspiratory reserve
volume,expiratoryreserve
volume,andresidualvolume
Fivecapacities:inspiratory
capacity,expiratorycapacity,
vitalcapacity,functionalresidual
capacity,andtotallungcapacity
Additionof2ormorevolumescompriseacapacity.
LUNGVOLUMES
TidalVolume (TV):volumeof
airinhaledorexhaledwith
eachbreathduringquiet
breathing(68ml/kg)500ml
InspiratoryReserveVolume
(IRV):maximumvolumeofair
inhaledfromtheend
inspiratorytidalposition.3000
ml
ExpiratoryReserveVolume
(ERV):maximumvolumeof
airthatcanbeexhaledfrom
restingendexpiratorytidal
position.1500ml
LUNGVOLUMES
ResidualVolume(RV):
Volumeofairremainingin
lungsaftermaximium
exhalation(2025ml/kg)
1200ml
Indirectlymeasured(FRC
ERV)
Itcannotbemeasuredby
spirometry.
LUNGCAPACITIES
TotalLungCapacity (TLC):Sumof
allvolumecompartmentsor
volumeofairinlungsafter
maximuminspiration(46L)
VitalCapacity(VC):TLCminusRV
ormaximumvolumeofair
exhaledfrommaximalinspiratory
level.(6070ml/kg)5000ml. VC~
3TIMESTVFOREFFECTIVE
COUGH
Inspiratory Capacity (IC):Sumof
IRVandTVorthemaximum
volumeofairthatcanbeinhaled
fromtheendexpiratorytidal
position.(24003800ml).
ExpiratoryCapacity(EC):TV+ERV
LUNGCAPACITIES
FunctionalResidualCapacity
(FRC):
SumofRVandERVorthe
volumeofairinthelungsat
endexpiratorytidal
position.(3035ml/kg)2500ml
Decreases
1.insupineposition(0.51L)
2.Obesepts
3.Inductionofanesthesia:by16
20%
FUNCTIONOFFRC
Oxygenstore
Bufferformaintainingasteadyarterialpo2
Partialinflationhelpspreventatelectasis
Minimizestheworkofbreathing
INDEX
1.
2.
3.
4.
5.
6.
7.
8.
9.
MeasurementofFRC,RV
Testsofgasfunction
Measuring RV, FRC

Itcanbemeasuredby
nitrogenwashouttechnique
Heliumdilutionmethod
Bodyplethysmography
N2 Washout Technique
Thepatientbreathes100%oxygen,andallthe
nitrogeninthelungsiswashedout.
Theexhaledvolumeandthenitrogen
concentrationinthatvolumearemeasured.
Thedifferenceinnitrogenvolumeattheinitial
concentrationandatthefinalexhaled
concentrationallowsacalculationof
intrathoracicvolume,usuallyFRC.
Helium Dilution technique

Ptbreathesinandoutfromareservoirwithknown
volumeofgascontainingtraceofhelium.
Heliumgetsdilutedbygaspreviouslypresentinlungs.
eg:if50mlHeliumintroducedandthehelium
concentrationis1%,thenvolumeofthelungis5L.
Body Plethysmography
Plethysmography (derivedfromgreek wordmeaning
enlargement).
BasedonprincipleofBOYLESLAW(P*V=k)
Priniciple advantageoverothertwomethodisit
quantifiesnon communicatinggasvolumes.
Apatientisplacedinasitting
positioninaclosedbodybox
withaknownvolume
Thepatientpantswithan
openglottisagainstaclosed
shuttertoproducechanges
intheboxpressure
proportionatetothevolume
ofairinthechest.
Asmeasurementsdoneat
endofexpiration,ityields
FRC
INDEX
1.
2.
3.
4.
5.
6.
7.
8.
9.
MeasurementofFRC,RV
Testsofgasfunction
FORCEDSPIROMETRY/TIMEDEXPIRATORY
SPIROGRAM
Includesmeasuring:
pulmonarymechanics to
assesstheabilityofthelungto
movelargevol ofairquickly
throughtheairwaystoidentify
airwayobstruction
FVC
FEV1
SeveralFEFvalues
Forcedinspiratory rates(FIFs)
MVV
FORCEDVITALCAPACITY
TheFVCisthemaximumvolumeofairthatcanbe
breathedoutasforcefullyandrapidlyaspossible
followingamaximuminspiration.
CharacterizedbyfullinspirationtoTLCfollowedby
abruptonsetofexpirationtoRV
Indirectlyreflectsflowresistancepropertyof
airways.
FORCEDVITALCAPACITY
FVC
Interpretation of % predicted:
80-120%
Normal
70-79%
Mild reduction
50%-69%
Moderate reduction
<50%
Severe reduction
FVC
MeasurementsObtainedfromtheFVC
Curveandtheirsignificance
Forcedexpiratoryvolume
in1sec(FEV1 )the
volumeexhaledduring
thefirstsecondofthe
FVCmaneuver.
Measuresthegeneral
severityoftheairway
obstruction
Normalis34.5L
FEV1 Decreasedinbothobstructive&restrictivelung
disorders(ifpatientsvitalcapacityissmallerthanpredicted
FEV1).
FEV1/FVC Reducedinobstructivedisorders.
Interpretationof%predicted:
>75%
Normal
60%75%
Mildobstruction
5059%
Moderateobstruction
<49%
Severeobstruction
Forcedmidexpiratory flow2575%(FEF25
75)
Max.Flowrateduringthe
midexpiratorypartofFVC
maneuver.
MeasuredinL/sec
Mayreflecteffort
independentexpiration
andthestatusofthesmall
airways
Highlyvariable
DependsheavilyonFVC
Nvalue 4.55l/sec.Or300
l/min.
Forcedmidexpiratory flow2575%(FEF25
75)
Interpretationof%predicted:
>60%
Normal
4060%Mildobstruction
2040%Moderateobstruction
<10%
Severeobstruction
Peakexpiratoryflowrates
MaximumflowrateduringanFVCmaneuveroccursininitial
0.1sec
Afteramaximalinspiration,thepatientexpiresasforcefully
andquicklyashecanandthemaximumflowrateofairis
measured.
Forcedexpiratoryflowbetween2001200mlofFVC
Itgivesacrudeestimateoflungfunction,reflectinglarger
airwayfunction.
Effortdependantbutishighlyreproductive
Peakexpiratoryflowrates
Itismeasuredbyapeakflowmeter,
whichmeasureshowmuchair(litres
perminute)isbeingblownoutorby
spirometry
The peak flow rate in normal adults
varies depending on age and height.
Normal : 450 700 l/min in males
300 500 l/min in females
Clinicalsignificance valuesof<200/l
impairedcoughing&hencelikelihood
ofpostopcomplication
MaximumVoluntaryVentilation(MVV)or
maximumbreathingcapacity(MBC)
Measures speedandefficiencyoffilling&
emptyingofthelungsduringincreasedrespiratory
effort
Maximumvolumeofairthatcanbebreathedinand
outofthelungsin1minutebymaximumvoluntary
effort
Itreflectspeakventilation inphysiologicaldemands
Normal:150175l/min.ItisFEV1*35
<80% grossimpairment
MaximumVoluntaryVentilation(MVV)or
maximumbreathingcapacity(MBC)
Thesubjectisaskedtobreatheas
quicklyandasdeeplyaspossible
for12secs andthemeasured
volumeisextrapolatedto1min.
Periodslongerthan15seconds
shouldnotbeallowedbecause
prolongedhyperventilationleads
tofaintingduetoexcessive
loweringofarterialpCO2 andH+.
MVVismarkedlydecreasedin
patientswith
A. Emphysema
B. Airwayobstruction
C. Poorrespiratorymusclestrength
TOSUMMARISE
PHYSIOLOGICALDETERMINANTSOFMAX.
FLOWRATES
1)DEGREEOFEFFORT drivingpressuregeneratedbymuscle
contraction(PEmax&PImax)
2) ELASTICRECOILPRESSUREOFLUNG:(PL)
Tendencytorecoilorcollapsed/tPL
PLincreasesfromRV(23)toTLC(2030)
OpposedbyPcw(recoilpr.Ofchestwall)
Prs=Pl+Pcw=0atFRCrestingstate
(Prsrecoilpr.ofresp.system)
3)AIRWAYRESISTANCE(Raw):
Determinedbythecalibreofairways
Decreasesaslungvolincreases(hyperboliccurve)
RawhighatRV&lowatTLC
INDEX
1.
2.
3.
4.
5.
6.
7.
8.
9.
MeasurementofFRC,RV
Testsofgasfunction
FLOWVOLUMELOOPS
SpirogramGraphicanalysisofflowatvariouslungvolumes
TracingobtainedwhenamaximalforcedexpirationfromTLC
toRVisfollowedbymaximalforcedinspirationbacktoTLC
Measuresforcedinspiratory andexpiratoryflowrate
Augmentsspirometryresults
Principaladvantageofflowvolumeloopsvs.typicalstandard
spirometric descriptions identifiestheprobableobstructive
flowanatomicallocation.
FLOWVOLUMELOOPS
First1/3rd ofexpiratoryflowiseffort
dependentandthefinal2/3rd near
theRViseffortindependent
Inspiratorycurveisentirelyeffort
dependent
Ratioof
maximalexpiratoryflow(MEF)
/maximalinspiratoryflow(MIF)
midVCratioandisnormally1
FLOWVOLUMELOOPSandDETECTIONOF
UPPERAIRWAYOBSTRUCTION
flowvolumeloopsprovide
informationonupperairway
obstruction:
Fixedobstruction:constant
airflowlimitationon
inspirationandexpiration
suchas
1. Benignstricture
2.Goiter
3.Endotrachealneoplasms
4.Bronchialstenosis
Variableintrathoracicobstruction:
flatteningofexpiratorylimb.
1.Tracheomalacia
2.Polychondritis
3.Tumorsoftracheaormain
bronchus
Duringforcedexpiration highpleural
pressure increasedintrathoracicpressure
decreasesairwaydiameter.Theflowvolume
loopshowsagreaterreductioninthe
expiratoryphase
Duringinspiration lowerpleuralpressure
aroundairwaytendstodecreaseobstruction
Variableextrathoracicobstruction:
1.Bilateralandunilateralvocalcord
paralysis
2.Vocalcordconstriction
3.Chronicneuromusculardisorders
4.Airwayburns
5.OSA
Forcedinspiration negativetransmural
pressureinsideairwaytendstocollapseit
Expiration positivepressureinairway
decreasesobstruction
inspiratoryflowisreducedtoagreaterextent
thanexpiratoryflow
INDEX
1.
2.
3.
4.
5.
6.
7.
8.
9.
MeasurementofFRC,RV
Testsofgasfunction
ObstructivePattern Evaluation
Commonobstructivelungdiseases
Asthma
COPD(chronicbronchitis,emphysema)
Cysticfibrosis.
ASTHMA
Peakexpiratoryflowreducedso
maximumheightoftheloopis
reduced
Airflowreducesrapidlywiththe
reductioninthelungvolumes
becausetheairwaysnarrowand
theloopbecomeconcave
Concavitymaybetheindicatorof
airflowobstructionandmay
presentbeforethechangeinFEV1
orFEV1/FVC
EMPHYSEMA
Airwaysmaycollapseduring
forcedexpirationbecauseof
destructionofthesupportinglung
tissuecausingveryreducedflowat
lowlungvolumeanda
characteristic(dogleg)appearance
totheflowvolumecurve
REVERSIBILITY
ImprovementinFEV1by1215%or
200mlinrepeatingspirometryafter
treatmentwithSulbutamol2.5mgor
ipratropiumbromidebynebuliser
after1530minutes
Reversibilityisacharacterestic
featureofB.Asthma
Inchronicasthmatheremaybeonly
partialreversibilityoftheairflow
obstruction
WhileinCOPDtheairflowis
irreversiblealthoughsomecases
showedsignificantimprovement
RESTRICTIVEPATTERN
Characterizedbyreducedlung
volumes/decreasedlung
compliance
Examples:
InterstitialFibrosis
Scoliosis
Obesity
LungResection
Neuromusculardiseases
CysticFibrosis
RESTRICTIVEPATTERNflowvolumeloop
lowtotallungcapacity
lowfunctionalresidualcapacity
lowresidualvolume.
Forcedvitalcapacity(FVC)maybe
low;however,FEV1/FVCisoften
normalorgreaterthannormaldue
totheincreasedelasticrecoil
pressureofthelung.
Peakexpiratoryflowmaybe
preservedorevenhigherthan
predictedleadstotall,narrowand
steepflowvolumeloopin
expiratoryphase.
INDEX
1.
2.
3.
4.
5.
6.
7.
8.
9.
MeasurementofFRC,RV
Testsforgasexchangefunction
TESTSFORGASEXCHANGEFUNCTION
ALVEOLARARTERIALO2TENSIONGRADIENT:
SensitiveindicatorofdetectingregionalV/Qinequality
Nvalueinyoungadultatroomair=8mmHgtoupto25
mmHgin8th decade(d/tdecreaseinPaO2)
AbNhighvaluesatroomairisseeninasymptomaticsmokers
&chr.Bronchitis(min.symptoms)
Aagradient=PAO2 PaO2
*PAO2=alveolarPO2(calculatedfromthealveolargas
equation)
*PaO2=arterialPO2(measuredinarterialgas)
PAO2:
(PB PH2O)*FiO2 (PaCO2/RQ)
DIFFUSINGCAPACITY
Rateatwhichgasenterstheblooddividedbyitsdrivingpressure
(gradient alveolarandendcapillarytensions)
Measuresabilityoflungstotransportinhaledgasfromalveolito
pulmonarycapillaries
Normal 2030ml/min/mmHg
Dependson:
thickeness ofalveolarcapillarymembrane
hemoglobinconcentration
cardiacoutput
SINGLEBREATHTESTUSINGCO
PtinspiresadilutemixtureofCOandholdthebreathfor10secs.
COtakenupisdeterminedbyinfraredanalysis:
DlCO=COml/min/mmhg
PACO PcCO
DLO2=DLCOx1.23
WhyCO?
A) HighaffinityforHbwhichisapprox.200timesthatofO2,so
doesnotrapidlybuildupinplasma
B) UnderNconditionithaslowbldconc0
C) Therefore,pulmconc.0
FACTORSEFFECTINGDLCO
DECREASE(<80%predicted)
INCREASE(> 120140%
predicted)
Anemia
Carboxyhemoglobin
Pulmonaryembolism
Diffusepulmonaryfibrosis
Pulmonary emphysema
Polycythemia
Exercise
Congestiveheartfailure
Predicted DLCO for Hb= Predicted DLCO * (1.7 Hb/10.22 + Hb)
INDEX
1.
2.
3.
4.
5.
6.
7.
8.
9.
MeasurementofFRC,RV
Testsofgasfunction
CARDIOPULMONARYINTERACTION
Stairclimbingand6minutewalktest
Thisisasimpletestthatiseasytoperformwithminimal
equipment.Interpretatedasinthefollowingtable:
Performance
VO2
Interpretation
max(ml/kg/min)
>5flightofstairs
>20
Low mortalityafter
pneumonectomy,FEV1>2l
>3flightofstairs
Lowmortalityafterlobectomy,
FEV1>1.7l
<2flightofstairs
Correlateswithhigh mortality
<1flightofstairs
<10
6minwalktest<600m
<15
CARDIOPULMONARYINTERACTION
Shuttlewalk
Thepatientwalksbetweencones10metersapartwith
increasingpace.
Thesubjectwalksuntiltheycannotmakeitfromconeto
conebetweenthebeeps.
Lessthan250mordecreaseSaO2>4%signifieshighrisk.
Ashuttlewalkof350mcorrelateswithaVO2maxof11ml.kg
1.min1
CardiopulmonaryExerciseTesting
Noninvasivetechnique
Effortindependent
Totestabilityofsubjectsphysiologicalresponseto
copewithmetabolicdemands
BasicPhysiologicalPrinciples
Exercisingmusclegetsenergyfrom3sources storedenergy
(creatine phosphate),aerobicmetabolismofglucose,
anaerobicmetabolismofglucose
Inexercisingmusclewhenoxygendemandexceedssupply
lactatestartsaccumulating lactateanaerobicthreshold(
LAT)
Withincrementalincreaseinexercise expiredminute
volume,oxygenconsumptionperminute,CO2production
perminuteincreases
WhatToMeasure
Anaerobicthreshold(>11ml/kg/min)
MaximumoxygenutilizationVO2(>20ml/kg/min)
Ventilatory equivalentofO2(<35L)
Ventilatory equivalentofCO2(<42L)
Oxygenpulse(46ml/heartbeat)
INDEX
1.
2.
3.
4.
5.
6.
7.
8.
9.
MeasurementofFRC,RV
Testsofgasfunction
Assessmentoflungfunctionin
thoracotomypts
Asananesthesiologistourgoalisto:
1)toidentifyptsatriskofincreasedpostopmorbidity&
mortality
2)toidentifyptswhoneedshorttermorlongtermpostop
ventilatorysupport.
Lungresectionmaybef/by inadequategasexchange,pulm
HTN&incapacitatingdyspnoea.
thoracotomypts
Calculating the predicted postoperative
FEV1 (ppoFEV1) and TLCO (ppoTLCO):
There are 5 lung lobes containing
19 segments in total with the division of each
lobe.
Ppo FEV1=preoperative FEV1 * no. of segments
left after resection
19
Can be assessed by ventilation perfusion scan. For eg:
A 57-year-old man is booked for lung
resection. His CT chest show a large RUL
mass confirmed as carcinoma:
ppoFEV1= 50*16/19=42%
thoracotomypts
ppoFEV1(% predicted)
Interpretation
>40
Noorminorrespiratory complications
anticipated
<40
Likelytorequire postoperative
ventilation/increasedriskof
death/complication
<30
Nonsurgerymanagementshouldbe
considered
ppoDLCO(% predicted)
Interpretation
>40,ppoFEV1> 40%,SaO2>90%onair
Intermediate risk,nofurtherinvestigation
needed
<40
Increasedrespiratoryandcardiacmorbidity
<40 andppoFEV1<40%
Highrisk requirecardiopulmonaryexercise
test
Inadditiontohistory,examination,chestX ray,PFTspre op
evaluationincludes:
ventilationperfusionscintigraphy/CTscan
splitlungfunctiontests
methodshavebeendescribedtotryandsimulatethe
postoperativerespiratorysituationbyunilateralexclusionofa
lungorlobewithanendobronchialtube/blockerorby
pulmonaryarteryballoonocclusionofalungorlobeartery
Combinationtests
ThereisnosinglemeasurethatisaGoldstandard
inpredictingpostopcomplications
Threeleggedstool
Respiratory
mechanics
FEV1(ppo>40%)
MVV,RV/TLC,FVC
Cardiopulmonary
reserve
Vo2max(>15ml/kg/min)
Stairclimb>2flights,6
minwalk,
ExerciseSpo2<4%
Lungparenchymal
function
DLco(ppo>80%)
PaO2>60
Paco2<45
Pulmonaryfunctioncriteriasuggestingincreasedriskofpost
operativepulmonarycomplicationsforvarioussurgeries
Parameters
Abdominal
Thoracic
FVC
<70%predicted
<2lit.or<70%predicted
FEV1
<70%predicted
<2lit. pneumonectomy
<1lit. lobectomy
<0.6lit. wedgeorsegmentectomy
FEV1/FVC
<65% predicted
<50%predicted
FEF2575%
<50%predicted
<1.6lit. pneumonectomy
<0.6lit. lobectomy/segmentectomy
MVV/MBC
<50%predicted
<50%predicted
PaCO2
>45mm Hg
>45mm Hg
Look at flow-vol loop and any

airway obstruction pattern
FEV1 /VC >LLN
Yes
No
VC>LLN
VC>LLN
No
No
Yes
TLC>LLN
TLC>LLN
No
Normal
Restriction
DLCO>LLN
Yes
Normal
Yes
Yes
Obstruction
DLCO>LLN
No
Pulmonary
Yes
VascularDs
Neuromuscular
diseases&chest
wallds
Yes
mixeddefects
DLCO>LLN
Yes
No
No
Asthma,bronchitis
ILD&pneumonitis
No
Emphysema
Yes,PFTsarereallywonderfulbutTheydonot
actalone.
Theyactonlytosupportorexcludea
diagnosis.
Acombinationofathoroughhistoryand
physicalexam,aswellassupporting
laboratorydataandimagingishelpfulin
developingaanaestheticplanforptwith
pulmonarydysfunction.

Pulmonary Function Test

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Pulmonary Function Test

Hochgeladen von

Copyright:

Verfügbare Formate

PULMONARYFUNCTIONTESTS

Bed side pulmonary function tests

Bed side pulmonary function tests

Bed side pulmonary function tests

Bed side pulmonary function tests

Bed side pulmonary function tests

Bed side pulmonary function tests

Bed side pulmonary function tests

Bed side pulmonary function tests

STATIC LUNG VOLUMES AND

Measuring RV, FRC

Helium Dilution technique

Predicted DLCO for Hb= Predicted DLCO * (1.7 Hb/10.22 + Hb)

Look at flow-vol loop and any

FEV1 /VC >LLN

Das könnte Ihnen auch gefallen