Beruflich Dokumente
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Dr Avneet Garg
Introduction
History
Underlying Principles
• Lung volume
• Airway resistance
Outline Technical aspects
Indications/ contraindications/Hazards
Applications
• Routine
• Beyond routine
• While spirometry is the most commonly used
method to assess lung function in clinical practice, at
times it is necessary to measure the volume of the
air that the lungs cannot displace (static lung
volumes)
• Various Techniques –
• Impulse Oscillometry
• Body Plethysmography
History 1
1790 Menzies - Dissertation on Respiration
• Plunged a man into water in a hogshead up
to his chin and measured the rise and fall
of the level in the cylinder round the chin
• Pressure transducer
• 1. serves to measure the pressure inside the box
relative to ambient pressure
• 2. placed close to the mouth for recording mouth
pressure during a shutter maneuver.
• Obstructive diseases, however, not only lead to a flattening of the loop but also alter its form.
Contra- • Claustrophobia.
indications
• Presence of devices or other condition that
interfere with pressure changes (e.g chest tube,
Trans tracheal O2 catheter, or rupture ear
drum).
• Improper panting technique for VTG and Raw
measurements may results in excessive
intrathoracic pressures causing syncopal
attacks.
Advantages Disadvantages
AIR TRAPPING
Response of Bronchodilators
• Bronchodilator testing,
• Spirometry might underestimate the response.
• Body plethysmography is capable of detecting bronchodilator responses that would be false
negative when solely relying on spirometry.
• A reduction of Raw or sRaw by 20% suggests partial reversibility, and changes by 50% indicate
reversibility with certainty.
• Serial measurements of sRaw also allow documentation of the time course of bronchodilation,
i.e. onset of drug effect.
• It also seems advantageous in specific provocation tests with inhaled allergens, as bouts of
coughing after allergen inhalation often do not allow to conduct a valid spirometry in time.
• The provocation test could be considered as positive when specific airway resistance (sReff) has
doubled and at the same time increased to 2.0 kPa s as a minimum value.
• Other criteria have also been used, such as a 35 or 40% fall in specific airway conductance
(sGaw) which is the reciprocal value of sRaw.
• Pellegrino R, Wilson O, Jenouri G, Rodarte J. Lung mechanics during induced bronchoconstriction. J Appl Physiol 1996;81:964e75.
• Criee CP et al. Body plethysmography e Its principles and clinical Use. Respiratory Mechanics 2011;105:959-971
Calculation of trapped air
• There is a difference between the lung volume measured via the helium-dilution technique
and that measured via body plethysmography.
• The helium-dilution technique may underestimate the exact volume of gas in the lung
because of inadequate time to equilibrate with slowly communicating and
noncommunicating air spaces such as bullae.
• However, lung volume can be more accurately measured and should be measured in these
cases, with body plethysmography, which measures the total volume of the thorax.
• In fact, the difference in TLC between the 2 techniques (body plethysmography minus
helium-dilution) approximates the volume of the bullae.
Agarwal R , Aggarwal AN. Bullous Lung Disease or Bullous Emphysema? Respiratory Care 2006;51(5):532-534
Lung volume
reduction
surgery
LUNG VOLUME REDUCTION SURGERY
Body plethysmography provides a more accurate reflection of the true size of the
lungs at RV, FRC and TLC than gas dilution techniques, especially in AWO.