SlideShare a Scribd company logo
1 of 60
Pulmonary Function
Tests
O Tidal Volume (TV): volume of air inhaled or exhaled
with each breath during quiet breathing (6-8 ml/kg)
O Inspiratory Reserve Volume (IRV): maximum volume
of air inhaled from the end-inspiratory tidal
position.(1900-3300ml)
O Expiratory Reserve Volume (ERV): maximum volume
of air that can be exhaled from resting end-expiratory
tidal position.( 700-1000ml).
O Residual Volume (RV):
O Volume of air remaining in lungs after maximium
exhalation (20-25 ml/kg) (1700-2100ml)
O Indirectly measured (FRC-ERV)
O It can not be measured by spirometry
• Total Lung Capacity
(TLC): Sum of all volume
compartments or volume
of air in lungs after
maximum inspiration (4-6
L)
• Vital Capacity (VC): TLC
minus RV or maximum
volume of air exhaled from
maximal inspiratory level.
(60-70 ml/kg) (3100-
4800ml)
• Inspiratory Capacity (IC):
Sum of IRV and TV or the
maximum volume of air
that can be inhaled from
the end-expiratory tidal
position. (2400-3800ml).
• Expiratory Capacity
(EC): TV+ ERV
Vital Capacity
O Considered abnormal if <80% of
predicted value.
O Physiological factors influencing VC:
 Height
 Sex
 Age
 Posture
 Strength of respiratory muscle
Factors decreasing Vital
Capacity:
① Alteration in muscle power.
② Pulmonary diseases.
③ Space occupying lesions in chest.
④ Abdominal causes.
⑤ Depression of respiration.
① Posture – by altering pulmonary Blood volume.
Different postures affecting VC
O POSITION
 TRENDELENBERG
 LITHOTOMY
 PRONE
 RT. LATERAL
 LT. LATERAL
O DECREASE IN VC
 14.5%
 18%
 10%
 12%
 10%
Vital Capacity pre and post op.
Before
epidural
1hr after
epidural
24hrs after
epidural
1. Upper
Abdominal
35.2% 69% 83.2%
2. Lower
Abdominal
55.5% 84.8% 94.7%
Vital capacity readings expressed as a % of pre op values.
Functional residual capacity
O Functional Residual Capacity (FRC):
O Sum of RV and ERV or the volume of air in the lungs
at end-expiratory tidal position.(30-35 ml/kg)
(2300-3300ml).
O Measured with multiple-breath closed-circuit
helium dilution, multiple-breath open-circuit
nitrogen washout, or body plethysmography.
O It can not be measured by spirometry)
Functional Residual Capacity
• FRC INCREASES WITH
• Increased height
• Erect position (30% more than in supine)
• Decreased lung recoil (e.g. emphysema)
• FRC DECREASES WITH
• Obesity
• Muscle paralysis (especially in supine)
• Supine position
• Restrictive lung disease (e.g. fibrosis, Pregnancy)
• Anaesthesia
Functions of FRC:
• Oxygen store
• Buffer for maintaining a steady arterial
po2
• Partial inflation helps prevent atelectasis
• Minimise the work of breathing
• Minimise pulmonary vascular resistance
• Minimised v/q mismatch
- only if closing capacity is less than FRC.
Maximum Voluntary
Ventilation
O Also known as the Maximum Breathing Capacity
(MBC)
O It is the largest volume of gas that can be moved
into and out of the lungs in 1 minute by voluntary
effort.
O Normal- 125-170L/min
O Subject is asked to breathe as hard and fast as
possible for 10-15secs. The value obtained is
converted to 60secs.
O Reflects the status of respiratory muscle,
compliance of chest wall and airway resistance.
O Effort dependent test.
O It can reveal diminished reserves of weak
respiratory muscles.
What are pulmonary function
tests?
O A group of studies or maneuvers that may
be performed using standardized
equipment to measure lung function.
Bedside PFT’s
O Sniders match blowing test
O Forced expiratory time
O Saberazes single breath count
O Saberazes breath holding test
O Cough test
O De bono’s whistle test
O Wrights peak flowmeter
Saberazes breath holding test
Ask the patient to take a full but not too deep breath &
hold it as long as possible.
>25 SEC.-NORMAL Cardiopulmonary Reserve (CPR)
15-25 SEC- LIMITED CPR
<15 SEC- VERY POOR CPR (Contraindication for
elective surgery)
25- 30 SEC - 3500 ml VC
20 – 25 SEC - 3000 ml VC
15 - 20 SEC - 2500 ml VC
10 - 15 SEC - 2000 ml VC
5 - 10 SEC - 1500 ml VC
Saberazes single breath count
After deep breath, hold it and start counting till
the next breath.
 N- 30-40 COUNT
 Indicates vital capacity.
Sniders match blowing test
Ask to blow a match stick from a distance of 6”
(15 cms) with-
 Mouth wide open
 Chin rested/supported
 No purse lipping
 No head movement
 No air movement in the room
 Mouth and match at the same level
O Can not blow out a match
O MBC < 60 L/min
O FEV1 < 1.6L
O Able to blow out a match
O MBC > 60 L/min
O FEV1 > 1.6L
O MODIFIED MATCH TEST:
DISTANCE MBC
9” >150 L/MIN.
6” >60 L/MIN.
3” > 40 L/MIN.
Cough test
Deep breath followed by cough
 ABILITY TO COUGH
 STRENGTH
 EFFECTIVENESS
INADEQUATE COUGH IF:
FVC<20 ML/KG
FEV1 < 15 ML/KG
PEFR < 200 L/MIN.
VC should be 3 TIMES TV FOR EFFECTIVE COUGH.
A wet productive cough / self propagated paraoxysms of
coughing :patient susceptible for pulmonary
complication.
Forced expiratory time
After deep breath, exhale maximally and
forcefully & keep stethoscope over trachea &
listen.
Normal FET – 3-5 SECS.
OBS.LUNG DIS. - > 6 SEC
RES. LUNG DIS.- < 3 SEC
Wrights Peak FLowmeter
• Measures tidal volume, mv (15 secs times
4)
• Simple and rapid
• Instrument- compact, light and portable.
• Disadvantage: It under- reads at low flow
rates and over- reads at high flow rates.
• Can be connected to endotracheal tube or
face mask
• Prior explanation to patients needed.
• Ideally done in sitting positoin.
Wrights peak flowmeter
• MV- instrument record for 1 min. And read
directly
• Accurate measurement in the range of 3.7-
20l/min.(±10%)
• USES: 1)BED SIDE PFT
2) ICU – Weaning patients from
Ventilation.
Measures PEFR (Peak Expiratory Flow Rate)
Normal – MALES- 450-700 L/MIN.
FEMALES- 350-500
L/MIN.
<200 L/ MIN. – INADEQUATE COUGH
EFFICIENCY.
De bono’s whistle test
MEASURES PEFR.
Patient blows down a wide bore tube at the
end of which is a whistle, on the side is a hole
with adjustable knob.
As subject blows → whistle blows, leak hole is
gradually increased till the intensity of whistle
disappears.
At the last position at which the whistle can
be blown , the PEFR can be read off the scale.
Components of PFT
1.Tests of
mechanical
function:
 Spirometry
 Static lung volumes
 Respiratory
Mechanics
 Respiratory muscle
strength
2.Tests of gas
exchange: ABG,
DLCO.
3.Cardiopulmonary
interaction:
• Qualitative- stair
climbing
• Quantitative- 6min
walking test
Indications for spirometry:
O Diagnostic:
• evaluate symptoms and signs
• Effect of disease on PFT
• Screen individuals
• Pre-op risk
O Monitoring- to assess therapeutic
interventions
O Public health
Contraindications
• Hemoptysis
• Pneumothorax
• Recent MI, unstable angina pectoris
• Thoracic, abdominal and cerebral
aneurysm
• Recent abdominal or thoracic surgical
procedure.
• H/o Syncope with forced exhalation
• Recent eye surgery
Pre-requisites
O Prior explanation to the patient
O Not to smoke /inhale bronchodilators 6 hrs prior or oral
bronchodilators 12hrs prior.
O Remove any tight clothings/ waist belt/ dentures
O Pt. Seated comfortably
O Nose clip to close nostrils.
O Minimum exhalation time of 6 seconds, but up to 15
seconds
O Number of maneuvers: Minimum of 3 and maximum
of 8
O Should not be interfered by coughing, glottic closure,
mechanical obstruction.
Requirements of a good PFT.
O Lack of artifact
O Satisfactory start
O Satisfactory exhalation with six seconds of
smooth continuous exhalation.
O ATS Criteria for reproducibility after obtaining
3 acceptable spirograms:
1) Largest FVC within 0.15L of next largest
FVC
2) Largest FEV1 within 0.15L of next largest
FEV1
Measurements obtained from
the FVC curve:
O FEV1---the volume exhaled during the first second
of the FVC maneuver
O FEF 25-75%---the mean expiratory flow during the
middle half of the FVC maneuver; reflects flow
through the small (<2 mm in diameter) airways
O FEV1/FVC---the ratio of FEV1 to FVC X 100
(expressed as a percent); an important value
because a reduction of this ratio from expected
values is specific for obstructive rather than
restrictive diseases
Causes of restrictive PFT
O Lung parenchymal pathology
O Inter pleural pathology
O Neuromuscular problems
Grading of severity of
abnormality
O Based on TLC:
 Mild: predicted TLC is less than lower limit of normal but
>70%
 Moderate: predicted TLC is <70% and >60%
 Moderately severe: predicted TLC <60%
O Based on spirometry:
 Mild: Predicted VC is less than lower limit of normal but
>70%
 Moderate: Predicted VC <70% and >60%
 Moderately severe: Predicted VC <60% and >50%
 Severe: Predicted VC <50% and >34%
 Very Severe: Predicted VC <34%
Causes of obstructive PFT
O Narrowing of airways due to bronchial smooth muscle
contraction.
O Narrowing of airways due to inflammation and swelling
of bronchial mucosa.
O Material inside the bronchial passage.
O Destruction of lung tissue with loss of elasticity.
Severity of obstructive lung
disease:
Obstructive vs Restrictive
diseases on spirometry
Obstructive disorders Restrictive disorders
O FVC N or↓
O FEV1 ↓
O FEF25-75% ↓
O FEV1/FVC ↓
O TLC N or ↑
O FVC ↓
O FEV1 ↓
O FEF 25-75% N to ↓
O FEV1/FVC N to ↑
O TLC ↓
Criteria for reversibility of small
airway obstruction on PFT:
O 2 PFTs should be done one before and one
after administration of bronchodilator.
O Drug used is usually beta-2
sympathomimetic.
O If 2 out of 3 measurements improve then
patient has reversible airway obstruction.
1) FVC of 10% or more
2) FEV1 an increase of 200ml or 15% of baseline FEV1
3) FEF25-75% an increase of 25% or more
Flow volume loops
O Helpful in evaluation of air flow limitation on
inspiration and expiration
O In addition to obstructive and restrictive
patterns, flow-volume loops can provide
information on upper airway obstruction:
O Fixed obstruction: such as in tumor, tracheal
stenosis
O Variable extrathoracic obstruction: such as in vocal
cord dysfunction
O Variable intrathoracic obstruction:as in malignancy
or tracheomalacia
Measurement of other lung
volumes
O Nitrogen washout technique
O Helium dilution technique
O Body plethysmography
DLCO (diffusion lung CO)
O The diffusing capacity is a measure of the
ability of the lungs to transfer gas.
O Measure of interaction of alveolar surface
area, alveolar capillary perfusion and
physical properties of the alveolar
capillary interface.
O CO is rapidly taken up by haemoglobin, its
transfer is therefore limited mainly by
diffusion
Causes of decreased
DLCO:
Causes of increased
DLCO:
O Anemia
O Emphysema
O ILD
O Pulmonary edema
O Pulmonary vascular
disease
O Obesity
O Asthma
O L to R shunt
O Alveolar
hemorrhage
DLCO- capacity of the lungs to transfer CO (ml/min/mmHg)
DLCOc- DLCO corrected for Hb (ml/min/mmHg)
DLVA- DLCO corected for volume (ml/min/mmHg/L)
DLVC- DLCO corrected for both volume and Hb (ml/min/mmHg/L)
Respiratory muscle
function
O A number of diseases such as motor neuron disease
can result in respiratory muscle weakness, which can
ultimately lead to respiratory failure
O Inspiratory mouth pressure
A measure of inspiratory muscle function in which
subjects generate as much inspiratory pressure as
possible against a blocked mouth piece .Values of 80
cm of water or more exclude any significant inspiratory
muscle weakness
O Expiratory mouth pressure
A measure of expiratory muscle function in which
subjects generate as much expiratory pressure as
possible against a blocked mouth piece. Values of 80
cm of water or more exclude any significant expiratory
muscle weakness
Tests for cardiopulmonary
reserve:
O Number of flights of stairs patient can
climb: inability to climb 2 flights of stairs
indicates increased risk of post-op
cardiopulmonary complications.
O Six minute walking test (6 MWT)
Anesthetic Implications
COPD classification by GOLD
ATS classification of severity of
COPD
Evaluation of patient for lung
resection
GOALS:
1) to identify patients at risk of increased post-
op morbidity & mortality
2) to identify patients who need short-term or
long term post-op ventilator support.
Lung resection may be followed by – inadequate
gas exchange, pulm HTN & incapacitating
dyspnoea.
EXAMPLE:
Assuming pre op FEV1 to be
70%
ppoFEV1= 70 X (1-29/100)
ppoFEV1= 50%
References
O A practice of anesthesia by Wylie 5th edition
O Millers 7th edition
O Clinical Anesthesiology- Morgan 5th edition
O Interpreting pulmonary function tests: Recognize the
pattern, and the diagnosis will follow. CLEVELAND
CLINIC JOURNAL OF MEDICINE VOLUME 70 •
NUMBER 10
O SERIES ‘‘ATS/ERS TASK FORCE: STANDARDISATION
OF LUNG
FUNCTION TESTING’’ 2005
Thank You
THE END

More Related Content

What's hot

physiological dead space and its measurements
physiological dead space and its measurementsphysiological dead space and its measurements
physiological dead space and its measurementsmeducationdotnet
 
Pulmonary function testing (spirometry )
Pulmonary function testing (spirometry ) Pulmonary function testing (spirometry )
Pulmonary function testing (spirometry ) Dr Emad efat
 
Bedside PULMONARY FUNCTION TEST/PFT
Bedside PULMONARY FUNCTION TEST/PFTBedside PULMONARY FUNCTION TEST/PFT
Bedside PULMONARY FUNCTION TEST/PFTZIKRULLAH MALLICK
 
Ventilation Perfusion Matching
Ventilation Perfusion MatchingVentilation Perfusion Matching
Ventilation Perfusion MatchingDang Thanh Tuan
 
Weaning from mechanical ventilation
Weaning from mechanical ventilationWeaning from mechanical ventilation
Weaning from mechanical ventilationAji Kumar
 
Ventilation: Basic Principles
Ventilation: Basic PrinciplesVentilation: Basic Principles
Ventilation: Basic PrinciplesJamie Ranse
 
Ventilation and perfusion
Ventilation and perfusionVentilation and perfusion
Ventilation and perfusionPawan Gupta
 
Pulmonary function test
Pulmonary function testPulmonary function test
Pulmonary function testravindrajha10
 
Ventilation and Perfusion in different zones of lungs.
Ventilation and Perfusion in different zones of lungs.Ventilation and Perfusion in different zones of lungs.
Ventilation and Perfusion in different zones of lungs.Gyaltsen Gurung
 
peak expiratory flow rate presentation
peak expiratory flow rate presentationpeak expiratory flow rate presentation
peak expiratory flow rate presentationRekha Marbate
 

What's hot (20)

14. pulmonary-function-tests
14. pulmonary-function-tests14. pulmonary-function-tests
14. pulmonary-function-tests
 
Anatomy of tracheobronchial tree
Anatomy of tracheobronchial treeAnatomy of tracheobronchial tree
Anatomy of tracheobronchial tree
 
physiological dead space and its measurements
physiological dead space and its measurementsphysiological dead space and its measurements
physiological dead space and its measurements
 
Pulmonary function testing (spirometry )
Pulmonary function testing (spirometry ) Pulmonary function testing (spirometry )
Pulmonary function testing (spirometry )
 
Pulmonary function tests
Pulmonary function testsPulmonary function tests
Pulmonary function tests
 
Non invasive ventilation
Non invasive ventilationNon invasive ventilation
Non invasive ventilation
 
Bedside PULMONARY FUNCTION TEST/PFT
Bedside PULMONARY FUNCTION TEST/PFTBedside PULMONARY FUNCTION TEST/PFT
Bedside PULMONARY FUNCTION TEST/PFT
 
Peep & cpap
Peep & cpapPeep & cpap
Peep & cpap
 
Dlco/tlco
Dlco/tlcoDlco/tlco
Dlco/tlco
 
HME
HME HME
HME
 
Ventilation Perfusion Matching
Ventilation Perfusion MatchingVentilation Perfusion Matching
Ventilation Perfusion Matching
 
Weaning from mechanical ventilation
Weaning from mechanical ventilationWeaning from mechanical ventilation
Weaning from mechanical ventilation
 
Ventilation: Basic Principles
Ventilation: Basic PrinciplesVentilation: Basic Principles
Ventilation: Basic Principles
 
Ventilation and perfusion
Ventilation and perfusionVentilation and perfusion
Ventilation and perfusion
 
Pulmonary function test
Pulmonary function testPulmonary function test
Pulmonary function test
 
Respiratory Muscle Assessment
Respiratory Muscle AssessmentRespiratory Muscle Assessment
Respiratory Muscle Assessment
 
Ventilation and Perfusion in different zones of lungs.
Ventilation and Perfusion in different zones of lungs.Ventilation and Perfusion in different zones of lungs.
Ventilation and Perfusion in different zones of lungs.
 
peak expiratory flow rate presentation
peak expiratory flow rate presentationpeak expiratory flow rate presentation
peak expiratory flow rate presentation
 
One lung ventilation
One lung ventilationOne lung ventilation
One lung ventilation
 
Pulmonary function testing
Pulmonary function testingPulmonary function testing
Pulmonary function testing
 

Viewers also liked

Initial Management :- the patient with AHF on the ICU
Initial Management :- the patient with AHF on the ICUInitial Management :- the patient with AHF on the ICU
Initial Management :- the patient with AHF on the ICUdrucsamal
 
Anticholinergics and anti emetics
Anticholinergics and anti emeticsAnticholinergics and anti emetics
Anticholinergics and anti emeticsAntara Banerji
 
Bedside respiratory assessment & spirometry
Bedside respiratory assessment & spirometryBedside respiratory assessment & spirometry
Bedside respiratory assessment & spirometryArjun Chhetri
 
Pharmacokinetics and dynamics
Pharmacokinetics and dynamicsPharmacokinetics and dynamics
Pharmacokinetics and dynamicsAntara Banerji
 
Neuromonitoring and Cerebral Protection Strategies
Neuromonitoring and Cerebral Protection StrategiesNeuromonitoring and Cerebral Protection Strategies
Neuromonitoring and Cerebral Protection Strategiesanaest_husm
 
Positioning in neurosurgical procedures
Positioning in  neurosurgical proceduresPositioning in  neurosurgical procedures
Positioning in neurosurgical proceduresSaikat Mitra
 
Sharon Kay: Echo for Everyone: 5 Things Never to Miss
Sharon Kay: Echo for Everyone: 5 Things Never to MissSharon Kay: Echo for Everyone: 5 Things Never to Miss
Sharon Kay: Echo for Everyone: 5 Things Never to MissSMACC Conference
 
Perioperative Optimisation of Coagulation and Haemostasis
Perioperative Optimisation of Coagulation and HaemostasisPerioperative Optimisation of Coagulation and Haemostasis
Perioperative Optimisation of Coagulation and HaemostasisAndrew Ferguson
 
Neuromonitoring in anesthesia
Neuromonitoring in anesthesiaNeuromonitoring in anesthesia
Neuromonitoring in anesthesiaAntara Banerji
 
Anaesthesia for neurosurgery
Anaesthesia for neurosurgeryAnaesthesia for neurosurgery
Anaesthesia for neurosurgerySiti Azila
 
Plethysmographic waveform
Plethysmographic waveformPlethysmographic waveform
Plethysmographic waveformalh076
 
Cardiac diagnostic procedures
Cardiac diagnostic proceduresCardiac diagnostic procedures
Cardiac diagnostic proceduresMMARTIN274
 
anaesthesia for liver transplantation
anaesthesia for liver transplantationanaesthesia for liver transplantation
anaesthesia for liver transplantationDrUday Pratap Singh
 
Anaesthesia for liver transplantation
Anaesthesia for liver transplantationAnaesthesia for liver transplantation
Anaesthesia for liver transplantationisakakinada
 

Viewers also liked (20)

Initial Management :- the patient with AHF on the ICU
Initial Management :- the patient with AHF on the ICUInitial Management :- the patient with AHF on the ICU
Initial Management :- the patient with AHF on the ICU
 
Anticholinergics and anti emetics
Anticholinergics and anti emeticsAnticholinergics and anti emetics
Anticholinergics and anti emetics
 
Bedside respiratory assessment & spirometry
Bedside respiratory assessment & spirometryBedside respiratory assessment & spirometry
Bedside respiratory assessment & spirometry
 
Liver function tests
Liver function testsLiver function tests
Liver function tests
 
Pharmacokinetics and dynamics
Pharmacokinetics and dynamicsPharmacokinetics and dynamics
Pharmacokinetics and dynamics
 
Neuromonitoring and Cerebral Protection Strategies
Neuromonitoring and Cerebral Protection StrategiesNeuromonitoring and Cerebral Protection Strategies
Neuromonitoring and Cerebral Protection Strategies
 
Positioning in neurosurgical procedures
Positioning in  neurosurgical proceduresPositioning in  neurosurgical procedures
Positioning in neurosurgical procedures
 
Sharon Kay: Echo for Everyone: 5 Things Never to Miss
Sharon Kay: Echo for Everyone: 5 Things Never to MissSharon Kay: Echo for Everyone: 5 Things Never to Miss
Sharon Kay: Echo for Everyone: 5 Things Never to Miss
 
Perioperative Optimisation of Coagulation and Haemostasis
Perioperative Optimisation of Coagulation and HaemostasisPerioperative Optimisation of Coagulation and Haemostasis
Perioperative Optimisation of Coagulation and Haemostasis
 
Neuromonitoring in anesthesia
Neuromonitoring in anesthesiaNeuromonitoring in anesthesia
Neuromonitoring in anesthesia
 
Anaesthesia for neurosurgery
Anaesthesia for neurosurgeryAnaesthesia for neurosurgery
Anaesthesia for neurosurgery
 
Vaporizers Basics
Vaporizers BasicsVaporizers Basics
Vaporizers Basics
 
Positioning in neurosurgeries
Positioning in neurosurgeriesPositioning in neurosurgeries
Positioning in neurosurgeries
 
Patient Positioning
Patient PositioningPatient Positioning
Patient Positioning
 
Plethysmographic waveform
Plethysmographic waveformPlethysmographic waveform
Plethysmographic waveform
 
Cardiac diagnostic procedures
Cardiac diagnostic proceduresCardiac diagnostic procedures
Cardiac diagnostic procedures
 
anaesthesia for liver transplantation
anaesthesia for liver transplantationanaesthesia for liver transplantation
anaesthesia for liver transplantation
 
Anaesthesia for liver transplantation
Anaesthesia for liver transplantationAnaesthesia for liver transplantation
Anaesthesia for liver transplantation
 
Head injury
Head injuryHead injury
Head injury
 
Donor assessment
Donor assessmentDonor assessment
Donor assessment
 

Similar to Pulmonary Function Tests

Pulmonary function tests
Pulmonary function testsPulmonary function tests
Pulmonary function testsPrasant N
 
lung volumes new v.pptx
lung volumes new v.pptxlung volumes new v.pptx
lung volumes new v.pptxudayasree30
 
Pulmonary function tests
Pulmonary function testsPulmonary function tests
Pulmonary function testsJaber Manasia
 
PULMONARY FUNCT TEST.pptx
PULMONARY FUNCT TEST.pptxPULMONARY FUNCT TEST.pptx
PULMONARY FUNCT TEST.pptxSaumya Singh
 
Pulmonary-Function-Tests and it's importance ppt
Pulmonary-Function-Tests and it's importance pptPulmonary-Function-Tests and it's importance ppt
Pulmonary-Function-Tests and it's importance pptpriadharshini31
 
14. pulmonary-function-tests
14. pulmonary-function-tests14. pulmonary-function-tests
14. pulmonary-function-testsSuhail Khan
 
Anaecon India - Spirometery
Anaecon India - SpirometeryAnaecon India - Spirometery
Anaecon India - SpirometerySarthak Jain
 
Pft dr s kundu sskm
Pft dr s kundu sskmPft dr s kundu sskm
Pft dr s kundu sskmRaja Lahiri
 
High frequency oscillatory ventilation
High frequency oscillatory ventilationHigh frequency oscillatory ventilation
High frequency oscillatory ventilationAhmed AlGahtani, RRT
 
pulmonary function tests
pulmonary function testspulmonary function tests
pulmonary function testsmadhu chaitanya
 
Pulmonary fuction test seminar
Pulmonary fuction test seminar Pulmonary fuction test seminar
Pulmonary fuction test seminar Abhishek Verma
 
Pulmonary function test Dr Kavita.pptx
Pulmonary function test Dr Kavita.pptxPulmonary function test Dr Kavita.pptx
Pulmonary function test Dr Kavita.pptxKavitaKadyan1
 

Similar to Pulmonary Function Tests (20)

Pulmonary function test
Pulmonary function testPulmonary function test
Pulmonary function test
 
Pulmonary function tests
Pulmonary function testsPulmonary function tests
Pulmonary function tests
 
lung volumes new v.pptx
lung volumes new v.pptxlung volumes new v.pptx
lung volumes new v.pptx
 
pulmonary function test
pulmonary function testpulmonary function test
pulmonary function test
 
Pulmonary function tests
Pulmonary function testsPulmonary function tests
Pulmonary function tests
 
PULMONARY FUNCT TEST.pptx
PULMONARY FUNCT TEST.pptxPULMONARY FUNCT TEST.pptx
PULMONARY FUNCT TEST.pptx
 
Pft 10.12.14
Pft 10.12.14Pft 10.12.14
Pft 10.12.14
 
Pulmonary-Function-Tests and it's importance ppt
Pulmonary-Function-Tests and it's importance pptPulmonary-Function-Tests and it's importance ppt
Pulmonary-Function-Tests and it's importance ppt
 
14. pulmonary-function-tests
14. pulmonary-function-tests14. pulmonary-function-tests
14. pulmonary-function-tests
 
Anaecon India - Spirometery
Anaecon India - SpirometeryAnaecon India - Spirometery
Anaecon India - Spirometery
 
pulmo test.pptx
pulmo test.pptxpulmo test.pptx
pulmo test.pptx
 
Spirometry
 Spirometry Spirometry
Spirometry
 
Pft dr s kundu sskm
Pft dr s kundu sskmPft dr s kundu sskm
Pft dr s kundu sskm
 
High frequency oscillatory ventilation
High frequency oscillatory ventilationHigh frequency oscillatory ventilation
High frequency oscillatory ventilation
 
pulmonary function tests
pulmonary function testspulmonary function tests
pulmonary function tests
 
Pulmonary fuction test seminar
Pulmonary fuction test seminar Pulmonary fuction test seminar
Pulmonary fuction test seminar
 
PFT.pdf
PFT.pdfPFT.pdf
PFT.pdf
 
Pulmonary function test Dr Kavita.pptx
Pulmonary function test Dr Kavita.pptxPulmonary function test Dr Kavita.pptx
Pulmonary function test Dr Kavita.pptx
 
Pulmonary Function Test's
Pulmonary Function Test's Pulmonary Function Test's
Pulmonary Function Test's
 
Bedside pft 1
Bedside pft 1Bedside pft 1
Bedside pft 1
 

Recently uploaded

Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...Cara Menggugurkan Kandungan 087776558899
 
Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...soniyagrag336
 
Gorgeous Call Girls Dehradun {8854095900} ❤️VVIP ROCKY Call Girls in Dehradun...
Gorgeous Call Girls Dehradun {8854095900} ❤️VVIP ROCKY Call Girls in Dehradun...Gorgeous Call Girls Dehradun {8854095900} ❤️VVIP ROCKY Call Girls in Dehradun...
Gorgeous Call Girls Dehradun {8854095900} ❤️VVIP ROCKY Call Girls in Dehradun...Sheetaleventcompany
 
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana GuptaLifecare Centre
 
Independent Bangalore Call Girls (Adult Only) 💯Call Us 🔝 7304373326 🔝 💃 Escor...
Independent Bangalore Call Girls (Adult Only) 💯Call Us 🔝 7304373326 🔝 💃 Escor...Independent Bangalore Call Girls (Adult Only) 💯Call Us 🔝 7304373326 🔝 💃 Escor...
Independent Bangalore Call Girls (Adult Only) 💯Call Us 🔝 7304373326 🔝 💃 Escor...Sheetaleventcompany
 
(RIYA)🎄Airhostess Call Girl Jaipur Call Now 8445551418 Premium Collection Of ...
(RIYA)🎄Airhostess Call Girl Jaipur Call Now 8445551418 Premium Collection Of ...(RIYA)🎄Airhostess Call Girl Jaipur Call Now 8445551418 Premium Collection Of ...
(RIYA)🎄Airhostess Call Girl Jaipur Call Now 8445551418 Premium Collection Of ...TanyaAhuja34
 
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptxSwetaba Besh
 
Circulatory Shock, types and stages, compensatory mechanisms
Circulatory Shock, types and stages, compensatory mechanismsCirculatory Shock, types and stages, compensatory mechanisms
Circulatory Shock, types and stages, compensatory mechanismsMedicoseAcademics
 
Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
Kolkata Call Girls Naktala  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Girl Se...Kolkata Call Girls Naktala  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Girl Se...
Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...Namrata Singh
 
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptxANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptxSwetaba Besh
 
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...Sheetaleventcompany
 
Cheap Rate Call Girls Bangalore {9179660964} ❤️VVIP BEBO Call Girls in Bangal...
Cheap Rate Call Girls Bangalore {9179660964} ❤️VVIP BEBO Call Girls in Bangal...Cheap Rate Call Girls Bangalore {9179660964} ❤️VVIP BEBO Call Girls in Bangal...
Cheap Rate Call Girls Bangalore {9179660964} ❤️VVIP BEBO Call Girls in Bangal...Sheetaleventcompany
 
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...Sheetaleventcompany
 
tongue disease lecture Dr Assadawy legacy
tongue disease lecture Dr Assadawy legacytongue disease lecture Dr Assadawy legacy
tongue disease lecture Dr Assadawy legacyDrMohamed Assadawy
 
Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now
Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book nowChennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now
Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book nowtanudubay92
 
Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...
Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...
Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...Dipal Arora
 
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...gragneelam30
 
Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
Call Girls Shahdol Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Shahdol Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Shahdol Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Shahdol Just Call 8250077686 Top Class Call Girl Service AvailableDipal Arora
 
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...
Kolkata Call Girls Shobhabazar  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Gir...Kolkata Call Girls Shobhabazar  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Gir...
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...Namrata Singh
 

Recently uploaded (20)

Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
 
Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...
Call Girls in Lucknow Just Call 👉👉8630512678 Top Class Call Girl Service Avai...
 
Gorgeous Call Girls Dehradun {8854095900} ❤️VVIP ROCKY Call Girls in Dehradun...
Gorgeous Call Girls Dehradun {8854095900} ❤️VVIP ROCKY Call Girls in Dehradun...Gorgeous Call Girls Dehradun {8854095900} ❤️VVIP ROCKY Call Girls in Dehradun...
Gorgeous Call Girls Dehradun {8854095900} ❤️VVIP ROCKY Call Girls in Dehradun...
 
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
 
Independent Bangalore Call Girls (Adult Only) 💯Call Us 🔝 7304373326 🔝 💃 Escor...
Independent Bangalore Call Girls (Adult Only) 💯Call Us 🔝 7304373326 🔝 💃 Escor...Independent Bangalore Call Girls (Adult Only) 💯Call Us 🔝 7304373326 🔝 💃 Escor...
Independent Bangalore Call Girls (Adult Only) 💯Call Us 🔝 7304373326 🔝 💃 Escor...
 
(RIYA)🎄Airhostess Call Girl Jaipur Call Now 8445551418 Premium Collection Of ...
(RIYA)🎄Airhostess Call Girl Jaipur Call Now 8445551418 Premium Collection Of ...(RIYA)🎄Airhostess Call Girl Jaipur Call Now 8445551418 Premium Collection Of ...
(RIYA)🎄Airhostess Call Girl Jaipur Call Now 8445551418 Premium Collection Of ...
 
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
 
Circulatory Shock, types and stages, compensatory mechanisms
Circulatory Shock, types and stages, compensatory mechanismsCirculatory Shock, types and stages, compensatory mechanisms
Circulatory Shock, types and stages, compensatory mechanisms
 
Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
Kolkata Call Girls Naktala  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Girl Se...Kolkata Call Girls Naktala  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Girl Se...
Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
 
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptxANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
 
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
 
Cheap Rate Call Girls Bangalore {9179660964} ❤️VVIP BEBO Call Girls in Bangal...
Cheap Rate Call Girls Bangalore {9179660964} ❤️VVIP BEBO Call Girls in Bangal...Cheap Rate Call Girls Bangalore {9179660964} ❤️VVIP BEBO Call Girls in Bangal...
Cheap Rate Call Girls Bangalore {9179660964} ❤️VVIP BEBO Call Girls in Bangal...
 
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
 
tongue disease lecture Dr Assadawy legacy
tongue disease lecture Dr Assadawy legacytongue disease lecture Dr Assadawy legacy
tongue disease lecture Dr Assadawy legacy
 
Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now
Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book nowChennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now
Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now
 
Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...
Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...
Bhawanipatna Call Girls 📞9332606886 Call Girls in Bhawanipatna Escorts servic...
 
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
💰Call Girl In Bangalore☎️63788-78445💰 Call Girl service in Bangalore☎️Bangalo...
 
Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Kathua Just Call 8250077686 Top Class Call Girl Service Available
 
Call Girls Shahdol Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Shahdol Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Shahdol Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Shahdol Just Call 8250077686 Top Class Call Girl Service Available
 
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...
Kolkata Call Girls Shobhabazar  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Gir...Kolkata Call Girls Shobhabazar  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Gir...
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...
 

Pulmonary Function Tests

  • 2.
  • 3. O Tidal Volume (TV): volume of air inhaled or exhaled with each breath during quiet breathing (6-8 ml/kg) O Inspiratory Reserve Volume (IRV): maximum volume of air inhaled from the end-inspiratory tidal position.(1900-3300ml) O Expiratory Reserve Volume (ERV): maximum volume of air that can be exhaled from resting end-expiratory tidal position.( 700-1000ml). O Residual Volume (RV): O Volume of air remaining in lungs after maximium exhalation (20-25 ml/kg) (1700-2100ml) O Indirectly measured (FRC-ERV) O It can not be measured by spirometry
  • 4. • Total Lung Capacity (TLC): Sum of all volume compartments or volume of air in lungs after maximum inspiration (4-6 L) • Vital Capacity (VC): TLC minus RV or maximum volume of air exhaled from maximal inspiratory level. (60-70 ml/kg) (3100- 4800ml) • Inspiratory Capacity (IC): Sum of IRV and TV or the maximum volume of air that can be inhaled from the end-expiratory tidal position. (2400-3800ml). • Expiratory Capacity (EC): TV+ ERV
  • 5. Vital Capacity O Considered abnormal if <80% of predicted value. O Physiological factors influencing VC:  Height  Sex  Age  Posture  Strength of respiratory muscle
  • 6. Factors decreasing Vital Capacity: ① Alteration in muscle power. ② Pulmonary diseases. ③ Space occupying lesions in chest. ④ Abdominal causes. ⑤ Depression of respiration. ① Posture – by altering pulmonary Blood volume.
  • 7. Different postures affecting VC O POSITION  TRENDELENBERG  LITHOTOMY  PRONE  RT. LATERAL  LT. LATERAL O DECREASE IN VC  14.5%  18%  10%  12%  10%
  • 8. Vital Capacity pre and post op. Before epidural 1hr after epidural 24hrs after epidural 1. Upper Abdominal 35.2% 69% 83.2% 2. Lower Abdominal 55.5% 84.8% 94.7% Vital capacity readings expressed as a % of pre op values.
  • 9. Functional residual capacity O Functional Residual Capacity (FRC): O Sum of RV and ERV or the volume of air in the lungs at end-expiratory tidal position.(30-35 ml/kg) (2300-3300ml). O Measured with multiple-breath closed-circuit helium dilution, multiple-breath open-circuit nitrogen washout, or body plethysmography. O It can not be measured by spirometry)
  • 10. Functional Residual Capacity • FRC INCREASES WITH • Increased height • Erect position (30% more than in supine) • Decreased lung recoil (e.g. emphysema) • FRC DECREASES WITH • Obesity • Muscle paralysis (especially in supine) • Supine position • Restrictive lung disease (e.g. fibrosis, Pregnancy) • Anaesthesia
  • 11. Functions of FRC: • Oxygen store • Buffer for maintaining a steady arterial po2 • Partial inflation helps prevent atelectasis • Minimise the work of breathing • Minimise pulmonary vascular resistance • Minimised v/q mismatch - only if closing capacity is less than FRC.
  • 12. Maximum Voluntary Ventilation O Also known as the Maximum Breathing Capacity (MBC) O It is the largest volume of gas that can be moved into and out of the lungs in 1 minute by voluntary effort. O Normal- 125-170L/min O Subject is asked to breathe as hard and fast as possible for 10-15secs. The value obtained is converted to 60secs. O Reflects the status of respiratory muscle, compliance of chest wall and airway resistance. O Effort dependent test. O It can reveal diminished reserves of weak respiratory muscles.
  • 13. What are pulmonary function tests? O A group of studies or maneuvers that may be performed using standardized equipment to measure lung function.
  • 14. Bedside PFT’s O Sniders match blowing test O Forced expiratory time O Saberazes single breath count O Saberazes breath holding test O Cough test O De bono’s whistle test O Wrights peak flowmeter
  • 15. Saberazes breath holding test Ask the patient to take a full but not too deep breath & hold it as long as possible. >25 SEC.-NORMAL Cardiopulmonary Reserve (CPR) 15-25 SEC- LIMITED CPR <15 SEC- VERY POOR CPR (Contraindication for elective surgery) 25- 30 SEC - 3500 ml VC 20 – 25 SEC - 3000 ml VC 15 - 20 SEC - 2500 ml VC 10 - 15 SEC - 2000 ml VC 5 - 10 SEC - 1500 ml VC
  • 16. Saberazes single breath count After deep breath, hold it and start counting till the next breath.  N- 30-40 COUNT  Indicates vital capacity.
  • 17. Sniders match blowing test Ask to blow a match stick from a distance of 6” (15 cms) with-  Mouth wide open  Chin rested/supported  No purse lipping  No head movement  No air movement in the room  Mouth and match at the same level
  • 18. O Can not blow out a match O MBC < 60 L/min O FEV1 < 1.6L O Able to blow out a match O MBC > 60 L/min O FEV1 > 1.6L O MODIFIED MATCH TEST: DISTANCE MBC 9” >150 L/MIN. 6” >60 L/MIN. 3” > 40 L/MIN.
  • 19. Cough test Deep breath followed by cough  ABILITY TO COUGH  STRENGTH  EFFECTIVENESS INADEQUATE COUGH IF: FVC<20 ML/KG FEV1 < 15 ML/KG PEFR < 200 L/MIN. VC should be 3 TIMES TV FOR EFFECTIVE COUGH. A wet productive cough / self propagated paraoxysms of coughing :patient susceptible for pulmonary complication.
  • 20. Forced expiratory time After deep breath, exhale maximally and forcefully & keep stethoscope over trachea & listen. Normal FET – 3-5 SECS. OBS.LUNG DIS. - > 6 SEC RES. LUNG DIS.- < 3 SEC
  • 21. Wrights Peak FLowmeter • Measures tidal volume, mv (15 secs times 4) • Simple and rapid • Instrument- compact, light and portable. • Disadvantage: It under- reads at low flow rates and over- reads at high flow rates. • Can be connected to endotracheal tube or face mask • Prior explanation to patients needed. • Ideally done in sitting positoin.
  • 22. Wrights peak flowmeter • MV- instrument record for 1 min. And read directly • Accurate measurement in the range of 3.7- 20l/min.(±10%) • USES: 1)BED SIDE PFT 2) ICU – Weaning patients from Ventilation. Measures PEFR (Peak Expiratory Flow Rate) Normal – MALES- 450-700 L/MIN. FEMALES- 350-500 L/MIN. <200 L/ MIN. – INADEQUATE COUGH EFFICIENCY.
  • 23. De bono’s whistle test MEASURES PEFR. Patient blows down a wide bore tube at the end of which is a whistle, on the side is a hole with adjustable knob. As subject blows → whistle blows, leak hole is gradually increased till the intensity of whistle disappears. At the last position at which the whistle can be blown , the PEFR can be read off the scale.
  • 24. Components of PFT 1.Tests of mechanical function:  Spirometry  Static lung volumes  Respiratory Mechanics  Respiratory muscle strength 2.Tests of gas exchange: ABG, DLCO. 3.Cardiopulmonary interaction: • Qualitative- stair climbing • Quantitative- 6min walking test
  • 25. Indications for spirometry: O Diagnostic: • evaluate symptoms and signs • Effect of disease on PFT • Screen individuals • Pre-op risk O Monitoring- to assess therapeutic interventions O Public health
  • 26. Contraindications • Hemoptysis • Pneumothorax • Recent MI, unstable angina pectoris • Thoracic, abdominal and cerebral aneurysm • Recent abdominal or thoracic surgical procedure. • H/o Syncope with forced exhalation • Recent eye surgery
  • 27. Pre-requisites O Prior explanation to the patient O Not to smoke /inhale bronchodilators 6 hrs prior or oral bronchodilators 12hrs prior. O Remove any tight clothings/ waist belt/ dentures O Pt. Seated comfortably O Nose clip to close nostrils. O Minimum exhalation time of 6 seconds, but up to 15 seconds O Number of maneuvers: Minimum of 3 and maximum of 8 O Should not be interfered by coughing, glottic closure, mechanical obstruction.
  • 28.
  • 29. Requirements of a good PFT. O Lack of artifact O Satisfactory start O Satisfactory exhalation with six seconds of smooth continuous exhalation. O ATS Criteria for reproducibility after obtaining 3 acceptable spirograms: 1) Largest FVC within 0.15L of next largest FVC 2) Largest FEV1 within 0.15L of next largest FEV1
  • 30.
  • 31. Measurements obtained from the FVC curve: O FEV1---the volume exhaled during the first second of the FVC maneuver O FEF 25-75%---the mean expiratory flow during the middle half of the FVC maneuver; reflects flow through the small (<2 mm in diameter) airways O FEV1/FVC---the ratio of FEV1 to FVC X 100 (expressed as a percent); an important value because a reduction of this ratio from expected values is specific for obstructive rather than restrictive diseases
  • 32.
  • 33.
  • 34. Causes of restrictive PFT O Lung parenchymal pathology O Inter pleural pathology O Neuromuscular problems
  • 35. Grading of severity of abnormality O Based on TLC:  Mild: predicted TLC is less than lower limit of normal but >70%  Moderate: predicted TLC is <70% and >60%  Moderately severe: predicted TLC <60% O Based on spirometry:  Mild: Predicted VC is less than lower limit of normal but >70%  Moderate: Predicted VC <70% and >60%  Moderately severe: Predicted VC <60% and >50%  Severe: Predicted VC <50% and >34%  Very Severe: Predicted VC <34%
  • 36. Causes of obstructive PFT O Narrowing of airways due to bronchial smooth muscle contraction. O Narrowing of airways due to inflammation and swelling of bronchial mucosa. O Material inside the bronchial passage. O Destruction of lung tissue with loss of elasticity.
  • 37. Severity of obstructive lung disease:
  • 38. Obstructive vs Restrictive diseases on spirometry Obstructive disorders Restrictive disorders O FVC N or↓ O FEV1 ↓ O FEF25-75% ↓ O FEV1/FVC ↓ O TLC N or ↑ O FVC ↓ O FEV1 ↓ O FEF 25-75% N to ↓ O FEV1/FVC N to ↑ O TLC ↓
  • 39.
  • 40.
  • 41.
  • 42. Criteria for reversibility of small airway obstruction on PFT: O 2 PFTs should be done one before and one after administration of bronchodilator. O Drug used is usually beta-2 sympathomimetic. O If 2 out of 3 measurements improve then patient has reversible airway obstruction. 1) FVC of 10% or more 2) FEV1 an increase of 200ml or 15% of baseline FEV1 3) FEF25-75% an increase of 25% or more
  • 43. Flow volume loops O Helpful in evaluation of air flow limitation on inspiration and expiration O In addition to obstructive and restrictive patterns, flow-volume loops can provide information on upper airway obstruction: O Fixed obstruction: such as in tumor, tracheal stenosis O Variable extrathoracic obstruction: such as in vocal cord dysfunction O Variable intrathoracic obstruction:as in malignancy or tracheomalacia
  • 44.
  • 45.
  • 46.
  • 47. Measurement of other lung volumes O Nitrogen washout technique O Helium dilution technique O Body plethysmography
  • 48. DLCO (diffusion lung CO) O The diffusing capacity is a measure of the ability of the lungs to transfer gas. O Measure of interaction of alveolar surface area, alveolar capillary perfusion and physical properties of the alveolar capillary interface. O CO is rapidly taken up by haemoglobin, its transfer is therefore limited mainly by diffusion
  • 49. Causes of decreased DLCO: Causes of increased DLCO: O Anemia O Emphysema O ILD O Pulmonary edema O Pulmonary vascular disease O Obesity O Asthma O L to R shunt O Alveolar hemorrhage
  • 50. DLCO- capacity of the lungs to transfer CO (ml/min/mmHg) DLCOc- DLCO corrected for Hb (ml/min/mmHg) DLVA- DLCO corected for volume (ml/min/mmHg/L) DLVC- DLCO corrected for both volume and Hb (ml/min/mmHg/L)
  • 51. Respiratory muscle function O A number of diseases such as motor neuron disease can result in respiratory muscle weakness, which can ultimately lead to respiratory failure O Inspiratory mouth pressure A measure of inspiratory muscle function in which subjects generate as much inspiratory pressure as possible against a blocked mouth piece .Values of 80 cm of water or more exclude any significant inspiratory muscle weakness O Expiratory mouth pressure A measure of expiratory muscle function in which subjects generate as much expiratory pressure as possible against a blocked mouth piece. Values of 80 cm of water or more exclude any significant expiratory muscle weakness
  • 52. Tests for cardiopulmonary reserve: O Number of flights of stairs patient can climb: inability to climb 2 flights of stairs indicates increased risk of post-op cardiopulmonary complications. O Six minute walking test (6 MWT)
  • 55. ATS classification of severity of COPD
  • 56. Evaluation of patient for lung resection GOALS: 1) to identify patients at risk of increased post- op morbidity & mortality 2) to identify patients who need short-term or long term post-op ventilator support. Lung resection may be followed by – inadequate gas exchange, pulm HTN & incapacitating dyspnoea.
  • 57. EXAMPLE: Assuming pre op FEV1 to be 70% ppoFEV1= 70 X (1-29/100) ppoFEV1= 50%
  • 58.
  • 59. References O A practice of anesthesia by Wylie 5th edition O Millers 7th edition O Clinical Anesthesiology- Morgan 5th edition O Interpreting pulmonary function tests: Recognize the pattern, and the diagnosis will follow. CLEVELAND CLINIC JOURNAL OF MEDICINE VOLUME 70 • NUMBER 10 O SERIES ‘‘ATS/ERS TASK FORCE: STANDARDISATION OF LUNG FUNCTION TESTING’’ 2005

Editor's Notes

  1. Patient should be seated vs. standing?  Nose clip is recommended  Start of test  Full inspiration with good expiratory effort  Extrapolated volume does not exceed 5% of FVC or 150 mL, whichever is greater  End of test  Obvious plateau in volume-time curve of at least 2 seconds  Minimum exhalation time of 6 seconds, but up to 15 seconds  Number of maneuvers  Minimum of 3 and maximum of 8