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Pulmonary Function Tests
What are they?
A group of tests that measure breathing and how well the lungs are functioning
Diagnose certain types of lung disease such as COPD, asthma, bronchitis and
emphysema
-instruct patient to not eat a heavy meal before the test and and to not smoke for
at least 4-6 hours before the test
-because there is some forced and rapid breathing involved, the patient may
experience some shortness of breath and/or lightheadedness
Question - Why should this testing be avoided in a patient with recent ophthalmic
surgery?
Simple Bedside Tests
Breath Holding Test
Match Test
Cough Test
Tracheal Auscultation
Balloon Test
Spirometry -using Micro spirometer
Wright Respirometer
Spirometry
-CORNERSTONE OF ALL PFTs
Sitting position
Patient breathes in and out on a mouthpiece
Nose clips prevent air leak
*Maximal inspiratory and expiratory effort is essential from the patient*
3 tests of acceptable effort - ensures reproducibility of results
Spirometer measures the volume of air displaced or airflow by a flow-sensing
device
Spirometry Standards
Spirometry Acceptability Criteria
http://www.frca.co.uk/article.aspx?articleid=100023
Pulmonary Function Tests
How to measure lung volume:
-breathe nitrogen or helium gas through a tube for a certain amount of time
-for a very short period of time, usually for only one breath, you breathe a
harmless gas called tracer gas
-the concentration of the gas in the air you breathe out is measured
-the difference in the amount of gas inhaled and exhaled measures how effectively
gas travels from the lung into the blood
-estimates how well the lungs move oxygen from the air into the bloodstream
Risks
Risks associated with the tests:
-pneumothorax
-avoid in patients who have recently had a heart attack or have other types of
heart disease
Diffusion Capacity for Carbon Monoxide
Measures the ability of the lungs to transfer gas from inhaled air to the red blood
cells in pulmonary capillaries.
Reflects the ease with which oxygen moves from inhaled air to the red blood cells
in the pulmonary capillaries.
Diseases in which the uptake of oxygen is reduced cause parallel decreases in the
uptake of CO
One of the most clinically valuable tests of lung function
Pulmonary Compliance Test
Pulmonary compliance: the lungs ability to expand or stretch
Abnormal high or low pulmonary compliance can impair the patient's ability to
maintain effective gas exchange
2 types of pulmonary compliance testing: Static vs. Dynamic
Pulmonary Compliance Test
Static Compliance
Airway obstructions
ET Tube kinking or blocking
Bronchospasm
Airway resistance diseases: asthma, bronchitis, emphysema
Pulmonary Compliance Test
Anesthesia
Impaired compliance affects the patient's pulmonary system and the ability to
maintain effective gas exchange
Important to think about when deciding airways and ventilator settings for these
types of patients
Cardiopulmonary Exercise Testing (CPET)
CPET provides assessment of the exercise responses of patients pulmonary,
cardiovascular, and skeletal muscle systems, which cannot be measured through
individual organ system tets.
Non-invasive test
Used for a wide spectrum of different clinical applications
Objective is to determine patient's functional capacity and impairment of the
systems
CPET involves measuring respiratory uptake (VO2), carbon dioxide production
(VCO2), and ventilatory measures during the exercise test.
Cardiopulmonary Exercise Testing (CPET)
The Fick Equation
VO2 is plotted in linear line until VO2max is reached then measurements begin
to plateau
Exercise training can increase VO2max results
Chest pain
Sustained tachyarrhythmias (tachycardia expected)
Large decrease in systolic BP (insufficient CO)
Extreme dyspnea
Muscle fatigue/exhaustion
Light-headedness / faint
Large vital sign changes
Cardiopulmonary Exercise Testing (CPET)
Tests the cardiorespiratory capacity of the entire oxygen transport system from
lungs-skeletal muscle
Testing tool that evaluates patient's exercise capacity and is used to help predict
patient outcomes.
Provides assessment of the pulmonary, cardiovascular, and skeletal systems in
response to stress/exercise .
CPET is being used for a wide spectrum of clinical applications for evaluations of
undiagnosed exercise intolerance and for determining functional capacity and
impairment.
PFTs - Normal Values
What is normal?
Obstructive
Restrictive
Obstructive Disorders
COPD
Progressive development of airflow obstruction that is not fully reversible
Includes obstructive bronchitis and emphysema
FEV decreased (less than 65%)
FEV /FVC ratio decreased
Increased Residual Volume (not blowing emptying the lungs)
Asthma
Decreased FEV and FEF
PFTs reflect severity of expiratory airflow obstruction
Restrictive Disorders
Restrictive Airway Disease
Pulmonary Fibrosis, Neuromuscular Disease, Kyphoscoliosis
Decreased compliance of the lungs or chest wall
Reduction of TLC, RV, and VC
How Do PFTs Relate to Anesthesia?
It is important for anesthesia providers to be able to interpret PFTs and know which
tests help define dysfunction if the patients history and physical examinations are
suggestive of disease. - Barash (pg 278)
Anesthesia providers care for patients with varying degrees of pulmonary dysfunction
Measurements Values
Cardiopulmonary reserve- VO2max, Stair climb > 2 flights, 6 min walk, Exercise Spo2
change of less than 4%
Primary method used to diagnose, stage, and monitor various pulmonary diseases.
disease.
Useful in determining an anesthesia plan (GA vs MAC, etc.) for patients with
respiratory disease.
Questions?
Citations
Albouaini, K., Egred, M., & Alahmar, A. (2007). Cardiopulmonary exercise testing and its application. Postgraduate Medical
Hadjiliadis, D. (2015). Pulmonary function tests. Medline Plus. Retrieved from https://medlineplus.gov/ency/article/003853.htm
Smetana, G. W. (1999). Preoperative pulmonary evaluation. New England Journal of Medicine, 340(12), 937-944.
Galetke, W., Feier, C., Muth, T., Ruehle, K.-H., Borsch-Galetke, E., Randerath, W. (August 2007). Reference values for dynamic and
static pulmonary compliance in men. Respiratory Medicine, 101 (8) 1783-1789. http://dx.doi.org/10.1016/j.rmed.2007.02.015
Citations
Gildea, T. R., & McCarthy, K. (2010, August). Pulmonary Function Testing. Retrieved November 21, 2016, from
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/pulmonary/pulmonary-function-testing
http://www.hopkinsmedicine.org/healthlibrary/test_procedures/pulmonary/pulmonary_function_tests_92,p07759/
Bapoje, S. R., Whitaker, J. F., Schulz, T., Chu, E. S., & Albert, R. K. (2007). Preoperative evaluation of the patient with pulmonary