ࡱ> on:<( /0(  0;[0 0 000$([\{b00 000000000  0=] 0 0 0000 2 3 !A0C0E0G0I0c00000000000000000!%),.:;?]}acdeghijklmnopDTimes New Romanbb(b0LbLb0DMonotype Sortsbb(b0LbLb0 DArialpe Sortsbb(b0LbLb0"@  @@``  @n?" dd@  @@`` ,$10$       !"#$&%'()*,+-./ `1?@ g46d6dXb0Pbf ppp@ ? %5Pulmonary FunctionDavid Arnall, Ph.D., PT&$&Purpose of Pulmonary Function Testing''iPulmonary Function Testing has been a major step forward in assessing the functional status of the lungs."ji$ dHow much air volume can be moved in and out of the lungs - how large the lungs are for this patient.ee$  qHow fast the air in the lungs can be moved in and out - a question about how open the lungs are moment to moment."rq$  JHow stiff are the lungs and chest wall - a question about lung compliance "KJ$  tThe diffusion characteristics of the alveolar membrane through which gases must move (determined by special tests). "ut$t  How the lungs respond to chest physical therapy procedures - it will be important to have an admissions PFT and a discharge PFT performed."$  Uses for PFTs  CScreening for the presence of obstructive and restrictive diseases DD$Uses cont dEvaluating the patient prior to surgery : a. are older than 60-65 years of age b. are known to have pulmonary disease c. are pathologically obese d. have a hx of smoking, cough, etc.8*'$ Uses cont dxe. will be under anesthesia for a lengthy period of time f. are undergoing an abdominal or a thoracic operation"yx$   Note : A vital capacity is an important preoperative assessment tool. Significant reductions in vital capacity (less than 20 cc/Kg of ideal body weight) indicates that the patient is at a higher risk for postoperative respiratory complications. This is because vital capacity reflects the patient's ability to take a deep breath, to cough, & to clear the airways of excess secretions. (S3 Uses cont dEvaluating the patient's condition for weaning from a ventilator. If the patient on a ventilator can demonstrate a vital capacity (VC) of 10 - 15 ml/Kg of body weight, it is generally thought that there is enough ventilatory reserve to permit (try) weaning & extubation.*A, #  Uses cont d Documenting the progression of pulmonary disease - restrictive or obstructive Documenting the effectiveness of therapeutic interventions 4  Equipment  The basic equipment is a spirometer Dry spirometers Wet spirometers Pneumotach versions Cold Pneumotachs Heated Ceramic Pneumotachs^$4,$$3 ,b     |Has to be calibrated using a 3-Liter syringe along with temperature and barometric pressure information at the testing site.}}$Performance of the PFTPatient Instructions :  Take a deep breath in  Place the mouthpiece in your mouth  Create a good lip seal  Blow out all of the air in your lungs  Blow out the air as fast as you can  Keep blowing until I say stop 8$  UWhen three PFTs are within < 5% variance between the tests, then the testing is over.:V$$9$ FWhat Are Normal Values ?Normal values are determined from a nomogram that has been developed after testing hundreds to thousands of people across the lifespan.$,$ Q pFactors to take into consideration when developing a nomogram are such things as : age gender height weight race0SS$5 3%Important Lung Volumes and Capacities&%Forced Vital Capacity (FVC) Forced vital capacity is the largest volume that can be forcibly exhaled from the lungs after a profoundly deep inhalation. :~$|$ FVC is a major marker for obstructive lung disease. If FVC is low or near normal but takes a long time to exhale, obstructive disease should be expected."4i$ Forced Expiratory Volume in One Second (FEV1) FEV1 is the volume of air that can be forcibly exhaled in the first second of a FVC maneuver.B._.$]$ FEV1 is a major marker for obstructive disease. If FEV1 is small it is a sign that either the volume of air in the lungs is small or it is difficult to blow out."0s$ FEV1/FVC - FEV1 Percent (FEV1%) This number is the ratio of FEV1 to FVC - it indicates what percentage of the total FVC was expelled from the lungs during the first second of forced exhalation.>  $$  FEV1% is a very important number in determining the presence of restrictive or obstructive disease. If FEV1% is 88% - 100%, it indicates the presence of restrictive disease. If this number is 69% or lower, then the presence of obstructive disease must be expected.  $ FEV3 - This is the amount of air that can be blown out of the lungs on exhalation in three seconds. In most people, FEV3 maybe very close to the actual value of FVC.$  PEFR - Peak Expiratory Flow Rate This is the maximum flow rate achieved by the patient during the forced vital capacity maneuver. It can either be measured in L/sec or L/min& $$! PEFR is a useful measure to see if a bronchodilatory treatment is improving obstruction as seen in asthma where there is lots of bronchoconstriction. $,%L" Forced Expiratory Flow 25% - 75% This measurement describes the amount of air expelled from the lungs during the middle half of the forced vital capacity test. . $$# ^Many physicians like to look at FEF25%-75% because it is an indicator of obstructive disease. _^$$Restrictive Diseases[Tuberculosis ARDS & IRDS Sarcoidosis Byssinosis Asbestosis Silicosis Ankylosing Spondylitis\\$,%Obstructive Diseases*Emphysema Bronchitis Bronchiectasis Asthma++$'!/How Do I Determine The Extent Of Lung Disease ?0/MHow do I determine if the patient has mild, moderate or severe lung disease ?&NM$(&  Normal PFT Outcomes - > 85 % of predicted values Mild Disease - > 65 % but < 85 % of predicted values Moderate Disease - > 50 % but < 65 % of predicted values Severe Disease - < 50 % of predicted values >$$("Reversible Lung DiseaseuIf 2 or more of the PFT variables change after a bronchodilator treatment, then the patient has reversible disease. &tv$$15)#What is Acceptible Change ?  1.FVC : an increase of 10% or more 2.FEV1 : an increase of 200 ml or 15% of the baseline FEV1 3.FEF25%-75% : an increase of 20% or more &$*$How Do I Read A PFT ?Step 1. Look at the forced vital capacity (FVC) to see if it is within normal limits. Step 2. Look at the forced expiratory volume in one second (FEV1) and determine if it is within normal limits. "$+% uStep 3. If both FVC and FEV1 are normal, then you do not have to go any further - the patient has a normal PFT test. "vu$u,' RStep 4. If FVC and/or FEV1 are low, then the presence of disease is highly likely.SS$-& fStep 5. If Step 4 indicates that there is disease then you need to go to the %predicted for FEV1/FVC. "ge$f.( If the %predicted for FEV1/FVC is 88%-90% or higher, then the patient has a restricted lung disease. If the %predicted for FEV1/FVC is 69% or lower, then the patient has an obstructed lung disease. "$/) Example # 1  Predicted Measured %Predicted FVC 5.80 L 5.50 L 95% FEV1 4.93 L 4.90 L 99% FEV1% 85% 89% 104%^&&$ $]$0* Example # 2 Predicted Measured %Predicted FVC 5.68 L 4.00 L 70% FEV1 4.90 L 3.25 L 66% FEV1% 84% 81% 96% B&&$$$1+ Example # 3 Predicted Measured %Predicted FVC 4.50 L 2.63 L 58% FEV1 3.80 L .80 L 21% FEV1% 84% 30% 36%6&y&$y$/Pb^ ` ̙33` ` ff3333f` 333MMM` f` f` 3>?" dd@,?nKd@ u FA@ " d`  n?" dd@   @@``PR    @ ` ` p>> ##(  @  Zvxaxa1 ? v RClick to edit Master text styles Second Level Third Level Fourth Level Fifth Level!     S   fdvxaxa1 ?P v T Click to edit Master title style! ! 8  #~  NO32 @1? @ 0f "0ff  61?0Pf  61?0@f  61?0pf  61?0`f   61?0f   61?0 f   61?0f   61?0@f   61?00 f  61?0` f  61?0 P f  61?0 f  61?0 p f  61?0 f  61?00 f  61?0 f  61?0P f  61?0 @f  61?0pf  61?0`f  61?0f  61?0 f  61?0ff  61?0Vf  61?0f  61?0vf  61?0f   61?06f ! 61?0&T  <f޽h @ ? 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H  0޽h ? a(rPKSB<TVXZ\a^A`!bdegikamAo!qstvxza|A~!aA!aA! ө1b Oh+'0  @ L X dpx Lorem IpsumoreMicrosoft CorporationPicricricrDavid Alan Arnallio21iMicrosoft PowerPoint 4.0i@@;1ְb@@ˆ@hÙ#1< ՜.+,D՜.+,X   On-screen ShowǪx,  0Times New RomanMonotype SortsArialSldshowPulmonary Function'Purpose of Pulmonary Function TestingNo Slide TitleNo Slide TitleNo Slide TitleNo Slide TitleNo Slide TitleUses for PFTs Uses contd Uses contdNo Slide Title Uses contd Uses contd EquipmentNo Slide TitlePerformance of the PFTNo Slide TitleWhat Are Normal Values ?No Slide Title&Important Lung Volumes and CapacitiesNo Slide TitleNo Slide TitleNo Slide TitleNo Slide TitleNo Slide TitleNo Slide TitleNo Slide TitleNo Slide TitleNo Slide TitleNo Slide TitleRestrictive DiseasesObstructive Diseases0How Do I Determine The Extent Of Lung Disease ?No Slide TitleReversible Lung DiseaseWhat is Acceptible Change ?How Do I Read A PFT ?No Slide TitleNo Slide TitleNo Slide TitleNo Slide Title Example # 1 Example # 2 Example # 3  Fonts UsedDesign Template Slide Titles,em  M Y a iqy _PID_GUID TemplateType GraphicType Compression ScreenSize ScreenUsage MailAddress HomePage Other DownloadOriginal DownloadIEButton UseBrowserColor BackColor TextColor LinkColor VisitedColorTransparentButton ButtonType ShowNotes NavBtnPos OutputDirAN{7FAE1A00-9C41-11D3-A740-00C04FA864B8}d(David.Arnall@NAU.EDU , DAArnall@AOL.COM'http://jan.ucc.nau.edu/~daa/heartlung/ttp  f3 C:\CardioPPP1\Pft.e)_㣪bDavid Alan Arnall  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUWXYZ[\]_`abcdeghijklmpRoot EntryFAFAFPGF,DIdO)(IFPIF4Current User/D%A/DxIF-AJAJA,KA