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PFTs and Homcare (Resp 327) > PFT interpretation (General Review) > Flashcards

PFT interpretation (General Review) Flashcards

1
Q

What counts as a good start for a FVC test?

A

BEV <150ml or 5% of FVC (whichever is larger)

  • long enough Expiratory flow ->6 sec of plateau for 2 sec
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2
Q

What can FVCs and FVLs be used for?

A

Identify level of upper airway obstruction

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3
Q

If PEF falls with repeated efforts (or other expiratory flows), what can be suspected?

A
  1. suspect pt fatigue or
  2. hyperreactive airways (as pt tries more times, R may ⬆ and PEF = ⬇)
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4
Q

A slow rise in PEF indicates what?

A

A large upper airway obstruction

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5
Q

I or E curve squared indicates what?

A

Large upper airway obstruction

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6
Q

Normal PEF criteria for women, men, and kids?

A
  1. Women: 340-550
  2. Men: 440-740
  3. Kids: 150-450
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7
Q

How often should PEF be monitored?

A

2x daily; try to establish a personal best

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8
Q

PEF green criteria indicates what treatment plan?

A

Green > 80% best -> Routine Tx

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9
Q

PEF yellow criteria indicates what treatment plan??

A

yellow 50-80% best = increase meds

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10
Q

PEF Red criteria indicates what treatment plan?

A

Red <50% best = SABA ASAP

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11
Q

What does Body plethysmography measure?

A

FRC; determines ERV via spirometry

  • FRC-ERV=RV
  • TLC = FRC + IC
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12
Q

What does nitrogen washout measure?

A

Measures FRC; only 1 good test needed

= if >1l should be change in 10% -> report mean

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13
Q

What does Helium dilution measure?

A

Measures FRC

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14
Q

What does single breath nitrogen washout measure?

A

Distribution of ventilation

  • measures change in N2 during exp of VC breaths after single breath of 100% of O2
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15
Q

What does P100 or P0.1 measure?

A

Measure airway hunger

  • Insp against closed shutter. Pas at mouth recorded
  • measures at 100ms after occlusion
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16
Q

What does Resting Energy Expenditure (REE) greater than 10% above normal indicate?

A

Hypermetabolic State

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17
Q

When to not smoke PFT

A

within 1hr (24hrs for DLCO)

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18
Q

When not to have alcohol

A

within 4hrs of testing

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19
Q

When not to have exercise

A

within 30 mins of testingW

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20
Q

When to not have a large meal

A

within 2hrs of tesing

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21
Q

Absolute contraindication to spirometry

A

1 month of MI

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22
Q

Obstruction in spirometry?

A
  • FEV1% is decreased
  • FVC MAY be decreased
  • FEV1/FVC is decreased
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23
Q

Restriction spirometry results

A
  • FEV1 is decreased
  • FVC decreased
  • FEV1/FVC normal
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24
Q

obstructive AND restrictive spirometry results

A
  • FEV1 decreased
  • FVC decreased
  • FEV1/FVC decreased
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25
Q

When to stop SABA before testing?

A

within 4hrs of testing

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26
Q

When to stop LABA and oral therapy before testing?

A

within 12hrs of testing

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27
Q

Pre test reversibility

A

3 accepctible FVC manoeuvres

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28
Q

How long to wait with SABA vs SAAC for PFT testing?

A
  1. > 10mins
  2. 30 mins
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29
Q

Asthma dx reversibility

A

12-15% improvement in FEV1 OR FVC AND a 200ml increase in either.

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30
Q

negative bronchodilator response

A

<8% change in FVC and FEV1

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31
Q

Where can PEF be done

A

PF lab, in hospital or bedside,at home via FVL or peak flow meter

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32
Q

Test procedure in PEF

A
  • rapid and maximum lung volume
  • no hesitation in blow
  • 1-3sec expiratory
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33
Q

Green zone PEF?

A

80-100% of PB

  • routine tx
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34
Q

Yellow zone PEF?

A

50-50% of PB

  • acute exacerbation, increase in meds
35
Q

Red zone PEF

A

<50% bronchodilators should be taken immediately, and if no improvement, contact clinician

36
Q

MVV

A

Maximum volume of air a subject can move in and out of the lungs in a specific period of time (12 seconds)
Not as good as FEV1

37
Q

MVV procedure

A

Patient should be sitting and wearing nose clips.

  • Breathe RAPID and as DEEP as possible for 12 seconds
  • ideal rate 90-110br/min
38
Q

Obstruction in MVV?

A

<75-80% of predicted

39
Q

What is Thoracic Gas Volume (TGV)?

A

TGV is all the gas trapped in the thorax at time of airflow obstruction

40
Q

What is FRC plethysmography?

A

Volume of intrathoracic gas when airflow occlusion happens at FRC

41
Q

What is plethysmography used for?

A

Diagnosis of restrictive lung diseases (indicated when Spirometry not showing results or indicating restrictive)

  • Evals obstructive diseases that usually produce lower results (bullous disease of CF)
  • Determination of response to bronchodilators/methacholine (Raw,Sgaw)
  • aka helps follow progression of disease
42
Q

Contraindications of pleth

A
  • Mental confusion
  • IV pumps or O2
  • Condition that interfere with pressure changes (chest tubes, ruptured eardrum, transtracheal O2 catheter)
43
Q

Measurement technique pleth

A

Quiet breathing until stable Vt and FRC established
near FRC, shutter closed and patient pants against closed shutter around 60br/min for 2-3 seconds.
Shutter will open and perform SVC when ready

44
Q

Repeatability of FRC

A

At least 3 FRCpleth values within 5% of eachother

45
Q

P.01

A

100ms of a closed shutter

  • big inspiration against and measures pressure change at mouth recorded.
46
Q

Normal P.01

A

1.5-2

47
Q

What does P.01 measure

A

Ventilatory drive

  • may be useful in determining weaning from ventilator capability
48
Q

Increased P100

A

Increased with hypercapnia and hypoxia.

  • 0.5-0.6cmH2O/mmhg/PcO2 (20% variability)
  • (0.5cmH2O per 1mmhg increase in PaCO2)
49
Q

How can MIP/MEP be assessed

A

against occluded airway either on intubated patients or mouthpiece

50
Q

What does MIP/MEP measure

A

Assess muscular strength and weaning/extubation potential

51
Q

MIP procedure

A

Exhale to RV, then occlude mouthpiece to inspire maximally for 1-3sec

52
Q

MEP procedure

A

inhale to TLC, mouthpiece occluded and patient is coached to expire maximally for 1-3seconds

53
Q

Normal MIP

A

-80–100cmH2O

54
Q

Normal MEP

A

> 80-100cmH2O

55
Q

critical MIP

A

> -20cmh2o = difficult to wean or extubate or impending respiratory failure.

56
Q

Normal DLCO

A

25ml/min/mmhg

57
Q

Tracer gases DLCO

A

He, Ne and CH4

58
Q

Results of patient with emphysema, Pulmonary fibrosis, ILD..etc

A

DLCO decreased
DLCO/Va decreased

59
Q

Results of patient with small lungs/lung resection/short person DLCO

A

DLCO decreased
DLCO/Va normal

60
Q

Reporting DLCO

A

Mean of results

61
Q

Repeatability DLCO

A

Two tests within 10% or 2ml

62
Q

Acceptability DLCO

A

Inspired volume >90% in less than 4 seconds
No leak or valsalva maneuvres
Expiration <4 seconds with a washout volume

63
Q

He dilution goal

A

To measure FRC

64
Q

What does Va determine

A

Alveolar volume. If DLCO/Va is decreased, it is an indicator for increased thickness of the AC membrane

65
Q

In Bronchoprovocation testing, what do PC20 values indicate?

A

Level of airway hyperresponsiveness

  • PC20 > 16 mg/mL = normal responsiveness
  • PC20 4.0-16 mg/mL = borderline bronchial hyper-responsiveness (BHR)
  • PC20 1.0-4.0 mg/mL = mild BHR and indicates a positive test
  • PC20 < 1.0 mg/mL = moderate to severe BHR
  • PC20 of ≤ 8 mg/mL is common in patients with hyperactive airways
66
Q

Normal FEV1% (FEV1/FVC) range?

A

> 70% of predicted

  • Remember, FVC and FEV normal are >80% of predicted
67
Q

What lung volumes make up Inspiratory capacity (IC)?

A

IRV and VT

68
Q

What lung volumes make up Functional residual capacity (FRC)

A

ERV and RV

69
Q

What lung volumes make up VC?

A

IRV, Vt, and ERV

70
Q

What could a TLC <80% of predicted indicate?

A

Restrictive lung disease

  • If you look at RV and TLC alone; Decreased TLC and with a normal RV/TLC ratio indicate RLD
71
Q

Normal Lung volumes?

A

80-120% of predicted

72
Q

What does a TLC > 120% of predicted indicate?

A

Obstructive lung disorder

  • If you look at the TLC and RV alone; Increased RV/TLC + increased TLC indicate OLD
73
Q

Normal RL/TLC ratio?

A

Anything less than 35% is considered normal.

  • Anything greater than 35% with normal TLC indicates acute air trapping aka asthma
  • Anything greater than 35% with increased TLC indicates chronic hyperinflation
74
Q

COPD vs Acute asthma lung volume comparison

A
  • COPD = Increased TLC and RV as well
  • Acute asthma = normal TLC
75
Q

What tests for lungs volumes

A
  1. Nitrogen washout aka open circuit test (alveolar volume aka gas in and out) –> gives 100% O2 to washout Nitrogen
  2. Helium dilution aka closed circuit test (alveolar volume)
  3. Body plethysmography measures thoracic gas volume (TGN)
76
Q

If you had to choose between nitrogen washout and helium dilution, which would you choose to test lung volumes on a COPD patient with hypercapnia?

A

Helium dilution bc nitrogen washout uses 100% fiO2 which is dangerous for COPD pateints

77
Q

What do diffusing capacities depend on (both corrected and non) that will lower the ratio?

A

Hb (g/dl)

  • If the Hb is low, the predicted diffusing capacity will be lower, but the actual measures, the DLCO/Va ratio will raise up higher than it should
78
Q

Normal DLCO ratio?

A

80-120% of predicted is normal

  • take actual/predicted DlCO…always use the corrected value = DLCO/Va
  • Tells us there is a problem somewhere diffusion defect
79
Q

Normal hemoglobin levels

A
  • For adult males: 13.8 to 17.2 grams per deciliter (g/dL)
  • For adult females: 12.1 to 15.1 g/dL
80
Q

How do you get your percentages for FVC, FEV1, RV, TLC, and DLCO/Va (corrected)

A

Always take the actual/predicted

81
Q

How do you get FEV1%?

A

FEV1/FVC

82
Q

FVC and FEV normal ranges?

A

<80% of predicted

83
Q

Normal FEV1% or FEV1/FVC?

A

> 70% of predicted is normal

  • Normal/restrictive normal bc they’re able to blow out
  • Anything less than 70% = obstructive bc they can’t blow out their the right amount in the first second (FEV1)
84
Q
A

PFTs and Homcare (Resp 327) (19 decks)

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