Spirometry Technique Maximizing Effort, Comprehension & Coordination

Transcription

1 Spirometry Technique Maximizing Effort, Comprehension & Coordination Carl Mottram, RRT RPFT FAARC Director - Pulmonary Function Labs & Rehabilitation Associate Professor of Medicine - Mayo Clinic College of Medicine

2 ATS/ERS General Standards Testing Contraindications Myocardial Infraction within 1 month Conditions where suboptimal lung function results are likely: Chest or abdominal pain of any cause Oral or facial pain exacerbated by a mouthpiece Stress incontinence Dementia or confusional state

3 ATS/ERS General Standards Testing Subject preparation Activities that should preferably be avoided prior to lung function testing. Smoking within 4 hours of testing Consuming alcohol within 4 hours of testing Performing vigorous exercise within 30 minutes of testing Wearing clothing that substantially restricts full chest and abdominal expansion Eating a large meal within 2 hours of testing

4 ATS/ERS Spirometry Standards Testing Test Procedure There are three distinct phases to the FVC maneuver: 1. maximal inspiration, 2. a blast of exhalation, 3. continued complete exhalation to the end of test (EOT).

5 ATS/ERS General Standards Testing Prepare the subject by explaining the purpose of the test: We are going to measure how well your lungs are functioning. I will show you exactly what you need to do.

6 Pre-test Instructions: Loosen or remove restrictive clothing. Remove gum or chewing tobacco.

7 Sitting vs Standing Sitting is preferable for safety reasons in order to avoid falling due to syncope. Severely overweight subjects with mid-section distribution will frequently be able to take a deeper breath if tested standing Children No recommendations for position If test is performed standing, a chair with arms but without wheels should be placed behind them.

8 Demonstrate Proper Mouthpiece Placement and Technique

9 Demonstrate Proper Mouthpiece Placement and Technique Place on top of your tongue Teeth biting gently Lips sealed around the mouthpiece Dentures? ATS/ERS suggests that well-fitting false teeth should not be routinely removed.

10 Mouthpiece Placement and Techniques Lip-holding Different mouthpieces

11 Mouthpiece Placement and Techniques Tracheotomies Cannula in or out? Through tube or mouth?

12 Instructions: Maintain good posture Sit or stand tall Chin elevated with neck slightly extended Nose clips are recommended, but not required.

13 Steps in a FVC Maneuver Open Circuit method Take the deepest breath possible Seal lips tightly around mouthpiece Blast out hard and fast until empty Closed Circuit method Seal lips tightly around mouthpiece Breathe normally, then take the deepest breath possible Blast out hard and fast until empty

14 Maximizing Effort Be a cheerleader! Use words like: Blast it out!, Snap it out!

15 Maximizing Effort Visual Aids Incentive software during the testing

16 Maximizing Effort Visual Aids Hynes KM, Mottram CD. Chapter 5, Neonatal and Pediatric Respiratory Care; Walsh 4 th 2014

17 Maximizing Effort Visual Aids

18 Maximizing results - Distracters Hynes KM, Mottram CD. Chapter 5, Neonatal and Pediatric Respiratory Care; Walsh 4 th 2014

19 Maximizing Results Communication Parents In or out??

20 Maximizing Results Communication Interpreter for non- English speaking subjects Using a family member is acceptable unless education is provided.

21 Maximizing Results Communication Elderly Hearing impaired

22 Maximizing Results Communication

23 AM REV RESPlR DIS 1987; 136:

24 Krowka Effect or Effort Dependence

25 Other issues Coughing IPF and Cystic fibrosis Upper airway noise Incontinence

26 GOOD TEST SESSION 1. Obtain 3 acceptable maneuvers Look at graphs individually to make sure there are no errors on at least 3 2. Check repeatability Look at values of the acceptable maneuvers (the 2 largest FVC s and 2 largest FEV1 s should not vary > 150 ml)

27 3 acceptable with 2 repeatable

28 Maximum of 8 trials in one session.

29 ATS/ERS Standards Standardization of Spirometry Reversibility Testing

30 ATS/ERS Standards Standardization of Spirometry Reversibility Testing Administer drug Example: albuterol 100 μg MDI: Use spacer, inhale slowly to TLC and hold breath for 5-10 sec. 4 doses (400 μg), 30 seconds apart ipratropium bromide the total dose is 160 µg (4 40 µg) Positive response: 12% or 200 ml increase

31 Spirometry Demo