Resistance-Volume Chart (R-V Chart) for simplified clinical and visual interpretation of body plethysmography Hans-Jürgen Smith CareFusion, Höchberg
Resistance-Volume Chart Innovation in bodyplethysmography Visual diagnostics become possible! 2
General notes R-V Chart is an innovative concept The R-V Chart is a new & informative REPORT No changes in the measurement procedure No changes in the current report/interpretation concept CLINICALLY oriented summary of test results! An innovative novelty on the world market. Complete and integrated description of body measurement results, e.g. airways resistance & lung volumes Airways resistance and lung volumes in one graph Predicted area for quick orientation Especially informative in pre-post-settings Complementary and new intra-breath information 3
SeS body application window Breathing loops and shutter curves Breathing loops (sraw loops) at spontaneous tidal breathing. Panting or resting breathing at FRC shutter manoeuvre. Shutter curves Shutter linked with slow or forced spirometry; launched with IC ERV Breathing loops 4
R-V transformation The R-V transformation integrates the sraw loops recorded during tidal breathing with the FRC shutter measurements. Hans-Juergen Smith. R-V graph in whole body plethysmography. White paper 2013 CareFusion Corporation.
Airways resistance - central Resistance-volume transformation Clinically oriented, based on standard parameters Instantaneous course of resistance Breathing loops R-V transformation FRCpleth linked with SVC R-V loop Predicted area Raw FRCpleth DRaw Absolute lung volumes - peripheral 6
Normal abnormal airways resistance Resistance-volume chart (R-V chart) Combination of current clinical parameters Raw (Rcent, Reff, Rtot ) FRCpleth Linked SVC (TLC, RV ) Raw Actual Predicted R-V loop Predicted area FRCpleth Absolute lung volumes DRaw Raw Central or large airways TLC, FRC, RV Peripheral airways Predicted area 7
Application screen menu SentrySuite SeS 2.15 R-V chart Breathing loops 8
Within breath dynamics of Raw Phenotyping of obstruction Scientific approach!! Phenotyping of obstruction, small airways diagnostics! Static Raw (Reff, Rtot ) Exhalation Inhalation Dynamic Raw Flow type (asthma) D between no-flow and maximal-flow Hysteresis Raw Volume type (COPD) D between end-expiration and end-inspiration Resistance = Static Raw + Dynamic Raw + Hysteresis Raw 9
R-V pattern Within breath diagnostics of tidal breathing Exhalation Intra breath variability Inhalation Normal Flow type End-exp. closing Volume type (Asthma) (Obesity) (COPD) 10
Parameters of the R-V tidal loop For phenotyping only! R-V loop parameters REmax > maximal (peak) expiratory airways resistance REmean > mean expiratory airways resistance REFmax > airways resistance at maximal expiratory flow RIFmax > airway resistance at maximal inspiratory flow RImean > Mean inspiratory airways resistance RImin > minimal (peak) inspiratory airways resistance RImax > maximal (peak) inspiratory airway resistance DiffRexM RinM = dr = REmean RImean > difference of mean airway resistance parameters PtPR = Peak to Peak R = REmax RImin > difference of peak airways resistance parameters Area R/Vloop > Area within the RV-loop Additional loop parameters VRmax%VE > percentage of expiratory volume at REmax related to expiratory VT VRmax%VI > percentage of inspiratory volume at RImax related to inspiratory VT SBE > slope of the linear regression from start of expiration to REmax SBI > slope of the linear regression from start of inspiration to RImax 11
Visual clinical interpretation The R-V graph identifies changes in the airway resistance as specific to the central components and changes in lung volumes exclusively depending on the peripheral characteristics of the respiratory tract. Hans-Juergen Smith. R-V graph in whole body plethysmography. White paper 2013 CareFusion Corporation.
Pre-post assessment (conventional) Questions can hardly or not be answered Shutter curves Pre Post Resistance? Lung volumes? Abnormality? Reversibility? Flow type? Volume type? Pre Breathing loop Post! Parameter table is needed to answer these questions, including predicted values! 13
Pre-post assessment (R-V chart) All clinical questions can be answered easily Pre Post Resistance Gets normal Lung volumes Improve Abnormality Border Reversibility Partial Additionally Intra breath variation decreases Volume type Typical in COPD 14
Restriction (pre-post) 15
COPD (pre-post) 16
Obesity combined with obstruction (pre-post) 17
End-expiratory inhomogeneity (pre-post) 18
R-V classification General principles End-expiratory inhomogeneity COPD Obesity Restriction Obstruction with hyperinflation Obstruction Combined obstructive & restrictive disease Hyperinflation R-V loop Restriction 19
Information material Concept, features, clinical application and integration White Paper: HJ. Smith. R-V graph in whole body plethysmography Powerpoint: HJ. Smith. Resistance-Volume-Loops (R-V Charts) Concept & application in daily clinical practice.ppt Video: M. Kaldenbach. Resistance-volume graph in whole body plethysmography.mp4 Digital Posters: K. Kwiatkowski. CareFusion R-V chart poster 1,2,3,4 List of R-V loop parameters: HJ. Smith. List of loop parameters.pdf 20
R-V charts summary Innovation in bodyplethysmography Routine measurement not effected report Current or recommended interpretation is kept! Relationship between Raw and lung volumes Differentiation in central airways and peripheral airways Relationship to normal range Phenotyping / Small airways diagnostics Volume type COPD Flow type asthma Pre-post / hyperresponsiveness Degree of reaction in Raw and lung volumes Innovation Visual diagnostics!
Document Name: Presentation R-V Chart Version 01 CareFusion Germany 234 GmbH Leibnizstrasse 7 97204 Hoechberg Germany +49 931 4972-0 tel +49 931 4972-423 fax 2016 CareFusion Corporation or one of its affiliates. All rights reserved. SentrySuite, CareFusion and the CareFusion logo are trademarks or registered trademarks of CareFusion Corporation or one of its affiliates. 22