Bedside Pulmonary Function Tests ,Lung Funtion Test.pptx

Bedside Pulmonary Function test

1. Bed side Pulmonary Function tests Dr Abhijith J Puttanani

2. Contents 2 Bed side Pulmonary Function tests Introduction Sabrasez Breath Holding Test Schneider’s Match-Blowing Test Single Breath Count Greene and Berowitz Cough test Forced Expiratory time Mini Wright Peak Flow Meter De-Bono whistle Blowing Test Maximum laryngeal height 6 Minutes Walk Test

3. Bed side Pulmonary Function tests Introduction 3 A bedside pulmonary function test refers to a quick assessment of lung function that can be performed at the patient's bedside. It's designed to provide immediate information about the patient's respiratory status without requiring them to go to a specialized pulmonary function laboratory. These tests are often used in situations where prompt evaluation of lung function is crucial, such as in emergency departments or intensive care units.

4. Bed side Pulmonary Function tests Introduction 4 Bedside PFTs helps To predict the presence of pulmonary dysfunction. To know the functional nature of disease (obstructive or restrictive. ) To assess the severity of disease. To assess the progression of disease To assess the response to treatment

5. Bed side Pulmonary Function tests Sabrasez Breath Holding Test 5 Ask the patient to take a full but not too deep breath & hold it as long as possible. >25 SEC.-NORMAL Cardiopulmonary Reserve 15-25 SEC- LIMITED CardioPulmonary Reserve <15 SEC- VERY POOR CardioPulmonary Reserve (Contraindication for elective surgery)

6. Bed side Pulmonary Function tests Sabrasez Breath Holding Test 6 25- 30 SEC - 3500 ml VC 20 – 25 SEC - 3000 ml VC 15 - 20 SEC - 2500 ml VC 10 - 15 SEC - 2000 ml VC 5 - 10 SEC - 1500 ml VC

7. Bed side Pulmonary Function tests SNIDER’S MATCH BLOWING TEST 7 Measures Maximum Breathing Capacity.(MBC) Patient is asked to blow a match stick from a distance of 6” (15 cms ) with Mouth wide open Chin rested/supported No pursed lips No head movement No air movement in the room Mouth and match stick at the same level

8. Bed side Pulmonary Function tests SNIDER’S MATCH BLOWING TEST 8 Interpretation Can not blow out a match MBC < 60 L/min FEV1 < 1.6L Able to blow out a match MBC > 60 L/min FEV1 > 1.6L

9. Bed side Pulmonary Function tests SNIDER’S MATCH BLOWING TEST 9 MODIFIED MATCH TEST of Olsen : DISTANCE MBC 9” >150 L/MIN. 6” >60 L/MIN. 3” > 40 L/MIN.

10. Bed side Pulmonary Function tests Single breath count 10 After deep breath, hold it and start counting till the next breath. Normal- 30-40 COUNT Indicates vital capacity <15 Severe Vital Capacity Impairment

11. Bed side Pulmonary Function tests GREENE & BEROWITZ COUGH TEST 11 DEEP BREATH followed by COUGH ABILITY TO COUGH STRENGTH EFFECTIVENESS INADEQUATE COUGH : FVC<20 mL/Kg FEV1 < 15 ml/Kg PEFR < 200 L/min. VC ~ 3 TIMES TV FOR EFFECTIVE COUGH. A wet productive cough / self propagated paroxysms of coughing – patient susceptible for pulmonary Complication.

12. Bed side Pulmonary Function tests FORCED EXPIRATORY TIME 12 After deep breath, exhale maximally and forcefully Stethoscope is kept over trachea & Expiratory breath sound is assessed. Normal FET – 3-5 SECS. Obstructive Lung Disease - > 6 SEC Restrictive Lung Disease - < 3 SEC

13. Bed side Pulmonary Function tests Mini-Wright Peak Flow Meter 13 It measures PEFR (Peak Expiratory Flow Rate)

14. Bed side Pulmonary Function tests Mini-Wright Peak Flow Meter 14 It measures PEFR (Peak Expiratory Flow Rate) Normal 400-700 L/min – Males 350-500 L/min – Females <200L /min – Inadequate Cough Efficency

15. Bed side Pulmonary Function tests DE BONO’S WHISTLE BLOWING TEST 15 It measures PEFR (Peak Expiratory Flow Rate) Patient blows down a wide bore tube at the end of which is a whistle, on the side is a hole with adjustable knob. As subject blows → whistle blows, leak hole is gradually increased till the intensity of whistle disappears. At the last position at which the whistle can be blown , the PEFR can be read off the scale.

16. Bed side Pulmonary Function tests DE BONO’S WHISTLE BLOWING TEST 16 It measures PEFR (Peak Expiratory Flow Rate) Patient blows down a wide bore tube at the end of which is a whistle, on the side is a hole with adjustable knob. As subject blows → whistle blows, leak hole is gradually increased till the intensity of whistle disappears. At the last position at which the whistle can be blown , the PEFR can be read off the scale.

17. Bed side Pulmonary Function tests Maximum Laryngeal Height 17 Distance between the top of the thyroid cartilage and the suprasternal notch at the end of expiration. <4 cm-abnormal accurate sign of obstructive airways disease compared to pulmonary function tests,

18. Bed side Pulmonary Function tests 6 minutes walk test 18 Gold standard test to assess Cardiopulmonary Reserve (CPR) Cardiopulmonary Reserve measured by estimating maximum O2 uptake during exercise If Patient cannot walk –Arm exercises can be used If patient can walk >2000 feets (610 meters) feet in 6 minutes  VO2 max > 15ml/Kg/Min >180 feets in 1 minute VO2 max -12ml/Kg/Min Pulse oximetry is done pre and post walk –if SPO 2 fall > 4% - High risk

19. Bed side Pulmonary Function tests Others 19 Micro-spirometer Portable Electronic Device Can Measure Vital Capacity Accurately Pulse Oximetry

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