Pulmonary function testing and cardiopulmonary stress testing

529 Pages·1998·56.098 MB·English

by  Vincent C Madama

s
Associate Professor
irector of Clinical Education
atory Care ~ r o g r a ~
k Valley College
Rockford, Illinois
.
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Library of Congress Cataloging-In-PublieationD ata
Madama, Vincent C.
Pulmonary function testing and cardiopulmonary stress testti@
Vincent C. Madama.-21id ed.
p. cm.
Includes hihliographical references and indcx.
lSRN 0-8273-84 10-6
1. Pulrnonarv fu~ct~toenst s. 2. Exercise tests. I. Title.
PNLM: 1. kespkatoiy Function Tests. 2. Exercise WB 284
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vi
......................................
enfs xi
.........................................
dii
. . . . .
~a~~~~~~~~~ 9 * * I * * 2
wing instruments . . . . . . . . . . . . . . . . . . . . . . 2
*. Plethysmographs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Directional Breathing Valves and ~ ~ r ~ cCotntr~ol ~Va~lveas .€ . . . . . . . . . . 21.
* ~ o ~ ~ ~~ u~t ~e r~ . .r.~. . ~. . .c. .e.s. . . . . . . . . . . . . . . . . . . . . . . . 22
~~s~lay/RecIon~strdu~mgen ts . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
8
....................
ics 30
*. Forced Vital Capacity Maneuver . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
..............................
~ o ~ ~ -Ga~s Speiroim~etrys ~ ~ 46
* Peak ~ x F ~ ~Falo~w ~~ yoy ~ j. .t. .~. .r. . .~. .~. . .~. . . . . . . . . . . . . 49
*. ~ aVol~t~ar~V7en til~ation ..~......u......~...... ....... 51
. Airway Resistance/Conductance . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Elastic Recoil Pressure/Compliance . . . . . . . . . . . . . . . . . . . . . . . . . . 59
* Maximum Inspiratory and Expiratory Pressures . . . . . . . . . . . . . . . . . . 64
.....................
e~~~~~G as ~ ~ a l y s ~ ~ 59
th Gaseous Samples ...................... 70
. . . .
~ ~ ~ t ~ l ~ t i Q ~
* /. a *
. . . . . . . . . . . . . . . . . . . . . . . .
Direct S ~ ~ r o .~.e. .t.~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
~ n ~ ~ ~ e ~ t .~. .~. .~. .r.o. .~. .e. .t.~. .y. . . . . . . . . . . . . . . . . . 86
4
.* i?aoz~t;pirometric/Radio'iogi~c stimatio~f ~Luin~g Volume . . . . . . . . . . . . . 99
Interpretation of Pulmonary Volumes and Ventilation . . . . . . . . . . . . . . . 100
.................
i s t ~ ~ b ~ t ~ o ~ 107
Deadspace Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Q* ~ i ~ t rof V~en~tilat~iont .i. ~. . .~. . . . . . . . . . . . . . . . . . . . . . . . . . 1.16
...................
. sion 1
~ ~ ~ ~ ~ ~. .s. .c. .r. .i. .~. .t. .~. . o. . .~. . . . . . . . . . . . . . . . . . 1.26
iv * CONTENTS
* Techniques for ~eas~iremen.t. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
* E~uip~~nt~e~L.~. .i.re. .d. . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
* ~e~~A d ~ ~ n i s ~. .a.~. .~.~. .n. . . . . . . . . . . . . . . . . . . . . . . . . . . 142
* ~~terpretoaf ~T~es~t Rne sults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
ckr
. . . . . . . . . . . . . . . . . . . 15
(i
* Sources of Predictive Equations for Normal I'ulmonary Function Values . . 154
. . .I . . .I
* Using Predictive Equations for Normal Ptdmonary Function Values 158
.
~ - ~ ~ l ~~ o n~aT ~ ~~ ~~~~~~~ ~~ ~. ". ~1. *. ~." e. .~.4 g.* .* .I . * Q.0 .* .* .I 1n6%
* Patient Assessment for Pulmonary Function Testing 167
* General A ~ ~ ~ i s ~of a1~'~i~o~~no Fnuanrcytio n Tests . . . . . . . . . . . . . . . 170
* Bronc~odilator~Be~eSftiutd ies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
* PrcoperativePulmonary Function Studies ...................... 177
. . . . . . . . . . . . . .
* Bro~~cho~rovoc~a~~one t ~ ~ ~Cchahll~en~~eSi~tnu deies 181
* Studies for Exercise-Induced Asthma . . . . . . . . . . . . . . . . . . . . . . . . . 186
. . . . . . . . . . . . . . . . . . . .
Studies to ~oc~~mIe~npta i~ment/~is~bili~ 191
e
CriticalCareMonitor~g . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194
4
..............
~~a~~~~ 2
* Lung~~ ~~ Volume ~eterm~ation.s . . . . . . . . . . . . . . . . . . . . . . . . . . . 207
PulmonaryR/lecha~ucsTests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209
9
* ~~f€L~sing~~.~.a.c.i.t.y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
Predicted Normal Pulmonary Function Values for Children . . . . . . . . . . . 214
...................
a s ~ ~ a ~ y $ ~ ~ 9.
B~oodGaAs nalyzers . . . . . . . . . . . . . . . . . . . . . . . . . 217
.......................
Spectrophotometric Blood Gas Analysis 226
c
xy..na..o., ~ ean ~ a~~~~~~ . 23~5 ~ a ~ ~ ~ ~ ~
* Tests Based on Direct Assessment of Blood Gas Values . . . . . . . . . . . . . . 237
* Indirect Indicators of Blood Gas Values ....................... 261
............................
* l ~ e ~Bl~ood~ G~as Aj ssces sment 268
..........................
~ ~Twelvae- ~ ~~~~Q~~e~~ ~ 276
Physiologic Needs During Rest and Exercise .................... 277
General Physiologic A~a~t~tiDounrsin g Exercise . . . . . . . . . . . . . . . . . 294
Significant Physiologic Adaptations anci Parameters During Exercise . . . . . . 296
~ ~ s t ~ ~ 30g
* Equipment Used for Creating a Measurable Physical Ac~t~i~v$it~y . . . .*. I. I. (I. f .* . 309
* Equipment Used for Measuring Breathing Volumes . . . . . . . . . . . . . . . . 317
~ r e a ~ i ~ ~ v a.l.v.e.s. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328
e
GasClollec.tion/MixingSystems . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318
* Gas Analysis and Blood Gas Evaluation lnstrumentation . . . . . . . . . . . . . 320
CONTENTS * v
~ardiovascuM~o~ni tor~ngS ystems . . . . . . . . . . . . . . . . . . . . . . . . . . 321
Oxygen Therapy ~~uipmen.t. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 324
1
Cardiopulmonary Stress Testing Systems . . . . . . . . . . . . . . . . . . . . . . 324
0
. . . . . . .
C~a~t~eOru rteen-A~~inistrao~fi oC~ar diovascular Stress Testing 333
* Indications and Contraindications for Cardiopulmi>naryS tress Testing . . . . . 334
* Types of Testing Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
* Prel~minaryE valuation of the Subject ......................... 342
* Preparation for the Test Procedure .......................... 342
Administration of Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
0
* Calculation of Physiologic Test Data . . . . . . . . . . . . . . . . . . . . . . . . . . 349
Interpretation of Cardiopulmonary Stress Testing Results . . . . . . . . . . . . . 352
0
................................
ssment 354
. . . . . . . . . . .
* The Need for Bedside Metabolic and Nutritional Assessment 360
Test Procedures for Metabolic and Nutritional Assessment . . . . . . . . . . . . 360
@* Methods for PerEorming Indirect Calorimetry .................... 361
. . . . . . . . . . . .
Adm~stra~oof nM eta~oliclNutritionalA ssessment Tests 354
* Calculations Required for ~etabolic/~~itr~~Aisosensasml ent . . . . . . . . . . . 365
* Significance of Metabolic/Nutr~~ionaDl ata . . . . . . . . . . . . . . . . . . . . . 368
. . . . . .
Cha~teSr ixteen- uality Assurance for ~ulmonaryF unction Testing 371
Components of a Quality Assurance Process . . . . . . . . . . . . . . . . . . . . 372
4
* Calibration and Quality Control for Spirometers and Plethysmographs . . . . . 375
Calibration and Quality Control for Gas and Blood Gas
0
Analysis Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Study Section
Study Section 1 - Evaluation of the Graphic Results of a
Forced Vital Capacity Maneuver . . . . . . . . . . . . . . . . . . 412
Study Section 11 -Sample Calculations for l’ulnionary Function Testing . . . . . . 425
Study Section 111-Case Studies in Pulmonary Function Testing . . . . . . . . . . . 437
Study Section 1V-Sample Calculations for Cardiopulmonary Stress Testing . . . . 447
Study Section V-Case Studies in Cardiopulmonary Stress Testing . . . . . . . . . 453
A ~ p e ~ ~ i c e ~
Appendix A-Symbols and Abbreviations ........................ 462
Appendix 8-Volume Conversions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
Appendix C-Standards for Spirometer S y s t ~ ~.s.. ................. 474
Appendix D-Typical Pulmonary Function Values . . . . . . . . . . . . . . . . . . . 478
Appendix E-Examples of Predictive Equations for
Pulmonary Function Testing . . . . . . . . . . . . . . . . . . . . . . . 480
Appendix F-Infection Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 486
Appendix 6-Reference Sources for Testing Standards aid Guidelines . . . . . . . 491
i ~ ~ ~ o g. .~. .a. .~. ~. .y. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494
~ ~ . . . .o. . . . .~. . . . . .s. . . . .~. . . . .~. . . . . . . . . . . . . . . . . . . 501
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 506
This book is ~ ~ ~ m ainr t~el~yd feo~r edLica~r~~is~p ~~atcoarrey prac~tio~~crasrd, io~ul-
mc~n~frLyi nc~ont ~c~~oIogi5atn§d, other health care ~~actiti~?wnh~o rmsu st learn about
pulmonary function testing, cardio~ul~os~tr~esas~ teyst ing, and indirect calorimetry fcw
nutritio~~asas~e ssment as part of their professional training, ~dd~~ionthae~ byoo,k can
be used by pr~~it~onaenrds p hy§~c~anass a general ~efer~nocne these subjects. It can
also serve as a review for the pulmonary function testing specialty exarninaticms of the
oard for LXcspiratory Care.
Specific goals guided the deve~o~~an~de wir~ititn g of this book
To present material organized in a way that effectively guides the learner through
the info~mation.
To use accepted e~ucati~t~e~cal~ ~fo~r s~~~~epso rth~e i lnea~^ ^ process (k.,
l ~obj~activelis~~t~s o f key~ terms~~re view~ q~e~~~oan gs lo,s s^^^ md a p ~ e ~ ~ i ~ ~ s ~
to their greatest effec~ive~i~ss.
* To ~aintaai r~~e a le~vel ~a~p~ro~~ri~aftoe r the learners who make use of the book.
To present tables and ~iag~athia~t os€ c us the iearner’s attent~ono n key concepts or
~ r o ~01~ i~i€onr~~~a~tio ~~.
* To stlpply a study section for the book that reinforces cognitive and ~s~cho~otor
learning needs.
To provide a ~ ~ e n do~f rcel~evsan t supporting ~~fo~~nation.
a
The subjects of pulmonary fLirtction testing and c a ~ ~ ~ o p u l ~str~es~s ite~stainrg ym ust em-
ploy medical and highly technical terms. If care is not taken hi the writing process, book
PREFACE * vii
on these subjects can have an excessively high reading level, one far beyond the comfort
level of students typically eilrolkd in health care ~rogra~s.
A deliberate effort has been made to maintain an appropriate reading level for this
book During its writing, very conscious control. was maintained over the length and
structure of sentences and paragraphs. This was done to establish clear, direct com-
~unicatioof ~th e information a learner needs to master on pulmonary function test-
ing and card~op~liiionarsytr ess testing. Bulleted lists and tables have been used to
bring attention to significant points. "Quality Assurance Notes" have been inclrrded to
clearly identify actions that can be taken to ensure the quality of pulmonary function
tests,
The result of all of these features is that the book provides all of the technical infor-
mation needed for pufmorzary fmction testing and card~opulmonaryst ress testing, but at
a reading level and with a ~resenta~moet~ho d that will be co~ortablefo r the typical
student in a health care practitioner training program.
The design of a book can Iiave a signifionnt impact on how effective it will be as a tool
for learning. Careful thought has been given to the need for chapter elements that facili-
tate learning. Each chapter in the book contains the following elements:
A list of related learning topics that are identified as being prerequisite to learning
material horn the chapter.
A list of learning objectives that relate specifically to the material in the chapter and
identify the learning that is meant to take place.
A list of key terms that will be found in the chapter, The definitions for all of tliese
terms are provided in the glossary of the book.
The body of the chapter, in which the information is carefully orgmLzed axid clearly
presented.
Review questions at the end of each chapter to serve as a benchmark of learning
from the chapter.
All of these chapter elements should be reviewed and used by the leaner.
Input was sought from students and fellow educators who used the first edition of this
book and has resulted in some notable ~ a n ~foer sthi s current edition. Their assistance
is greatly ap~reciated.
viiI PREFACE
0
The current edition reflects a change in the o r ~ n i ~ ao~f othne b ook's chapters from the
first edition. In some ways, the new chapter organization is similar to that of the first edi-
tion. For example, as in the first edition,
Chapters on equipment precede chapters on test procedures. Test equipmcnt opera-
0
ticm and use should be learned before the test procedures that require the equip-
ment are learned.
* Chapters on pulmonary function testing procedures precede chapters that dismss
nornial values, test regimens, and testing for children.
Chapters on cardi~~puli~~ost~reisasr tye sting and nutritional assessment procedures
@
are patterned on those describing pulmonary function testing. A chapter on exercise
physiology is included to provide a concise backpound for the chapters on car-
~ ~ o p u l ~ os~treasrs tyes ting.
The significant changes that have occurred in tlie current edition are as follows:
* The chapters on equipment are now divided more evenly throughout the book. This
provides better correlation between equipment chapters and the tests that make use
of the equipment. There are now separate chapters for gas analyzers and for blood
gas analyzers instead of the single chapter that combined them in the first edition.
The chapter on blood gas analyzers occurs later in the book and now immediately
precedes the chapter relating to blood gases.
* The chapter on pulmonary mechanics tests is placed ahead of the chapter on tests
for lung volumes and ventilation. It is now the first chapter in which pulmonary
function test procedures are described. This is a significant change. Tests for pul-
monary mechanics are the least complicated and are the most frequently performed
pulmonary function tests. This is true both inside and outside the laboratory setting.
Also, pulmonary mechanics tests provide the most broadly applied information ac-
quired from pulmonary function testing. Idearninga bout pulmonary mechanics tests
is an effective starting point for learning about other types of test procedures.
The chapter on quality assurance has now been made the last chapter of the book.
0
This is because it includes information on quality assurance for all types of equip-
ment and forms of testing.
The tables and ~€l~s~ra€ioinns t his edition have been newly formatted to better present
information to the learner. A number of new tables have been added to this edition to
make the presentation of key points of information even clearer,
A Study Section is included in this edition of the book. The Study Section is, ~ss~n~~al~y,
material pulled from tlie workbook that accompanied the first edition of tlie book. E-fav-
ing this material within the book itself now makcs it inore accessible to all learners.
PREFACE ix
The purpose of the Study Section is to provide an additional resource for learning
about pulmonary function testing and cardiopulmonary stress testing. The material pro-
vided here is too detailed for inclusion in the chapters (i.e., Study Sections I, 11, and IV)
or relates to material drawn from a variety of chapters in the book (Study Sections 111
and V’I.
The Study Sections should be used in the following manner:
Study Section I, ”Evaluation of the Graphic Results of a Forced Vital Capacity Test,”
should be used in conjunction with Chapter 2 of the book.
Study Section 11, ”Sample Calculations for Pulmonary Function Testing,” should be
used selectively in conjunction with Chapters 2,4,5, and 6. This will allow the
learner to relate the calculations that are presented in the Study Section to the mater-
ial in the chapters.
Study Section 111, Case Studies for Pulmonary Function Testing,” should be used af-
ter Chapters 1 through 8 have been covered. The case studies provided in this study
sections will reinforce the learning that occurred from those chapters.
Study Sections IV and V, “Sample Calculations for Cardiopulmonary Stress Testing”
and ”Case Studies for Cardiopulmonary Stress Testing,” should be used in conjunc-
tion with the chapters on cardiopulmonary stress testing.
PROVIDING REFERENCE SOURCES FOR TEST1
G s
Appendix G has been added to specifically identify the reference source of pulmonary
function testing standards from the American Thoracic Society and Clinical Practice
Guidelines from the American Association for Respiratory Care. Both organizations have
published very concise and effective descriptions for testing. These descriptions have been
instrumental in the development of this book and are the basis for a great deal of infor-
mation provided in the book. Unfortunately, they are too lengthy to be included in orig-
inal form within the book itself. However, the listing of specific sources for these refer-
ences in the appendix should help both learners and educators to find them if they are
needed in original form.
An additional feature of this appendix is that it provides the Internet addresses of pul-
monary medicine-oriented organizations. Although these organizations do not publish
standards or guidelines for testing, communication with them through Internet connec-
tions may be a source of useful professional information.
Y
The material in this book will provide a strong basis for understanding how pulmonary
function tests and cardiopulmonary stress tests are performed. It will also help the learner
to understand the interpretation and usefulness of information that pulmonary function
testing and cardiopulmonary stress testing can provide.