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The total amount of air that the lungs can accommodate is divided into four
separate volumes and four capacities. Combinations of these volumes are used
to designate lung capacities.
LUNG VOLUMES
The lung volumes are the:
Tidal volume (VT): the volume of air that normally moves in and out of the
lungs in one quiet breath
Inspiratory reserve volume (IRV): the maximum volume of air that can be
inhaled after a normal tidal volume inhalation
Expiratory reserve volume (ERV): the maximum volume of air that can be
exhaled after a normal tidal volume exhalation
Residual volume (RV): the amount of air remaining in the lungs after
maximum exhalation; air that cannot be exhaled
Lung Capacities
The lung capacities consist of the:
Vital capacity (VC): the maximum volume of air that can be exhaled after a
maximum inspiration; expressed as IRV + VT + ERV. Two VC
measurements are the slow vital capacity (SVC), in which exhalation is
performed slowly, and the forced vital capacity (FVC), in which exhalation
is performed rapidly with maximum effort. Obstructive disorders with small
airway collapse will cause the FVC to decrease as a result of air trapping
with forced exhalation.
Inspiratory capacity (IC): the volume of air that can be inhaled after a
normal exhalation; expressed as VT + IRV
Functional residual capacity (FRC): the volume of air remaining in the
lungs after normal exhalation; expressed as ERV + RV
Total lung capacity (TLC): the maximum amount of air that the lungs can
accommodate; expressed as IC + FRC
Residual volume/total lung capacity ratio: the percentage of the total lung
capacity occupied by the residual volume; expressed as RV/TLC 100
Lung volume and capacity vary with age, race, height, and gender. Table 4-1 in
the text shows the approximate lung volumes and capacities of average men and
women ages 20 to 30.
In obstructive lung disorders:
Measuring RV
Because the residual volume (RV) cannot be exhaled, the RV and the lung
capacities that contain the RV are measured indirectly by:
Pulmonary Mechanics
In addition to volumes and capacities, the rate at which gas flows into and out of
the lungs can be measured. Collectively, the tests used to measure expiratory
flow rates are referred to as pulmonary mechanic measurements. These tests
are discussed below.
FORCED VITAL CAPACITY (FVC)
The forced vital capacity (FVC) is the maximum volume of gas that can be
exhaled as forcefully and rapidly as possible after a maximal inhalation.
In normal lung function:
FEV0.5 = 60 percent
FEV1 = 83 percent
FEV2 = 94 percent
FEV3 = 97 percent
Because timed FEV is decreased in both restrictive and obstructive diseases, the
ratio to FVC is important to distinguish the type of disorder.
Figure 4-5 in the text illustrates FEVT.
FORCED EXPIRATORY VOLUME1 sec/FORCED VITAL CAPACITY RATIO
(FEV1/FVC)
The forced expiratory volume1 sec/forced vital capacity ratio compares the amount
of air exhaled in 1 second to the total amount exhaled during a forced vital
capacity (FVC) maneuver. This value is also called forced expiratory volume in 1
second percentage (FEV1%).
FEV, FEV1, and FEV1% are most often used to:
Figures 4-13 and 4-14 in the text illustrate abnormal flow-volume loops resulting
from obstructive and restrictive lung disorders.
EFFECTS OF DYNAMIC COMPRESSION ON EXPIRATORY FLOW RATES
During the first 30 percent of forced vital capacity (FVC), the maximum peak flow
rate depends on the amount of effort exerted by the individual. Originating from
the large airways, this part of FVC is called effort-dependent. The more effort the
patient exerts, the higher the FEF200-1200 and PEFR values.
The flow rate of the last 70 percent of FVC is effort-independent: Once the
maximum flow rate is obtained, further muscular effort will not increase the flow
rate. This limitation of flow rate during the last 70 percent of FVC is due to the
dynamic compression of the airway walls.
Inspiratory and Expiratory Pressures
An individuals maximum inspiratory pressure (MIP) and maximum expiratory
pressure (MEP) are directly related to muscle strength. These measurements
can help evaluate a patients ability to maintain spontaneous, unassisted
ventilation. MIP should be measured at the patients residual volume, and MEP
should be measured at the patients total lung capacity.