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PULMONARY FUNCTION
TESTING IN CHILDREN
Uses many of the same basic tests as for
adults
Differences exists in dimensions and two main
areas of concern
newborns, infants, and very young children cannot
strictly perform tests that require and depend on pt.
cooperation ( VC, FVC, MVV and DLCO)
young children may perform with variability those
tests that are effort dependent and require
cooperation
RAPID
THORACOABDOMINAL
COMPRESSION ( RTC) the
squeeze or hug
Non-intubated infants
uses an inflatable jacket that surrounds the
thorax and abdomen
WOW!
testing
METHODS
BRONCHODILATOR
BENEFIT TEST
Is the dz is reversible? Lets find out.
Indication
a pt. with an FEV1% of less than 70%
Technique
follow guidelines on withholding certain meds prior
to test
do PFT - give tx with bronchodilator via neb or MDI
- wait 15-20 mins before doing post tests
monitor pt. for adverse effects
Significance
Calculate percent change of
each parameter
%change = postdrug - predrug
predrug
FEV 1 or FVC are evaluated - an
increase of > 12 % and > 200
ml is significant
asthma shows the best
improvement
SGaw should increase 30-40 % to
be significant
100.00%
80.00%
60.00%
40.00%
20.00%
0.00%
FVC
FEV1
% Pred
% Pred Postdrug
% Change
SGAW
BRONCHOPROVOCATION
(METHACHOLINE
CHALLENGE)
Methacholine
Used to determine whether or not a patient has a
disorder of airway hypersensitivity
And to what extent
Is a parasympathomimetic
May trigger bronchospasm
Methacholine challenge
the test is positive when there is a 20 %
decrease in the FEV 1 - the concentration at
which the decrease occurs is called the
provocative concentration or PC20%
Healthy subjects do not display a decrease in
FEV1 greater than 20 %
SGaw can be used with FEV1 to demonstrate
a reaction
Use a 16 mg/ml stock methacholine solution
Technique
Subjects should be
tested when
asymptomatic, baseline
FEV 1 > 70 % of the pt.
norm
Withhold meds
according to chart
2 methods accepted by
ATS,1st baseline spiro
5-breath dosimeter method
2-minute tidal breathing method
Preoperative PF Testing- to
Estimate postop lung
function
Plan periop care
Estimate morbidity &
mortality
Look at
Spirometry/obstruction
Bronchodilation studies
ABGs, Ex. Testing &
DLCO
To determine impairment
should characterize the type, extent and cause of
impairment
other factors need to be known - age, educational
background and the subjects motivation and energy
requirements
for pulm. dz impairment, you also need a hx, physical,
CXR, other appropriate imaging techniques and PFTs (should be specific to disorder being investigated)
ABGs
may be nonspecific due to various factors
look at other parameters along with ABGs
Exercise Testing
subjects considered should have resting ABGs
a Steady State protocol using the treadmill is
preferred
specific protocols should be followed
Limits for determining disability on the bases of
pulm. impairment have been set for the US by
the SS administration