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Particular Impairments. Pulmonary Function Tests Ventilation & Respiration Chest X-Ray Ventilation Arterial Blood Gases Respiration SpO 2 Respiration Lung Sounds Ventilation Exercise Test Oxygen Consumption Ventilatory Muscle Strength Ventilation
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Particular Impairments • Pulmonary Function Tests Ventilation & Respiration • Chest X-Ray Ventilation • Arterial Blood Gases Respiration • SpO2 Respiration • Lung Sounds Ventilation • Exercise Test Oxygen Consumption • Ventilatory Muscle Strength Ventilation • Thoraco Abdominal Movements Ventilation • Breathing Patterns Ventilation / Respiration
Capability for Work Skeletal Muscle Oxygen Consumption Advanced Methods for Understanding the medical complexity of your pulmonary patient….Impairment Interactions PaCO2 Oxygen Carrying Capacity PaO2 Respiration Alveoli Health RBC Alveolar (PAO2) Alveolar (PACO2) Renal Function Pump Effectiveness Pulmonary Blood Flow Alveolar Ventilation Arrhythmia Ventilation “Cardiac Effects” Breathing Mechanics
Pulmonary Function Tests Ventilation & Respiration • Mild COPD • FEV1/FVC 70-80% predicted • FEV165-80 % predicted • With or withoutsymptoms • Moderate COPD • FEV1/FVC 50-70% predicted • FEV1 50-65% predicted • With or without symptoms • Very Severe COPD • FEV1/FVC < 50% • FEV1 < 30% predicted or presence of respiratory failure or right heart failure • Severe COPD • FEV1/FVC < 50% • FEV1 30-50% predicted • With or without symptoms
Pulmonary Function Tests Ventilation & Respiration DLCO – Diffusion Limited Carbon Monoxide
Arterial Blood Gases Respiration • PO2 • PCO2 • pH • HCO3-
SpO2 Respiration • Oxyhemoglobin Dissociation Curve • CO2? • Related to exercise capacity?
Exercise Test Oxygen Consumption • Peak VO2 • Peak Ve • VE/VO2 • VE/VCO2
What is required for the examination – evaluation? • Functional task – absolute workload and how long the patient was able to sustain • What was the relative response? • System (HR, BP, RPE, Dyspnea, muscle strength) • Ventilation (RR, chest wall, breathing mechanics, breathing patterns, spirometry, ventilatory muscle strength) • Respiration (SpO2, ABG’s, color, mentation)
Hyperinflation • Irreversible (chest x ray; Hoover’s sign; barrel chest; accessory muscle use; chest wall mobility; lung sounds) • Reversible or Dynamic (chest x ray; Hoover’s sign; barrel chest; accessory muscle use; chest wall mobility; lung sounds)
O’Donnell et al. 2001. Am J Respir Crit Care Med 164: 770-777
O’Donnell et al. 2001. Am J Respir Crit Care Med 164: 770-777
Hypoventilation • Can be caused by Hyperinflation (as in obstructive conditions) or from restrictive processes • ILD • Pneumonia • Masses • Pleural effusions
Breathing Mechanics / Chest wall Ventilation • Normal Movements – how to measure? evaluate? • Paradoxical movements • Accessory muscle use • Measurement • Palpation • Tape measure • Hoover’s sign
Ventilatory Muscle Strength Ventilation • Maximal Inspiratory Pressure • Maximal Expiratory Pressure • Endurance • Relationship between strength and endurance
Breathing Patterns Ventilation / Respiration • Ve = Vt x RR • How does pattern / balance of Vt and RR influence alveolar ventilation? • How do you assess this influence?
SpO2 & ABG’s Respiration • How do these influence your evaluation of ventilatory impairments?
Interventions • Remember – as therapists we treat Impairments, Functional Limitations and Disability – NOT Disease • Therefore – we have spent time to understand impairments and their functional implications and as such we focus our interventions here • We use disease knowledge to help identify probable impairments and to establish whether impairments are reversible or irreversible, medical optimization, and overall prognosis – but we DO NOT HAVE A PARTICULAR TREATMENT FOR A PARTICULAR DISEASE
Absolute Workload (Function) Limited associated with Reduced Endurance due toDisease Specific Impairment? Yes No • Can response be changed? • Reversible vs. Irreversible? • Medically optimized? • What does this workload allow? • Pacing • Maximize Efficiency • Conditioning • Biomechanical optimization • What is limiting factor? • Degree / time frame of reversibility? • Specific vs. General training - • Increase maximal workload • Conditioning
Absolute Workload (Function) Limited associated with Reduced Endurance due toDisease Specific Impairment? Yes Ventilatory Ms Strength DHI – PLB Posture Chest wall exercises BPH - ACT Can response be changed? Reversible? Yes No Medically optimized? Yes No • What does this workload allow? • Pacing • Maximize Efficiency • Conditioning • Biomechanical optimization
Absolute Workload (Function) Limited associated with Reduced Endurance due toDisease Specific Impairment? No • What is limiting factor? • Degree / time frame of reversibility? • Specific vs. General training - • Increase maximal workload • Conditioning