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Tests

u 3 types of measurements
n
n
n

Ventilation
Distribution
Diffusion

Parameters
u Tidal Volume (TV)
u Inspiratory Reserve Volume (IRV)
u Expiratory Reserve Volume (ERV)
u Residual Volume (RV)
u Vital Capacity (VC) = IRV + ERV + TV
u Total Lung Capacity (TLC) = VC + RV
u Inspiratory Capacity (IC) = TV + IRV
u Functional Residual Capacity (FRC)
n
n
n

= RV + ERV
= TLC IC
Very stable

Parameters
u Dead Space
uTranspulmonary pressure (PL)
n

Pressure gradient across mouth (Pao) and pleural


surface at lung (PPL)

uTransalveolar Pressure (PEL)


n

Pressure gradient across alveolar wall (PALV - PAL)

uTransairway Pressure (PRES)


n

Pressure gradient across alveolar and mouth

uStatic Elastic recoil Pressure (PST(L))


n

Pressure developed in elastic fibers of lung by


expansion

Dynamic parameters
u Respiratory minute volume
n

Amount of air inspired during 1 min at rest

= TV * respiratory cycles /min

u Forced breathing tests to assess muscle power and


airway resistance
n

Forced Vital Capacity (FVC)


n

Amount of air that can be forcefully expired as quickly as


possible after deepest possible breath

Timed Vital Capacity

Forced Expiratory Volume (FEV)

Maximum mid-expiratory flow rate


n

Flow measurement over middle half of forced vital capacity


(25% to 75% level) [FEV25% -75%]

Maximum mid-expiratory flow rate

Dynamic parameters
u Maximal Breathing Capacity (MBC) or Maximal
Voluntary Ventilation (MVV)
n

15 20 seconds

u Closing volume
n
n

Detect obstruction of small airways


Volume level at which certain zones within lungs cease
to ventilate

u BTPS
n

Measurements made a body temperature and ambient


pressure, with gas saturated with water vapor

u STPD
n

Standard Temperature and pressure and dry


measurement

Mechanical measurements
uDirect measurement of
Compliance of lungs and rib cage
n Resistance of all air passages

Compliance of lungs and rib cage


uVolume increase in lungs per unit increase in
pressure
n

n
n

Measurement of: volume of gas inspired or expired


and intrathoracic pressure
2 types: static and dynamic
Static compliance represents pulmonary compliance
during periods without gas flow, such as during an
inspiratory pause.
Dynamic tidal volume/ (intrathoracic pressure at
end inspiratory and end expiratory)

uNot constant over respiratory cycle


n

Decrease as lungs are inflated

Airway Resistance
uRatio of pressure to flow
n

Intra-alveolar pressure and flow

uNot constant over respiratory cycle


n

Inhalation - As pressure becomes more negative


airways widened - airway resistance
Exhalation - pressure becomes more positive
airways narrowed - airway resistance

uMeasured at or near end expiratory level

Instrumentation
u Basic Spirometer
Bell volumes 9 & 13.5 L
Bell little inertia
n For fast RR measurement
Kymograph paper speeds: 32,160,300 and 192 mm/min

n
n

u Frequency response
Adequate to measure FEV
n No Hysteresis
Fast Response time
n Flat frequency response up to
12 Hz
n

Spirometer
u Is a Mechanical Integrator
n
n
n

Input airflow
Output volume displacement
Electrical signal proportional to volume
displacement can be obtained
n Linear motion potentiometer connected to pulley
n Signal fed to flow-volume differentiator for
evaluation and recording of data

uHeavily damped system


uNot analytical
uNot completely objective

Some uses
uClinical spirography
uCardiopulmonary function testing
uMetabolism determinations
uDirect measurements
n
n
n

Basal minute volume


Exercise ventilation
Maximum breathing capacity

uCalculated
n

Ventilation equivalent of oxygen

Waterless Spirometers
uWedge or bellows type
uRolling Seal or Dry Seal
uDiaphragm

Wedge Spirometer
uBreathed air is held
between in a chamber
enclosed by parallel
metal pans hinged to
each other on one
edge
uOne metal pan is
permanently fixed
n

Contains pair of 5 cm
tubes

uSpace between two


pans is sealed airtight
with vinyl bellows

Wedge Spirometer..
uBellows
n
n
n

Extremely flexible in the direction of pan motion


Offers high resistance to ballooning
\when pressure gradient exists between
atmosphere and interior of wedge there will be
negligible distortion of bellows

uVolume and flow signals


n

Obtained from two linear transducers


n Attached to fixed frame and coupled to edge of
moving pan
n One transducer produces dc signal a
displacement (volume)
n Other produces dc output a velocity (flow)

Wedge Spirometer
uElectronics unit
n

Power supply, amplifier and built-calibration


networks

uMechanical Read-out
uAdjustable tilt mechanism or magnetic stop
provide desired volume (resting) position
n

No effect on moving pans due to large surface area


of pans

uCalibrated using selector switch determines


magnitude of calibration signal

Horizontal Bellows

Other types of Spirometers


uUltrasonic Spirometers
uAirflow Spirometers or Pneumotachometers
uBronchospirometer
n

Measures volumes and capacities of each lung


individually
Used for pre-operative evaluation of oxygen
consumption of each lung

Ultrasonic Spirometers
uBased on transit-time
uFrequency: 40 200 kHz
n
n

>200 k Hz: absorption losses


< 40 kHz: audible

uPulse transit time upstream (t1)


and downstream (t2) are given by:
n
n

D: Distance between transducers


C: velocity of sound propagation in
fluid
v : velocity of fluid vector in the
path of pulses

Ultrasonic Spirometers..
uAverage gas velocity : v

uOutput accuracy unaffected by (since no C in


final equation):
n

Fluid density, temperature or viscosity

uTube diameters: >3 cm

Ultrasonic Spirometers
uDisadvantages:
n
n
n

Contamination by flowing substances


Unwanted turbulence and moisture accumulation
Deadspace is undesirable

Pneumotachometers
u Measure instantaneous rate of volume flow
u Types: Differential Manometer and Hot-wire
anemometer
u Differential Manometer:
n

Consists of a small resistance which allows flow but


causes pressure drop
Change measured using differential pressure transducer
which works on Poiseuilles Law
Assumption: Flow is Laminar

u Hot-wire anemometer
n
n

Uses small heated element in the pathway of gas flow


Current needed to maintain the element at constant
temperature is measured

Pneumotachometers
uParameters studied:
n

FEV, MMEV, peak flow

uAlso used to generate flow-volume loops


uAbsolute volume derived by electronically
integrating the flow rate
uConventional Spirometers have limitations of
mechanical inertia, hysteresis and CO2 build-up
uAdvantage: Non-Obstructive continuous
monitoring possible
uRequirement minimum resistance to breathing
n

Acceptable between: 0.5 to 1 cm H2O s/l

Pneumotachometers
u Frequency components 10 Hz
uQuick Response time
uGood zero stability
n

To avoid false integration during volume


measurements

uSometime bias flow is introduced


n

Avoid rebreathing for expired air

Fleisch Pneumotachometer
u Thin sheet of corrugated metal is
rolled and inserted in a metal cover
n

These corrugations are parallel channels


and act as resistance elements
Helps to maintain laminar flows at
higher flow rates
n

n
n

Flow rate directly proportional to


pressure drop

o/p of flow transducer is pressure drop


A second transducer required to convert
pressure to electrical signal Capacitive
is used
n

More stable and less vibration sensitive

Poiseuilles Law
uPressure developed across Pneumotach directly
proportional to gas viscosity
uViscosity of mixture of gases is approximated
by:
n

Where X is fraction of gas having viscosity h

Fleisch Pneumotachometer
uTemperature effect 1% change per C
uSaturating air with water vapor reduce
output head by 1.2%
uMeasurements done at BTPS
n

To avoid condensation and maintain gases under


BTPS device maintained at 37 C

Venturi-type Pneumotachometer
uPressure drop proportional to square of
volume flow
uOpen geometry less prone to liquid
accumulation
uDisadvantage
n
n

Non-linearity of calibration
Requirement of laminar flow

Turbine Type Pneumotachometer


uAir flowing through transducer rotates low mass
blades
uRotation interrupts beam of light
n
n

Detected by photocell
Generates pulses corresponding to accumulated volume

uAccuracy is not affected by turbulence, water


vapor or gas composition
u Biased airflow is applied
using a pump blades in
constant motion even
without sample overcome
rotational inertia linear
range 3-600 l/min

Measurement of volume

Measurement of Volume

Maximal expiratory flow- volume (MEFV) curves

Nitrogen Washout Technique


uUsed for indirect measurement of RV, FRC and
TLC
uSubject breaths 100% O2
uNitrogen analyzer placed near mouth-piece
continuously monitors N2
n

Decreases with each successive breath

u alveolar N2 becomes 1% and steady state is


reaches steady state
uNitrogen washout curves
uComplete washout curves takes about 10 min

Nitrogen washout curve


u% N2 in expired air Vs time
uTheoretically %N2 Vs expired volume
straight line on graph paper
uActually not presence of anatomic dead
space/ tidal volume ratio
uCompensation subtract deadspace from each
breath

Single Breath N2 washout curve


u Maximal inspiration of 100%
u Exhaling VC slowly till
Residual volume
u N2 concentration plotted vs
volume
u Parameters derived from this:
n

Closing volume
n the lung volume at which the flow from the lower parts of the
lungs becomes severely reduced or stops during
expiration, presumably because of airway closure; measured by
the sharp rise in expiratory concentration of a tracer gas that had
been inspired at the beginning of a breath that started from
residual volume.

Pulmonary Function Analyzers


uCompletely automated for the measurement of
ventilation, distribution and diffusion

Pulmonary Function Analyzers


u Pneumotach: signal proportional to airflow
u CO and He analyzers: diffusion measurements
u Linearity from 0-15 l/s
n

Better precision for recording flow-loop in range of high


flows and well as low flows

u Flow proportional pressure drop is fed to pressure


transducer
n
n
n

Pneumatic value converted into electrical signal


Fed to amplifier o/p is flow
Signal is integrated to volume by voltage to frequency
converter
Flow and volumes are converted into digital signal

Processing, Evaluation and representation of data


u8-bit microprocessor
uProgram memory capacity: 46kB
n
n

16kB used for software


30kB used for measurement and organization

uIntermediate storage of data: 12kB RAM


uSystem communication: 20-digit alphanumeric
display line
u20-digit alphanumeric printer-plotter:
hardcopy of o/p
uFEV curves: histograms also

Impedance Pneumograph
uIndirect technique for measurement of
respiration
n
n

Respiratory volume and rate is measured


Relationship between respiratory depth and
thoracic impedance change

uAdvantages: no masks, tubes or flow-meters


n
n
n

Do not impede respiration


Minimal effect on Psyche of patient
Provide continuous volumetric record of respiration

Measurement
uThoracic impedance change
n
n

AC excitation is applied to subject


Should be independent of
n Impedance due to resting thoracic impedance and
n Contact impedance between electrodes and skin

uOptimum frequency considerations


n
n
n
n
n

Excitability of various tissues between electrodes


Nature of other recording made at same time. Ex: ECG
Typical used: 50-100 kHz
Does not stimulate tissues &
Amplitude: 1mA p-p
Natural rejection of other
bioelectric events
Power < 1mW

Thoracic impedance and impedance change signals


u Polar or Cartesian vectors used
u Respiratory signal (DZ) = change between initial
impedance (Zo) and new impedance (Z)
n
n
n

Essentially a change in resistance component


Independent of frequency in 20-600kHz range
Correlates well with changes in respired volume (DV)

u Transthoracic impedance
n
n

Function of frequency
Type and size of electrodes
n

Ag/AgCl electrodes
n
n

9.5mm dia 500-800W at 50kHz


4mm dia. 1000-1500 W at 50kHz

Typical impedance change: 3W/l respiratory volume change

Disadvantages
uWhen absolute respiration measurements are
required
n

Conversion of impedance change to lung-volume


change is a function of
n Electrode position: generally placed eighth rib
bilaterally on midaxillary lines
n Body size
n Posture

Respiratory Gas Analyzers


uQualitative and quantitative analysis of
inspired and expired air
uUsed in respiratory physiology, lung function
assessment and anesthesia
uDifferent principles
n
n
n
n

Infrared/ ultraviolet absorption


Paramagnetism
Thermal conductivity
Ratio of charge to mass of ionized molecules

uGases monitored
n

CO, CO2, Nitrous Oxide (N2O), Halothane

Infrared Gas Analyzers


u Some gases and vapours absorb specific wavelengths of IR
u Most commonly CO2
u Can be used for CO, N2O and halothane
u Conventional double beam IR spectrometer
u Non-dispersive IR analysis

Infrared Gas Analyzers


u Major Advantage:
n
n

Highly specific
Requires separate pick-up head

u Samplers:
n

n
n

Micro-catheter cell
n Used with vacuum pump to draw samples from nasal
cavity or trachea
n Typical volume: 0.1ml
Breathe-through cell
n Entire tidal volume of breath
n No vacuum assistance
n Connected directly into circuit of anesthesia machine
Response time: 0.1 s
Sensitivity range: 0 to 10% CO2

Block diagram
u Solid-state detector:
n

PbSe

u High speed chopper


n
n

3000 rpm
Response time: 100ms for 90% reading

u IR source
n
n

Temperature: 815C
Collimated using parabolic reflector
n No internal reflections

u Chopper
n

Allows IR to pass alternately through reference and sample

u Sample tube length


n

Selected according to absorption strength and concentration of gas

u Detector-filter assembly
n

Narrow BP interference filter matched with absorption characteristics of gas

Paramagnetic O2 Analyzer
u O2 is paramagnetic in nature
n

Attracted to in magnetic field

NO and NO2 are also paramagnetic

u Magnetic susceptibility
n

Measure of tendency of O2 molecule to become


temporarily magnetized when placed in magnetic field

Principle of operation
u In the cell, two glass spheres
filled with nitrogen gas are
suspended with strong
Quartz wire.
u At first, the spheres are kept
in balance in an
inhomogeneous magnetic
field.
When oxygen molecules having a large magnetic
susceptibility flow there, the molecules are pulled toward the
stronger magnetic field zone and the spheres are moved away
from the zone.

Principle of operation
u Resulting deviation of the
spheres is detected with the
light source, reflecting mirror
and light receiving element, and
a current is passed through the
feedback loop to control so that
the spheres can return to the
initial balanced state.
u The current flowing through the
feedback loop is proportional to
oxygen concentration.
u Thus, oxygen concentration is
converted into an electric signal.

Paramagnetic O2 Analyzer

Polarographic Oxygen Analyzer


uUsed to measure partial pressure or percentage of
O2 in
n

Injected samples (or) continuous streams (or) static gas


monitoring

uMost used in respiratory and metabolic labs


uPrinciple:
n
n

n
n
n

Redox reactions in a cell with 2 noble electrodes


When potential is applied, O2 is reduced at cathode in
presence of KCl as electrolyte
Current will flow
Cathode is covered with O2 permeable membrane
Rate at which O2 reaches cathode is controlled by
diffusion through membrane

Polarogram
u Voltage current curve
u Diffusion coefficient changes with temperature

uTemperature
coefficient

Diffusion
rate limited

2-4% /C
Proportional to
pO2 at given
temperature

uUses
uPortable gas
detectors
n

Simplicity, low-cost
and light-weight

uCommercial gas
analyzers
n
n
n
n

Gold cathode
Silver anode
KCl electrolyte gel
Thin membrane

uElectrical potential
750 mV

Thermal Conductivity Analyzers


uThermal conductivity of
gas is defined as:
n

Quantity of heat (in


calories) transferred in unit
time (sec) to gas between
two surfaces (1 cm2 in area)
and 1 cm apart, when
temperature difference
between two surfaces is 1C

Principle of operation
u The gas analyzer sensor uses four matched filaments that
change resistance according to the thermal conductivity of
the gas passing over it.
u These four filaments are connected in a Wheatstone Bridge
configuration.
u When all four resistances are the same, VOUT is zero and the
bridge is considered balanced. When zeroing, the reference
gas is passed over all the filaments, the resistances will be
the same (because filaments are matched) and the bridge is
balanced.
u When the sample gas is passed over half of the bridge, then
VOUTs value correlates to the content of the sample gas in
the reference.

Principle of operation..
uThe four elements are electronically connected in
a bridge circuit and a constant current is passed
through the bridge to heat the elements.
u If each element is surrounded by the same
gas, then the temperature and hence the
resistance of each element will be similar and the
bridge circuit will be balanced.

Principle of operation
uWhen the gas to be measured is introduced into
the sample gas stream, the two resistive
elements in this gas stream will be cooled to a
greater extent than the two elements in the
reference gas.
u The bridge circuit will be
unbalanced, producing a signal voltage related
to the measure gas content of the sample gas.
This relationship is non-linear.
uAs a result, the analyzer is calibrated at
zero, mid-span, and high span and the software
mathematically linearises the curve.

N2 analyzer based on ionization technique


uGas sample is ionized, selectively filtered, and
detected with a photocell
uPresence of N2 is detected by presence of purple
color by spectrophotometer, when discharge takes
place in low pressure chamber
uSampling head
uIonizing
chamber, filter, detector
uDischarge tube
uPower supply, amplifier
and filter

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