A space to discuss all things related to pulmonary function testing! Equipment, predicted values, protocols, and challenges. I hope this will be a useful space for technicians, physicians, and others to "meet" and share information.
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Thursday, July 29, 2010
Spirometry.
Didn't mean to leave out our most commonly done test for discussion points!
Dr Weiner, I am a respiratory therapist who has done PFT's for several years in a small community hospital, and more recently at Lehigh Valley Hospital. I've also been involved in critical care throughout the years.
While at the small community hospital all PFTs were done in the seated position. When I started to do PFT's at LVH, I found that all spirometry on pediatric patients were done standing if capable of standing.
Recently the AARC started a forum for members of specific specialty sections, including a diagnostic section. Someone posted a question about whether pediatric patients should be done standing or seated. Someone else posted that according to the ATS all PFTs are to be done seated. I brought up the idea that maybe the patients should be done in the same position as were used by the creator of their reference ranges. I thought it might make an interesting topic for your blog, but wasn't sure where to put it.
Janet, I think we do almost all of our kids in Pittsburgh seated. In Philly, I kind of remember that kids were given their choice. I agree that it makes some sense to consider whether the normative data was collected standing or sitting.
Janet, I am at Washington University/St. Louis Children's Hospital and we do all our kids standing unless they are too ill to stand. We find they do much better standing than sitting. The ATS guidelines recommend standing for adults, it does not specify for children.
I have another question for discussion. I am curious how you interpret the ATS/ERS criteria for "End of Test". Previously, I assumed that the patient had to have a plateau in volume AND reach a minimum time (>6 seconds for >10 years of age; >3 seconds for 6-9 year olds). Our current software considers EOT met if plateau OR time criteria is met. How do you read this part of the ATS statement?
I have a question for readers. I am at Washington University/St. Louis Children's Hospital, currently our protocol for an exercise challenge states a positive response at 20% decrease in FEV1. According to ATS, FEV1 decrease of 15% is positive in adults. I am curious to what others are using and if you are in an adult or pediatric setting. Thanks! Gina Simpson
Where I am (Children's Hospital Pittsburgh), I typically use a decrease of 15% in FEV1 (although we have a paragraph of disclaimer after our results commenting on the potential insensitivity of exercise testing, and that different cutoffs may be used). Most of our kids are tested on treadmill rather than bike.
Dr Weiner,
ReplyDeleteI am a respiratory therapist who has done PFT's for several years in a small community hospital, and more recently at Lehigh Valley Hospital. I've also been involved in critical care throughout the years.
While at the small community hospital all PFTs were done in the seated position. When I started to do PFT's at LVH, I found that all spirometry on pediatric patients were done standing if capable of standing.
Recently the AARC started a forum for members of specific specialty sections, including a diagnostic section. Someone posted a question about whether pediatric patients should be done standing or seated. Someone else posted that according to the ATS all PFTs are to be done seated. I brought up the idea that maybe the patients should be done in the same position as were used by the creator of their reference ranges. I thought it might make an interesting topic for your blog, but wasn't sure where to put it.
Janet Navin RRT RPFT
Janet, I think we do almost all of our kids in Pittsburgh seated. In Philly, I kind of remember that kids were given their choice. I agree that it makes some sense to consider whether the normative data was collected standing or sitting.
ReplyDeleteJanet, I am at Washington University/St. Louis Children's Hospital and we do all our kids standing unless they are too ill to stand. We find they do much better standing than sitting. The ATS guidelines recommend standing for adults, it does not specify for children.
ReplyDeleteGina Simpson, RRT, CPFT
How does everyone perform bronchodilator testing? Our lab uses 2 puffs of albuterol via aerochamber.
ReplyDeleteOur lab uses 4 puffs albuterol via cut tubing.
ReplyDeleteGina Simpson, RRT, CPFT
In our adult lab at Cleveland Clinic we administer 4 puffs of albuterol via a valved holding chamber (z-stat).
ReplyDeleteKevin, say hi to Mark Patterson for me!
ReplyDeleteHi, we're from the Montreal Children's Hospital.
ReplyDeleteHow do you do your sputum inductions?
Isabelle, we typically only do them as part of research protocols in our lab. We use 7% HS.
ReplyDeleteI have another question for discussion. I am curious how you interpret the ATS/ERS criteria for "End of Test". Previously, I assumed that the patient had to have a plateau in volume AND reach a minimum time (>6 seconds for >10 years of age; >3 seconds for 6-9 year olds). Our current software considers EOT met if plateau OR time criteria is met. How do you read this part of the ATS statement?
ReplyDeleteI have a question for readers. I am at Washington University/St. Louis Children's Hospital, currently our protocol for an exercise challenge states a positive response at 20% decrease in FEV1. According to ATS, FEV1 decrease of 15% is positive in adults. I am curious to what others are using and if you are in an adult or pediatric setting. Thanks!
ReplyDeleteGina Simpson
Where I am (Children's Hospital Pittsburgh), I typically use a decrease of 15% in FEV1 (although we have a paragraph of disclaimer after our results commenting on the potential insensitivity of exercise testing, and that different cutoffs may be used). Most of our kids are tested on treadmill rather than bike.
ReplyDelete