UAMS MEDICAL PHYSIOLOGY December 3, 2012 MECHANICS OF BREATHING LABORATORY M.

Jennings Introduction: The goal of this laboratory is to give students hands-on experience with a spirometer and to reinforce basic concepts about lung volumes and capacities. One or more instructors will be at each spirometer to assist and troubleshoot, but the students should be the ones who operate the equipment. The instruments are reliable, but it is easier to use them with some detailed tips, which are described below. A group of 9-10 students will be assigned to each Welch-Allyn instrument, which is the same device that records electrocardiograms. At the beginning, decide who will hit the buttons on the instrument. You can take turns doing this if you want. The device will boot up in the ECG mode. To get to the Spirometry mode, first hit the cancel button (the rectangular button with the X on it) to close the dialog box that says Patient Cable Disconnected. Then hit the rectangular blue button (second from the left below the screen) that has the picture of the two lungs. A screen should come up for entering patient data. Enter an arbitrary number, e.g., 98765 and then enter the volunteers name, date of birth, etc. Enter all the data, because predicted values depend on age, gender, height, and weight. Once the data are entered, hit the Done button on the far right. (The screen is not a touch screen; you need to use the round buttons below the screen.) 1. Slow Vital Capacity, Upright Posture The screen that comes up next should have the following labels across the bottom for the 5 buttons: Effort Type FVC Curve Flow/Volume Start Test Done

We will do Forced Vital Capacity (FVC) after doing volume vs time spirometry, which measures lung volumes and Slow Vital Capacity (SVC). To get in SVC mode, hit the button on the left that is labeled Effort Type. The display above the button should switch from FVC to SVC, and the screen should show an empty graph of volume vs time. The button labels at the bottom of the screen should now look like this: Effort Type SVC Start Test Done

Attach a new mouthpiece to the white cable coming from the spirometer. The mouthpiece is attached correctly when the white wingnut is oriented parallel to the axis of the mouthpiece. The volunteer should put on the noseclips and start breathing normally into and out of the mouthpiece. (The mouth goes around the end of the mouthpiece that is farther away from the cable.)

UAMS Medical Physiology Respiratory Mechanics Lab December 3, 2012

Make sure the volunteer stands up straight and breathes normally through the mouthpiece, without any conscious effort to change breathing pattern. The volunteer should not lean over and look at the screen. Postural changes will distort the lung volumes. After the volunteer has breathed quietly for several breaths and is comfortable breathing through the mouthpiece, the Instrument Operator should press the button that says Start. This initiates a 30 second recording. After the Start button is hit, the volunteer should continue breathing normally for 3 breaths. On the 4th inspiration, (s)he should inspire as much air as possible and then exhale as much air as (s)he can. To do this test the subject should not expire as fast as (s)he can, but make sure to expire as much air as possible. Imagine a deep sigh, with the expiratory part continuing until you cant expire any more air. After expiring completely, resume normal tidal breathing. The instrument will stop the test after a total elapsed time of 30 seconds. A volume vs. time display will come up on the screen, with increases in lung volume plotted as downward deflections in the trace. Unless you think the mouthpiece or noseclips got detached during the test, or something else went wrong like a cough, sneeze or giggles, hit the Accept button. After several seconds (be patient), a dialog box will come up saying that the memory is full. Hit Enter to erase the old file. Then hit the Test Done button on the far right. A volume vs time trace should come up. Then hit Print Test. Another screen comes up, and you need to hit Print again (the button second from right). The printout will contain numerical values as well as a volume vs. time graph. Dont look at these numbers yet. 2. Slow Vital Capacity, Supine Posture Before analyzing the above data, the volunteer should do the same drill but lying on the table. Hit the blue button with the lungs on it, and the same patient data should come up. If you have trouble retrieving the same patient data, just enter it again. Then repeat all the above, but with the subject lying on his/her back. 3. Data Analysis Once you have printed both the upright and supine results for the same person, fold the printouts just above each of the two graphs to avoid the temptation of looking at the instrument-derived numbers. Divide into two groups of 5 students, one for the upright data and one for the supine data. As a team, estimate the numerical values of Slow Vital Capacity, Inspiratory Reserve Volume, Expiratory Reserve Volume, Tidal Volume, Breathing Frequency, and Inspiratory Capacity. To estimates the volumes, first determine how many small divisions of the graph paper are equal to one liter. Then count the number of divisions for whatever volume or capacity you are calculating, divide by the number of small divisions per liter. Dont peek at the numbers on the printout! Fill in the graphs on the next page. Then fill in the numbers derived from the instrument and compare them with what you calculated.

UAMS Medical Physiology Respiratory Mechanics Lab December 3, 2012

Upright Posture Parameter Abbreviation Units Value from Graph Value Calc. by Instrument

Slow Vital Capacity Expiratory Reserve Volume Inspiratory Reserve Volume Tidal Volume Breathing Frequency Inspiratory Capacity

SVC ERV IRV Vt BF IC

L L L L 1/min L

Supine Posture Parameter Abbreviation Units Value Estimated from Graph Value Calc. by Instrument

Slow Vital Capacity Expiratory Reserve Volume Inspiratory Reserve Volume Tidal Volume Breathing Frequency Inspiratory Capacity Discussion Questions:

SVC ERV IRV Vt BF IC

L L L L 1/min L

How does upright vs supine posture affect the measured volumes? Why do you think posture has these effects?

UAMS Medical Physiology Respiratory Mechanics Lab December 3, 2012

4. Forced Vital Capacity After analyzing the volume vs time graphs, go back to the Forced Vital Capacity mode. You will have spent several minutes thinking about and talking about the volume vs time data, and the instrument may have defaulted back to ECG mode. If so, switch it back to Spirometry by hitting the button with the picture of the two lungs (after closing the dialog box about cable not attached). If the ECG mode has not automatically come back, just hit the lung button and get a new volume vs time screen. Once you get the screen in Forced Vital Capacity (FVC) mode, have the same volunteer enter his or her data, or retrieve the data from the instrument, and then hit the done button. The screen should come up with the same row of buttons on the bottom you saw previously: Effort Type FVC Curve Flow/Volume Start Test Done

After the volunteer has put on the nose clips and mouthpiece, he or she should breathe in and out normally a few times. Then the Instrument Operator hits the Start button. Once the test has started, the volunteer should breathe in and out quietly for two or three breaths, then take a maximum inspiration and blow out as much are as you can, as rapidly and completely as possible. Once the volunteer is sure (s)he cant expire one more milliliter of air, then (s)he should inspire rapidly back to resting lung volume. Then hit the Stop button. The instrument will then display a screen showing air outflow (L/s) vs volume of air expired (L). If this curve is reasonably smooth, hit Accept Effort. Again, after several seconds, a box will come up telling you to delete an old record. Hit Return to do this and then hit Test Done. The next screen is the flow vs volume graph. Hit Print Test. A new screen comes up; as previously, you need to hit Print again to print out the results. 5. Data Analysis From the flow vs volume graph, determine the peak expiratory flow (L/s) and forced vital capacity (L) and compare these numbers with those calculated by the instrument. Discussion questions: Is FVC larger or smaller than SVC? Why? Can you determine FEV1 from the flow/volume curve?