Consensus Statement for Inert Gas Washout Measurement Using Multiple- and Single- Breath Tests
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Testing Regimes 3364-136-PF-01 Respiratory Care Approving Officer
Name of Policy: Testing Regimes Policy Number: 3364-136-PF-01 Department: Respiratory Care Approving Officer: Associate VP Patient Care Services / Chief Nursing Officer Responsible Agent: Director, Respiratory Care Scope: Effective Date: June 1, 2020 The University of Toledo Medical Center Initial Effective Date: July 1, 1979 Respiratory Care Department New policy proposal X Minor/technical revision of existing policy Major revision of existing policy Reaffirmation of existing policy (A) Policy Statement Pulmonary function testing is to be ordered according to these regimes or as individual procedures. All tests may be ordered individually. (B) Purpose of Policy To standardize the ordering procedures for pulmonary function testing. (C) Procedure 1. Pulmonary Function Test I: a. Nitrogen washout test: Determination •Functional Residual Capacity (FRC) • Indirect calculation of Residual Volume (RV) • In conjunction with the Slow Vital Capacity, determination of all lung volumes. b. Carbon Monoxide single breath test: • Determination of diffusing capacity (DLCO-sb) c. Slow Vital Capacity: determination of • Slow Vital Capacity (SVC) • Expiratory Reserve Volume (ERV) • Inspiratory Capacity (IC) d. Flow/Volume Loop: determination of the mechanics of breathing: • Forced Vital Capacity (FVC). • Forced Expiratory Volume in one second (FEV-1) %FEV-1/FVC • Average Forced Expiratory Flow between 25% and 75% of vital capacity (FEF 25-75%) • Maximum Forced Expiratory Flow (FEF-max) • Forced Expiratory Flow at 25%, 50% and 75% of vital capacity (FEF 25%, FEF 50%, FEF 75%) • Forced Inspiratory Vital Capacity (FIVC) • Average Forced Inspiratory Flow between 25% and 75% of FIVC (FIF 25-75%), Forced Inspiratory Flow at 25%, 50% and 75% of FIVC (FIF 25%, FIF 50%, FIF 75%) • FIVC/FVC ratio Policy 3364-136-PF- 01 Testing Regimes Page 2 •FIF 50/FEF 50 ratio e. -
Asthma Initiative Content
WAO Symposium Why Are Small Airways Important In Asthma? “Physiology Of Small Airways Disease” Thomas B Casale, MD Professor Of Medicine Chief, Allergy/Immunology Creighton University Omaha, NE USA Disease Process in Asthma is Located in All Parts of Bronchial Tree Including Small Airways and Alveoli Workgroep Inhalatie Technologie, Jun 1999. Relevant Questions On Small Airway Involvement In Asthma • How can „small airway disease‟ be defined? • What is the link between small airway abnormalities and clinical presentation in asthma ? • When does small airway involvement become relevant in the natural history of the disease? • Is it possible to reverse small airway abnormalities with pharmacological treatment? Contoli et al Allergy 2010; 65: 141–151 Pathophysiologic Changes in the Small Airways of Asthma Patients Transbronchial Biopsies 1 Lumen occlusion 2 Subepithelial fibrosis 3 Increase in smooth muscle mass 4 Inflammatory infiltrate 1 Immunostaining of eosinophils in small airway with major basic protein (in red) 2 Shows large number of eosinophils around the small airway Contoli M, et al. Allergy. 2010;65:141-151. Structural Alterations in Small Airways Associated With Fatal Asthma Small airway of a Small airway of a control subject subject with fatal asthma Mucus plugging Structural alterations in small airways have been implicated as an underlying reason for increased asthma severity and AHR….. Difficult to control asthma. Mauad T, et al. Am J Respir Crit Care Med. 2004;70:857-862. Differences In ECM Composition In Small Airways Between Fatal Asthma And Controls Dolhnikoff et al, JACI 2009; 123:1090-1097 Is There Differential Inflammation in Proximal and More Distal Airways? • Some studies suggest that the cellular infiltrate increases toward the periphery, but others show similar or decreased infiltration – May reflect heterogeneity of asthma as well as the different methods used in the studies . -
Multiple-Breath Nitrogen Washout Techniques: Including Measurements with Patients on Ventilators
Eur Respir J 1997; 10: 2174–2185 Copyright ERS Journals Ltd 1997 DOI: 10.1183/09031936.97.10092174 European Respiratory Journal Printed in UK - all rights reserved ISSN 0903 - 1936 ERS/ATS WORKSHOP REPORT SERIES Multiple-breath nitrogen washout techniques: including measurements with patients on ventilators C.J.L. Newth*, P. Enright**, R.L. Johnson+ CONTENTS Definition ....................................................................... 2174 Nitrogen washout test for infants and young children Methods for determining FRC ................................... 2175 FRC measured during spontaneous ventilation ........ 2178 Choice of method Assumptions and limitations of the method ............. 2178 FRC measurement during mechanical ventilation FRC measured by plethysmography (FRCpleth) ......... 2175 Helium (He) dilution ................................................. 2179 FRC measured by helium dilution (FRCHe) ............. 2175 Sulphur hexafluoride (SF6) washout ......................... 2179 FRC measured by nitrogen washout (FRCN2) ........... 2175 Nitrogen (N2) washout ............................................... 2179 Standards for lung volume measurement by gas Procedure for testing .................................................. 2180 dilution/washout techniques ......................................... 2177 Assumptions and limitations ..................................... 2180 Nitrogen washout test for adults and older, Equipment and technical procedures ......................... 2181 Normal values: spontaneous breathing -
Inert Gas & Winemaking a Moremanual !™ by Shea A.J
Inert Gas & Winemaking A MoreManual !™ by Shea A.J. Comfort www.MoreWineMaking.com 1–800–823–0010 The Importance of Inert Gas therefore eliminating any headspace (as is the case when filling/topping-up barrels), but as we shall see in the next During aging, if a wine is not protected from both microbial section this may not always be practical. spoilage and oxygen at all times it is likely to spoil. Protecting wine usually involves maintaining proper SO 2 Expansion & Contraction — The Need For levels and keeping containers full. Additionally, purging your headspaces with inert gas to effectively remove the Headspaces: oxygen greatly increases the amount of protection. When Unless you are in a situation with a guarantee of temperature stability, as with a glycol-jacketed tank, or a it comes to using SO2, the benefits are widely understood and in-depth information describing its usage is readily temperature-controlled storage area, tanks and carboys available in most winemaking literature. Yet, often when should have a small headspace kept at the top (note that these texts refer to purging with inert gas they fail to barrels should not have any space in them when filled/ explain the actual, step-by-step techniques needed to topped). This headspace is needed because it helps to do so. It is important be aware that creating an effective compensate for the expansion and contraction of the blanket of gas to protect your wine requires more than liquid due to ambient temperature changes (remember just shooting some Argon into the headspace of your things expand when heated and contract when cooled). -
Calculation of Lung Volume in Newborn Infants by Means of a Computer-Assisted Nitrogen Washout Method
SJOQVIST ET AL. 003 1-3998/84/18 1 1-1 160$02.00/0 PEDIATRIC RESEARCH Vol. 18, No. 1 1, 1984 Copyright O 1984 International Pediatric Research Foundation, Inc. Printed in U.S.A. Calculation of Lung Volume in Newborn Infants by Means of a Computer-assisted Nitrogen Washout Method BENGT ARNE SJOQVIST, KENNETH SANDBERG, OLA HJALMARSON, AND TORSTEN OLSSON Research Laboratory of Medical Electronics, Chalmers University of Technology [B.A.S., T.O.] and Department of Pediatrics I, University of Gateborg [K.S., O.H.], Gateborg, Sweden ABSTRACT. A clinically adapted method for the calcula- uring F~c.Despite its central importance, measurements of tion of the functional residual capacity in newborn infants FRC are seldom used clinically in neonatal medicine, because of has been developed. The method is based on a multiple the lack of suitable methods. breath nitrogen washout test, during which the ventilatory Therefore, in order to facilitate such measurements, we have air flow and the nitrogen concentration signals are sampled developed a clinically adapted computer-assisted plethysmo- by a minicomputer, which also performs the calculations. graphic nitrogen washout method for the calculation of FRC in The ventilatory air flow is measured by a pneumotachom- newborn infants, which reduces the problems connected with eter connected to a face-out volume displacement body ordinary washout methods (3, 8, 15). It also enables further plethysmograph, and the nitrogen concentration by a nitro- analysis of the collected washout data, for instance nitrogen gen analyzer. The functional residual capacity volume is elimination pattern ("distribution of ventilationn) analysis. The calculated from the sampled signals by adding the expired method has been tested on a group of healthy newborn infants nitrogen volumes during each expiration, and finally divid- and on a mechanical lung model. -
Effects of Continuous Positive Airway Pressure on Pulmonary Function and Blood Gases of Infants with Respiratory Distress Syndrome
Pediat. Res. 12: 771-774 (1978) Continuous positive airway pressure pulmonary function functional residual capacity respiratory distress syndrome hyaline membrane disease Effects of Continuous Positive Airway Pressure on Pulmonary Function and Blood Gases of Infants with Respiratory Distress Syndrome C. PETER RICHARDS ON'^" AND A. L. JUNG Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA Summary the infants were 33.7 -+ 0.4 wk and 2013 + 93 g. Some infants were studied several times during the course of their disease so Nitrogen washout measurements and blood-gas analyses were that 52 sets of data were gathered at infant postnatal ages ranging made on 32 newborn infants with severe RDS at continuous from 4 to 152 h (mean 38 h). Four of the infants required positive airway pressures (CPAP) of 5, 10, and 15 cm H2O. mechanical ventilation due to the inability to maintain Paon of 60 Increases in airway pressure resulted in significant increases in mm Hg with airway pressure greater than 15 cm HzO and FiOz of Pa02 and functional residual capacity (FRC). It also produced 1.0. Three of these four infants died of intraventricular hemor- significant decreases in alveolar turnover rates of the "fast" and rhages. A fourth infant died of necrotizing enterocolitis. All four "slow" alveolar spaces of a two-space lung model. Changes in infants that died also had pneumothoraces, and were the only CPAP did not significantly affect the distribution of ventilation. infants with pneumothoraces. The changes in PaO2. due to changes in CPAP, did not correlate well with changes in &/wt nor wi& changes in'alveolar turnover EQUIPMENT rates. -
Biological Effects of Noble Gases
Physiol. Res. 56 (Suppl. 1): S39-S44, 2007 Biological Effects of Noble Gases J. RŮŽIČKA, J. BENEŠ, L. BOLEK, V. MARKVARTOVÁ Department of Biophysics, Medical Faculty of Charles University, Plzeň, Czech Republic Received May 23, 2007 Accepted May 29, 2007 On-line available May 31, 2007 Summary Noble gases are known for their inertness. They do not react chemically with any element at normal temperature and pressure. Through that, some of them are known to be biologically active by their sedative, hypnotic and analgesic properties. Common inhalation anesthetics are characterized by some disadvantages (toxicity, decreased cardiac output, etc). Inhalation of xenon introduces anesthesia and has none of the above disadvantages, hence xenon seems to be the anesthetic gas of the future (with just one disadvantage – its cost). It is known that argon has similar anesthetic properties (under hyperbaric conditions), which is much cheaper and easily accessible. The question is if this could be used in clinical practice, in anesthesia of patients who undergo treatment in the hyperbaric chamber. Xenon was found to be organ-protective. Recent animal experiments indicated that xenon decreases infarction size after ischemic attack on brain or heart. The goal of our study is to check if hyperbaric argon has properties similar to those of xenon. Key words Noble gases • Xenon• Argon • Diving • Anesthesia • Stroke Introduction it is the point of this work. Above all, available information and our own observation concerning xenon Helium, neon, argon, krypton, xenon and radon and argon will be gathered here. are elements of the eighth group of the periodic table of Argon is the longest known and the least rare gas elements. -
CHEMICAL ACTIVITY of NOBLE GASES Kr and Xe and ITS IMPACT on FISSION GAS ACCUMULATION in the IRRADIATED UO2 FUEL M
ANNUAL REPORT 2005 Nuclear Technology in Energy Generation CHEMICAL ACTIVITY OF NOBLE GASES Kr AND Xe AND ITS IMPACT ON FISSION GAS ACCUMULATION IN THE IRRADIATED UO2 FUEL M. Szuta Institute of Atomic Energy It is generally accepted that most of the insoluble We can further assume that above a limiting value inert gas atoms Xe and Kr produced during fissioning of fission fluency (burn-up) a more intensive process of are retained in the fuel irradiated at a temperature lower irradiation induced chemical interaction occurs. Signifi- than the threshold. Some authors assume random diffu- cant part of fission gas product is thus expected to be sion of gas atoms to grain boundaries and consider the chemically bound in the matrix of UO2. effect of trapping the atoms at inter-granular bubbles From the moment of discovering the rare gases until saturation occurs. Others confirmed that bubbles (helium, neon, argon, krypton, xenon and radon) at the tend to concentrate in the grain boundaries during irra- end of XIX century until to the beginning of sixties diation. Likewise, some authors further assume that years of XX century it was considered that the noble most of the gas atoms are retained in solution in the gases are chemically inactive. matrix of grains being there immobilised or are precipi- The nobility of rare gases started to deteriorate af- tated into small fission gas bubbles. ter the first xenon compound was found by Barlett in The experimental data presented in the open litera- 1962 [1]. Barlett showed that the noble gases are capa- ture imply that we can assume that after irradiation ble of forming what one could consider as normal exposure in excess of 1018 fissions/cm3 the single gas chemical compounds, compelling chemists to readjust atom diffusion can be disregarded in description of considerably their thinking regarding these elements. -
Infant/Toddler Pulmonary Function Tests (2008)
AARC Clinical Practice Guideline Infant/Toddler Pulmonary Function Tests—2008 Revision & Update ITPFT 1.0 PROCEDURE: 2.4.3 Tidal breathing measures: RR; time Infant/toddler pulmonary function tests (ITPFTs) to reach peak tidal expiratory flow (tPTEF); 41, total expiratory time (tE); ratio of tPTEF/tE ITPFT 2.0 DESCRIPTION/DEFINITION: 42 2.4.4 Partial expiratory flow-volume 2.1 Infant/toddler pulmonary function tests curves: maximal flow at functional residual measure a variety of pulmonary variables in capacity (VmaxFRC) 49, 68 subjects who are generally too young to per- 2.4.5 Raised volume rapid thoracoabdomi- form, comprehend, or comply with necessary nal compression technique: forced vital ca- instructions for conventional pulmonary diag- pacity (FVC); forced expired volume at 0.5 nostic procedures and 0.75 seconds respectively (FEV0.5, 2.2 Subjects are typically tested under con- FEV0.75); forced expiratory flow at 25%, scious sedation or while sleeping and are spon- 50%, 75% and between 25% and 75% of taneously breathing. ITPFTs have also been FVC (FEF25, FEF50, FEF75, FEF25-75) performed in subjects who are mechanically 68, 73 ventilated. 2.4.6 Whole body plethysmography: 2.3 ITPFTs may include measurements of: plethysmographic functional residual ca- 2.3.1 Passive respiratory mechanics, 1-35 pacity (FRCpleth); airway resistance 2.3.2 Dynamic respiratory mechanics, 32, 33, (Raw) 97, 101 35-39 2.4.7 Gas dilution techniques: helium dilu- 2.3.3 Tidal breathing measurements, 1, 35, 40 -42 tion (FRCHe), nitrogen washout (FRCN2), 2.3.4 -
The Effect of Continuous Positive Airway Pressures on Lung Volumes
Paraplegia (1996) 34, 54- 58 © 1996 International Medical Society of Paraplegia All rights reserved 0031-1758/96 $12.00 The effect of continuous positive airway pressures on lung volumes in tetraplegic patients 2 LA Harveyl and ER Ellis 2 1 Physiotherapy Department, The Prince Henry Hospital, Sydney; School of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Sydney, Australia Continuous positive airway pressure (CPAP) is widely advocated for the treatment of respiratory complications. However the effects of CPAP on the respiratory function of tetraplegic patients have not yet been investigated. The purpose of this study was to examine the effects of breathing with different levels of CPAP on the relationship between closing volume (CV) and functional residual capacity (FRC) in ten recently injured, but otherwise healthy tetraplegic patients with lesions between the fourth and eighth cervical segments. Lung volumes were measured before, during and after 32 min of zero end-expiratory pressure and 5 and 10 cm H20 of CPAP. FRC was measured by the open-circuit nitrogen washout method and CV was measured by the single breath nitrogen washout method. FRC was unaffected by zero end-expiratory pressure, but both 5 cm H20 and 10 cm H20 of CPAP caused significant increases in FRC. FRC returned to pre-CPAP values by the first minute after removal of 5 and 10 cm H20 of CPAP. We were unable to measure CVs in any subjects. It was concluded that 5 and 10 cm H20 of CPAP increase FRC in healthy tetraplegic individuals, but that these increases are rapidly lost with the subsequent removal of CPAP. -
Fire Code Section 5309 Inert Gas Systems Used in Commercial
Section 5309 Inert Gas Systems Used in Commercial, Manufacturing or Industrial Applications is added as follows: SECTION 5309 INERT GAS SYSTEMS USED IN COMMERCIAL, MANUFACTURING OR INDUSTRIAL APPLICATIONS 5309.1 General. Inert gas systems with more than 100 pounds (45.4 kg) of an inert gas or any system using any amount of an inert gas below grade used in a commercial, manufacturing or industrial application, such as water treatment with pH balancing, food processing or laboratories shall comply with Sections 5309.1 through 5309.8. Inert gases include but are not limited to argon, helium, nitrogen and carbon dioxide. Provisions of Section 5307 are applicable where CO2 is used. Exceptions: 1. Medical gas systems 2. Gaseous Fire suppression systems 3. Carbon dioxide gas enrichment systems in accordance with Section 5310 5309.2 Permits. Permits shall be required in accordance with Sections 105 and in accordance with Denver Fire Department policy. 5309.3 Equipment. The storage, use, and handling of inert gases shall be in accordance with IFC Chapters 53 and 55, as amended, and the applicable requirements of NFPA 55. All equipment utilized in compressed gas systems shall be compatible with the intended gas and use. 5309.3.1 Containers, cylinders and tanks. Gas storage containers, cylinders and tanks shall be designed, fabricated, tested and labeled with manufactures’ specifications and shall be maintained in accordance with the regulations of DOTn 49 CFR, Parts 100-185 or the ASME Boiler and Pressure Vessel Code, Section VIII. 5309.3.1.1 Location. Location of gas storage containers, cylinders and tanks, inside or outside the building, shall be at an approved location. -
The Noble Gases
INTERCHAPTER K The Noble Gases When an electric discharge is passed through a noble gas, light is emitted as electronically excited noble-gas atoms decay to lower energy levels. The tubes contain helium, neon, argon, krypton, and xenon. University Science Books, ©2011. All rights reserved. www.uscibooks.com Title General Chemistry - 4th ed Author McQuarrie/Gallogy Artist George Kelvin Figure # fig. K2 (965) Date 09/02/09 Check if revision Approved K. THE NOBLE GASES K1 2 0 Nitrogen and He Air P Mg(ClO ) NaOH 4 4 2 noble gases 4.002602 1s2 O removal H O removal CO removal 10 0 2 2 2 Ne Figure K.1 A schematic illustration of the removal of O2(g), H2O(g), and CO2(g) from air. First the oxygen is removed by allowing the air to pass over phosphorus, P (s) + 5 O (g) → P O (s). 20.1797 4 2 4 10 2s22p6 The residual air is passed through anhydrous magnesium perchlorate to remove the water vapor, Mg(ClO ) (s) + 6 H O(g) → Mg(ClO ) ∙6 H O(s), and then through sodium hydroxide to remove 18 0 4 2 2 4 2 2 the carbon dioxide, NaOH(s) + CO2(g) → NaHCO3(s). The gas that remains is primarily nitrogen Ar with about 1% noble gases. 39.948 3s23p6 36 0 The Group 18 elements—helium, K-1. The Noble Gases Were Kr neon, argon, krypton, xenon, and Not Discovered until 1893 83.798 radon—are called the noble gases 2 6 4s 4p and are noteworthy for their rela- In 1893, the English physicist Lord Rayleigh noticed 54 0 tive lack of chemical reactivity.