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E-raamat: Making Sense of Lung Function Tests

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Mark Mottershaw (Havant, UK), Elena Kourteli, Jonathan Dakin (Portsmouth Hospitals NHS Trust, UK)

Formaat: 224 pages
Sari: Making Sense of
Ilmumisaeg: 06-Jul-2017
Kirjastus: CRC Press Inc
Keel: eng
ISBN-13: 9781315355351

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Respiratory medicine

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Formaat: 224 pages
Sari: Making Sense of
Ilmumisaeg: 06-Jul-2017
Kirjastus: CRC Press Inc
Keel: eng
ISBN-13: 9781315355351

Teised raamatud teemal:

Respiratory medicine

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Respiratory problems are the most common cause of acute admission to hospital. A variety of diagnostic investigations are required, both for acute and clinic assessment. Making Sense of Lung Function Tests, Second Edition familiarises both trainees and more experienced clinicians with the interpretation of a range of respiratory parameters. It places lung function in a clinical context using real-life examples and provides invaluable hands-on guidance.

For this second edition Consultant Respiratory Physician Jonathan Dakin and Consultant Anaesthetist Elena Kourteli are joined by Mark Mottershaw, Chief Respiratory Physiologist from Queen Alexandra Hospital, Portsmouth, all contributing a broad range of expertise and perspectives. Together they have updated the book throughout and added new chapters including an algorithm for interpretation of pulmonary function tests, exhaled nitric oxide (FENO) and cardiopulmonary exercise testing.

The text offers a clear explanation of the concepts which students find difficult, including:

The basis of obstructive and restrictive defects

Pattern recognition of the flow volume loop

Differences between TLCO and KCO

Assessment of oxygenation using PO2 and SO2

The basis of Type 1 and type 2 respiratory failure

Distinguishing respiratory and metabolic acidosis

The relationship between sleep and respiratory failure

The information is presented in an accessible way, suitable for those seeking a basic grounding in spirometry or blood gases, but also sufficiently comprehensive for readers completing specialist training in general or respiratory medicine.

Preface

Acknowledgement

Abbreviations

xvii

1 Expressions of normality

(4)

Part 1 Tests Of Airway Function And Mechanical Properties

(98)

2 Peak expiratory flow

(6)

Introduction

(1)

Test description and technique

(1)

Pitfalls

(1)

Physiology of test

(1)

Normal values

(1)

Peak flow variability in the diagnosis of asthma

(3)

Assessment and management of asthma

(1)

Pitfall

(1)

3 Spirometry and the flow-volume loop

(22)

Introduction

(1)

Measured indices and key definitions

(1)

Test description and technique

(3)

Physiology of tests

(2)

Restrictive and obstructive defects

(7)

Restrictive defects

(2)

Obstructive defects

(1)

Maximum expiratory flows

(2)

Normal values

(1)

Assessment of severity of obstruction

(1)

Mid-expiratory flows

(1)

FVC versus VC

(1)

Patterns of abnormality

(4)

Obstructive spirometry

(2)

Restrictive spirometry

(2)

Reduction of FEV, and FVC

(1)

Mixed obstructive/restrictive defect

(1)

Non-specific ventilatory defect

(1)

Large airways obstruction

(1)

Fixed upper airway obstruction

(1)

Variable extrathoracic obstruction

(2)

Variable intrathoracic obstruction

(1)

Clinical pearls

(4)

4 Airway responsiveness

(6)

Introduction

(1)

Test physiology

(1)

Test descriptions

(1)

Reversibility

(1)

Challenge testing

(1)

Interpretation of results

(4)

Reversibility

(1)

Challenge testing

(3)

5 Fractional concentration of exhaled nitric oxide

(4)

Introduction

(1)

Test description/technique

(1)

Physiology of test

(1)

Normal values and interpretation

(1)

Specific considerations

(1)

6 Gas transfer

(12)

Introduction

(1)

Measured indices/key definitions

(2)

Alveolar volume

(1)

Kco

(1)

Test description

(1)

Physiology of gas exchange

(1)

Normal values

(1)

Patterns of abnormality

(5)

Incomplete lung expansion

(2)

Discrete loss of lung units

(1)

Diffuse loss of lung units

(1)

Pulmonary emphysema

(1)

Pulmonary vascular disease

(1)

Causes of increased gas transfer

(1)

Clinical pearls

(3)

Interstitial lung disease

(1)

Obstructive disease

(1)

Acute disease

(1)

7 Static lung volumes and lung volume subdivisions

(16)

Introduction

(1)

Measured indices/key definitions

(2)

Test descriptions/techniques

(5)

Helium dilution

(2)

Nitrogen washout

(1)

Whole-body plethysmography

(2)

Comparison of methods

(1)

Physiology of lung volumes

(1)

Total lung capacity

(1)

Residual volume

(1)

Functional residual capacity

(1)

Closing capacity

(1)

Normal values

(1)

Patterns of abnormality

(2)

Relationship between VC and TLC

(1)

Obstructive lung disease

(1)

Interstitial lung disease

(1)

Miscellaneous

(1)

Specific considerations

(2)

Anaesthesia

(1)

FRC in patients receiving ventilatory support: PEEP and CPAP

(2)

Clinical pearls

(3)

8 Airway resistance

(14)

Introduction

(1)

Physiology of airway resistance tests

(1)

Plethysmography technique

(4)

Test description/technique

(1)

Measured indices/key definitions

(1)

Normal values

(1)

Patterns of abnormality

(3)

Oscillometry techniques

(5)

Test description/technique

(1)

Measured indices/key definitions

(3)

Normal values

(1)

Patterns of abnormality

(2)

Assessment of severity

(1)

Specific and clinical considerations

(3)

9 Respiratory muscle strength

(16)

Introduction

(1)

Test descriptions/techniques

(6)

Upright and supine vital capacity

(3)

Static lung volumes

(1)

Maximal expiratory pressure

(1)

Maximal inspiratory pressure

(1)

Sniff nasal inspiratory pressure

(1)

Sniff trans-diaphragmatic pressure

(1)

Direct electromagnetic phrenic nerve stimulation

(1)

Cough peak flow

(1)

Arterial blood gases

(1)

Radiological assessment of muscle strength

(1)

Clinical interpretation of tests of muscle strength

(2)

Forced vital capacity

(1)

Sniff nasal inspiratory pressure

(1)

MIP and MEP

(1)

The twitch Pm

(1)

Sleep, ventilatory failure, and VC

(4)

Clinical pearls

(4)

Part 2 Blood Gas Interpretation

103

(42)

10 Assessment of ventilation

105

(10)

Introduction

105

(1)

Measured indices/key definitions

105

(1)

Physiology of ventilation in relation to CO2

105

(3)

Normal values

108

(1)

Measurement of venous blood gases

109

(1)

Causes of hypercapnia

109

(3)

Chronic obstructive pulmonary disease

110

(1)

Obesity hypoventilation syndrome

111

(1)

Exhaustion

111

(1)

Increased CO2 production

112

(1)

Causes of low PCO2

112

(1)

Hypoxaemia

112

(1)

Metabolic acidosis

112

(1)

Central nervous system disorders

112

(1)

Drugs

112

(1)

Anxiety

113

(1)

Clinical pearls

113

(2)

11 Assessment of haemoglobin saturation

115

(10)

Introduction

115

(1)

Measured indices

115

(1)

Measurement of oxygen saturation

116

(4)

Pulse oximetry

117

(3)

Waveform

117

(1)

Accuracy

118

(1)

Specific sources of error

119

(1)

Pros and cons of pulse oximetry

120

(1)

Physiology-oxygen dissociation curve

120

(2)

What determines the amount of oxygen carried in blood?

121

(1)

Normal values

122

(1)

Carbon monoxide poisoning

122

(1)

Clinical pearls

123

(2)

12 Assessment of oxygenation

125

(12)

Introduction

125

(1)

Normal values

125

(1)

Measurement of PaO2

125

(1)

Measurement of arterialised capillary PO2

126

(1)

The oxygen cascade

127

(5)

Humidification of dry air

128

(1)

Alveolar gas

128

(1)

Arterial blood

129

(3)

A-a partial pressure PO2 difference

129

(3)

Tissue

132

(1)

Relationship between alveolar PO2 and arterial PcO2

132

(1)

Clinical pearls

133

(1)

Specific clinical considerations

133

(4)

Hypoxaemia

133

(1)

Apnoeic respiration

134

(1)

Chronic respiratory failure

135

(2)

13 Assessment of acid-base balance

137

(8)

Introduction

137

(1)

Measured indices/key definitions

137

(1)

Physiology of acid-base balance

138

(2)

Compensation

139

(1)

Classification of acid-base disorders

140

(1)

Respiratory disorder

140

(1)

Metabolic disorder

140

(1)

Evaluating compensation of acid-base disturbance

141

(2)

Respiratory compensation for metabolic disorder

142

(1)

Metabolic compensation for respiratory disorder

142

(1)

Time course of compensation

143

(1)

Summary: Evaluation of acid-base disorders

143

(2)

Part 3 Exercise Testing

145

(28)

14 Field exercise tests

147

(8)

Introduction

147

(1)

Measurement indices

147

(1)

Description of tests

148

(1)

Six-minute walk test

148

(1)

Incremental shuttle walk test

149

(1)

Endurance shuttle walk test

149

(1)

Choice of field-walking test

149

(1)

Physiology of field exercise tests

150

(1)

Normal values

151

(1)

Six-minute walk test

151

(1)

Incremental shuttle walk test

151

(1)

Endurance shuttle walk test

151

(1)

Clinical pearls

152

(3)

15 Cardiopulmonary exercise testing

155

(18)

Introduction

155

(1)

Measured indices/key definitions

155

(1)

Test description/technique

155

(4)

Physiology of exercise testing

159

(6)

Normal physiological responses

159

(5)

Normal values

164

(1)

Patterns of abnormality

165

(4)

Exercise tolerance

165

(1)

Lung disease

165

(1)

Heart disease - ischaemic heart disease

166

(2)

Heart disease - cardiomyopathy

168

(1)

Pulmonary vascular disease

168

(1)

Summary

169

(1)

Assessment of severity

169

(2)

Specific considerations

171

(2)

Part 4 Interpretation

173

(16)

16 A strategy for interpretation of pulmonary function tests

175

(8)

Introduction

175

(8)

17 Characteristic pulmonary function abnormalities

183

(6)

Airway diseases

183

(2)

Asthma

183

(1)

Chronic obstructive pulmonary disease

183

(1)

Bronchiolitis

184

(1)

Bronchiectasis

184

(1)

Large airway obstruction - variable extrathoracic

184

(1)

Large airway obstruction - variable intrathoracic

184

(1)

Fixed upper airway obstruction

185

(1)

Restrictive diseases interstitial lung disease

185

(2)

Pleural disease

185

(1)

Chest wall deformity

186

(1)

Muscle weakness

186

(1)

Post-pulmonary resection surgery

186

(1)

Pulmonary vascular disease

187

(1)

Pulmonary arterial hypertension

187

(1)

Recurrent pulmonary emboli

187

(1)

Chronic pulmonary venous congestion

187

(1)

Carbon monoxide poisoning

187

(2)

References

189

(8)

Index

197

Jonathan Dakin MD FRCP BSc Hons, is Consultant Respiratory Physician at Royal Surrey County Hospital NHS Foundation Trust, Surrey. He is also Honorary Consultant Respiratory Physician at Portsmouth Hospitals NHS Trust, Hampshire.

Mark Mottershaw is Chief Respiratory Physiologist at Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Hampshire.

Elena Kourteli is Consultant Anaesthetist at St Georges University Hospitals Foundation NHS Trust, London.

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