PULMONARY FUNCTION
TEST
 is a complete evaluation of the
respiratory system including patient
history, physical examinations, and
tests of pulmonary function.
 The primary purpose of pulmonary
function testing is to identify the
severity of pulmonary impairment.
WHAT DOES A PFT CONSIST
OF ?
 measure how well your lungs work.
They include tests that measure lung
size and
airflow, such as spirometry and lung
volume tests.
 Other tests measure how well
gases such as oxygen get in and out
of your blood.
IMPORTANCE
 an important tool in the assessment
of patients with suspected or
known respiratory disease.
 They are also important in the
evaluation of patients prior to major
surgery.
INDICATION
 Evaluation of respiratory complaints,
such as cough and dyspnea
 Assessment and monitoring of
disease severity and progression
 Monitoring for drug toxicity and
efficacy
 Pre-operative assessment
 Evaluation of the effects of
occupational or hazardous
exposures
 Participation in epidemiologic
surveys
CONTRAINDICATION
 Recent eye surgery
 thoracic,abdominal and cerebral
aneurysms
 active hemoptysis
 pneumothorax
 unstable angina
SPIROMETRY
 It measures lung function,
specifically the amount (volume)
and/or speed (flow) of air that can
be inhaled and exhaled.
 Spirometry is helpful in assessing
breathing patterns that identify
conditions such
as asthma, pulmonary fibrosis, cystic
fibrosis, and COPD.
 For this test, you’ll sit in front of a
machine and be fitted with a
mouthpiece. It’s important that the
mouthpiece fits snugly so that all the
air you breathe goes into the
machine. You’ll also wear a nose clip
to keep you from breathing air out
through your nose. The respiratory
technologist will explain how to
breathe for the test.
LUNG VOLUMES AND
CAPACITIES
• Tidal Volume (TV): volume of air
inhaled or exhaled with each breath
during quiet breathing (6-8 ml/kg)
500ml.
• Inspiratory Reserve Volume (IRV):
maximum volume of air inhaled
from the end-inspiratory tidal
position:3000ml
• Expiratory Reserve Volume (ERV):
maximum volume of air that can be
exhaled from resting end- expiratory
tidal position. 1500ml
• Residual Volume (RV): volume of air
remaining in lungs after maximum
exhalation (20-25 ml/kg) 1200 ml
• It can not be measured by
spirometry
LUNG CAPACITIES
• Total Lung Capacity (TLC) : Sum of
all volume compartments or volume
of air in lungs after maximum
inspiration (4-6 L)
• Vital Capacity ( VC): TLC minus RV
or maximum volume of air exhaled
from maximal inspiratory level. (60-
70 ml/kg) 5000ml.
• Inspiratory capacity (IC): sum of IRV
and TV or the maximum volume of
air that can be inhaled from end-
expiratory tidal position. (2400-
3800ml). Lung capacities
• Expiratory capacity (EC): sum of
TV+ERV
• Functional Residual Capacity (FRC):
sum of RV and ERV or the volume of
air in the lungs at end-expiratory
tidal position. (30-35 ml/kg) 2500ml.
FUNCTION
• Oxygen stores
• Buffer for maintaining a steady
arterial P02
• Partial inflation help prevents
atelectasis
• Minimizes the work of breathing
Why are these test done?
• Your doctor will order these tests to
determine how your lungs are
working. If you already have a
condition that’s affecting your lungs,
your doctor may order this test to
see
• if the condition is progressing or
how it’s responding to treatment.
DIAGNOSE
• asthma
• allergies
• chronic bronchitis
• respiratory infections
• lung fibrosis
• bronchiectasis, a condition in which
the airways in the lungs stretch and
widen
• COPD, which used to be called
emphysema
• asbestosis, a condition caused
by exposure to asbestos
• sarcoidosis, an inflammation of your
lungs, liver, lymph nodes, eyes, skin,
or other tissues
 • scleroderma, a disease that affects
your connective tissue
• pulmonary tumor
• lung cancer
• weaknesses of the chest wall
muscles
Airway Management
• It includes a set of maneuvers and
medical procedures
• performed to prevent and relieve
airway obstruction.
• It ensures an open pathway for gas
exchange between a
• patient's lungs and the atmosphere.
This is accomplished
• by either clearing a previously
obstructed airway; or by
• preventing airway obstruction
• Airway obstruction can be caused by
the tongue, foreign
• objects, the tissues of the airway
itself, and bodily fluids
• such as blood and gastric contents
(aspiration).
Basic Airway Management
• Basic techniques are generally non-
invasive and do not require
specialized medical equipment or
advanced training. These include
head and neck maneuvers to
optimize ventilation, abdominal
thrusts, and back blows.
Advanced Airway Management
• Advanced techniques require
specialized medical training and
equipment, and are further
categorized anatomically into
supraglottic devices (such as
oropharyngeal and nasopharyngeal
airways), infraglottic techniques
(such as tracheal intubation), and
surgical methods (such as
cricothyrotomy, and tracheotomy).
SUCTIONING
• Suctioning is the application of
negative pressure (vacuum) to the
airways through a collecting tube
(flexible catheter or suction tip).
• Airway obstruction can be caused by
retained secretions, foreign bodies,
and structural changes such as
edema, tumors, or trauma. Retained
secretions increase airway
resistance and the work of breathing
and can cause hypoxemia,
hypercapnia, atelectasis, and
infection.
• Removal of foreign bodies,
secretions, or tissue masses beyond
the main stem bronchi requires
bronchoscopy, which is generally
performed by a physician; however,
an increasing number of centers
have trained RTs to perform
therapeutic bronchoscopy.
• Suctioning can be performed by way
of either the upper airway
(oropharynx) or the lower airway
(trachea and bronchi).
Secretions or fluids also can be removed
from the oropharynx by using a rigid
tonsillar or Yankauer suction tip
 INDICATIONS OF
SUCTIONING:
• Patient has an ineffective cough and
unable to clear the secretion
• spontaneously (audible secretion
sound in patients under mechanical
• ventilation)
• Retained secretion is causing patient
distress or physiological
• derangement (e.g. increased work of
breathing, respiratory rate,
• impaired oxymetry or blood gases)
• Maintain airway patency with
secretion clearance
• When all other less invasive
Access to the lower airway is by secretion clearance interventions
introduction of a flexible suction catheter • have failed (e.g. cough assist
through the nose (nasotracheal suctioning) (manual or mechanical), positioning,
or artificial airway (endotracheal • other breathing/coughing techniques)
suctioning). • To stimulate cough
• To obtain sputum sample for
microbiology or cytological analysis.

CONTRAINDICATIONS:
• Severe bleeding disorder,
unexplained hemoptysis
• Severe bronchospasm or laryngeal
spasm, irritable airway
• Epiglottitis or croup
• Basal skull fractures / facial injury
• Cerebral spinal fluid leak
Bronchoscope • Recent nasal, oral or esophageal
surgery
• Occluded nasal passage, nasal
bleeding
• Loose teeth, denture or crown
• Increased intra-cranial pressure
 • Severe gag reflex
• Hemodynamic instability
• Tracheo/oesophageal fistulae

INDICATIONS:
HAZARDS
• Mechanical trauma to the airway
• Bleeding
• Hypoxemia/hypoxia
• Cardiac arrhythmias
• Vasovagal stimulation (↓HR/BP)
• Gagging/vomiting
• Aspiration
• Pain/distress/discomfort
• Laryngospasm or bronchospasm
• Respiratory arrest
• Changes in ICP
• Atelectasis
• Lesions in tracheal mucosa
ENDOTRACHEAL SUCTIONING
(Mechanically Ventilated Patients With
Artificial Airways)
• is a component of bronchial hygiene
therapy and mechanical ventilation
and involves the mechanical
aspiration of pulmonary secretions
from a patient with an artificial
airway in place. The procedure
includes patient preparation, the
suctioning event(s), and follow-up
care.
• Need to maintain patency and
integrity of the artificial airway
• Need to obtain a sputum specimen
to rule out or identify pneumonia or
other pulmonary infection or for
sputum cytology
• Need to remove accumulated
pulmonary secretions as evidenced
by one of the following:
 Sawtooth pattern on the flow-
volume loop on the monitor screen
of the ventilator or the presence of
coarse crackles over the trachea
 both are strong indicators of
retained pulmonary secretions
 Increased peak inspiratory pressure
on volume control ventilation or
 decreased tidal volume on pressure
control ventilation
 Deterioration of O2 saturation or
blood gas values
 Visible secretions in the airway
 Inability of patient to generate an
effective cough
 Acute respiratory distress
 Suspected aspiration of gastric or
upper airway secretions

CONTRAINDICATIONS
Endotracheal suctioning is a necessary
procedure for patients with artificial
airways. Most contraindications are relative
to the patient's risk of developing adverse
reactions or worsening clinical condition as
result of the procedure. When indicated,
there is no absolute contraindication to
endotracheal suctioning because the
decision to abstain from suctioning in order
to avoid a possible adverse reaction may, in
fact, be lethal
HAZARDS/COMPLICATIONS
• Hypoxia/hypoxemia
• Tissue trauma to the tracheal and/or
bronchial mucosa
• Cardiac arrest
• Respiratory arrest
• Cardiac dysrhythmias
• Pulmonary atelectasis
• Bronchoconstriction/bronchospasm
• Infection (patient and/or caregiver)
• Pulmonary hemorrhage/bleeding
• Elevated intracranial pressure
• Interruption of mechanical
ventilation
• Hypertension
• Hypotension
NASOTRACHEAL SUCTIONING
• NTS is intended to remove
accumulated saliva, pulmonary
secretions, blood, vomitus, and
other foreign material from the
trachea and nasopharyngeal area
that cannot be removed by the
patient’s spontaneous cough or
other less invasive procedures. NTS
has been used to maintain a patent
airway thus ensuring adequate
oxygenation and ventilation and
avoiding intubation that was solely
intended for the removal of
secretions.
• It refers to the insertion of a suction
catheter through the nasal passage
and pharynx into the trachea
without a tracheal tube or
tracheostomy (although a
nasopharyngeal airway may be
used) in order to aspirate
accumulated secretions or foreign
material.
INDICATIONS
• The need to maintain a patent
airway and remove saliva,
pulmonary secretions, blood,
vomitus, or foreign material from
the trachea in the presence of
• Inability to clear secretions when
audible or visible evidence of
secretions in the large/central
airways that persist in spite of
patient’s best cough effort. This is
evidenced by one or more of the
following;
o Visible secretions in the
airway
o Chest auscultation of coarse,
gurgling breath sounds,
rhonchi or diminished breath
sounds
o Feeling of secretions in the
chest (increased tactile
fremitus)
o Suspected aspiration of
gastric or upper airway
secretions
o Clinically apparent increased
work of breathing
 o Deterioration of arterial • Bronchoconstriction/bronchospasm
blood gas values suggesting • Discomfort7,41 and pain
hypoxemia or hypercarbia • Nosocomial infection
o Chest radiographic evidence • Atelectasis
of retained secretions • Misdirection of catheter
resulting in atelectasis or • Increased intracranial pressure
consolidation. Restlessness
TRACHEOSTOMY
• To stimulate cough or for unrelieved
coughing • Tracheotomy is the procedure of
• To obtain a sputum sample for establishing access to the trachea
microbiological or cytological via a neck incision. The opening
analysis created by this procedure is called a
tracheostomy. Tracheotomy may be
CONTRAINDICATIONS performed as a regular surgical
• Occluded nasal passages procedure or by a percutaneous
• Nasal bleeding dilation procedure.
• Epiglottitis or croup (absolute) • Performed in critically ill patients
• Acute head, facial, or neck injury requiring prolonged mechanical
• Coagulopathy or bleeding disorder ventilation for acute respiratory
• Laryngospasm failure and for airway issues.
• Irritable airway
• Upper respiratory tract infection
• Tracheal surgery
• Gastric surgery with high
anastomosis
• Myocardial infarction
• Bronchospasm

HAZARDS AND
COMPLICATIONS
• 1 Mechanical trauma
Hypoxia/hypoxemia INDICATIONS
• Cardiac dysrhythmias/arres
• Acute respiratory failure and
• Bradycardia
need for prolonged
• Increase in blood pressure
mechanical ventilation
• 6Hypotension
(representing two thirds of
• Respiratory
all
• Uncontrolled coughing
cases) and
• Gagging/vomiting
• Laryngospasm
• Traumatic or catastrophic
neurologic insult requiring
airway, or mechanical
ventilation or both. Upper
airway obstruction is a less
common indication for
tracheostomy.