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Full download Ruppel’s Manual of Pulmonary Function Testing 11th Edition file pdf all chapter on 2024
Full download Ruppel’s Manual of Pulmonary Function Testing 11th Edition file pdf all chapter on 2024
Full download Ruppel’s Manual of Pulmonary Function Testing 11th Edition file pdf all chapter on 2024
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Advanced
Summary
Case studies
Self-assessment questions
Entry-level
Advanced
Summary
Case studies
Self-assessment questions
Entry-level
Advanced
8
Flow-sensing spirometers
Peak flowmeters
Body plethysmographs
Breathing valves
Summary
Self-assessment questions
Entry-level
Advanced
Path of workflow
Summary
Case studies
Self-assessment questions
Entry-level
Advanced
9
Pulmonary function testing interpretation, “bringing it all together”
Interpretation algorithm
Summary
Case studies
Self-assessment questions
Entry-level
Advanced
Chapter 2, Spirometry
Glossary
10
Index
11
Inside Front Cover
12
v Venous
Mixed venous
BTPS Body temperature and pressure saturated with water vapor
ATPS Ambient temperature and pressure saturated with water
vapor
STPD 0°C, 760 mm Hg, dry
Lung Volumes
VC Vital capacity
IC Inspiratory capacity
IRV Inspiratory reserve volume
ERV Expiratory reserve volume
FRC Functional residual capacity
RV Residual volume
TLC Total lung capacity
RV/TLC (%) Residual volume to total lung capacity ratio expressed
as a percentage
VTG Thoracic gas volume
VT Tidal volume
VA Alveolar volume
VD Dead space volume
VL Lung volume
13
Dead space ventilation per minute (BTPS)
fb, f Respiratory rate per minute, breathing frequency
VD/VT Dead space to tidal volume ratio
P100, P0.1 Pressure in the first 100 msec of an occluded breath,
occlusion pressure
Spirometry
FVC Forced vital capacity with maximal expiratory effort
FIVC Forced inspiratory vital capacity with maximal inspiratory
effort
FEVT Forced expiratory volume for a specific interval T
FEVT/FVC%, FEVT% Forced expiratory volume to forced vital
capacity ratio expressed as a percentage
FEFx Forced expiratory flow related to some specific portion of the
FVC, denoted as subscript X, referring to the volume of FVC
already exhaled at the time of measurement
FEF25%–75% Forced expiratory flow during the middle half of the FVC
(formerly the MMF)
FEF50%/FIF50% Forced expiratory flow to forced inspiratory flow at
50% of VC expressed as a ratio or a percentage
FET Forced expiratory time
PEF Peak expiratory flow
MEFV Maximal expiratory flow-volume curve
MIFV Maximal inspiratory flow-volume curve
PEFV Partial expiratory flow-volume curve
Forced expiratory flow related to the actual volume of the
lungs denoted by subscript X, referring to the lung volume
remaining when measurement is made
14
MVVX Maximal voluntary ventilation as the volume of air expired
in a specified interval, denoted by subscript X (formerly MBC)
Pulmonary Mechanics
C Compliance, volume change per unit of pressure change
Cdyn Dynamic compliance, measured during breathing
*
Where two symbols are given, both are commonly used.
15
Copyright
16
Notices
Knowledge and best practice in this field are constantly changing.
As new research and experience broaden our understanding,
changes in research methods, professional practices, or medical
treatment may become necessary.
To the fullest extent of the law, neither the Publisher nor the
authors, contributors, or editors, assume any liability for any injury
and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of
any methods, products, instructions, or ideas contained in the
material herein.
17
testing / Gregg L. Ruppel. 10th ed. c2013. | Includes bibliographical
references and index.
Identifiers: LCCN 2016048605 | ISBN 9780323356251 (pbk.)
Subjects: LCSH: Pulmonary function tests–Handbooks, manuals,
etc.
Classification: LCC RC734.P84 R86 2017 | DDC 616.2/40754–dc23
LC record available at https://lccn.loc.gov/2016048605
18
Contributors/Reviewers
Contributors
19
Foreword
This text began as a series of notes for respiratory therapy students
who were interested in learning to perform pulmonary function
tests. In the 1970s, a great deal of time was devoted not only to
performing the physiologic measurements but also to manually
measuring graphic recordings and calculating the results. Much has
changed over the past 40 years in regard to performing pulmonary
function studies. Most notably, microprocessors have supplanted
the drudgery of measuring and calculating, so that the results of
complicated tests are available almost as soon as the patient has
completed the maneuver. While this permits the person conducting
the test to concentrate on acceptability and repeatability, it may
allow the tester to give minimal attention to the physiology
responsible for the patient’s symptoms. With few exceptions, the
physician treating the patient no longer performs the test but relies
on a technologist to make the measurements that will determine a
course of therapy or whether additional studies might be needed.
Understanding respiratory physiology has taken a back seat to
learning how to navigate sophisticated computer software.
Previous editions of the Manual have attempted to bridge the gap
between making standardized physiologic measurements of lung
function and interpreting the results of those tests to answer the
clinical question being asked. This latest edition continues with that
intent by updating the content and expanding the best practices as
new techniques become available. The new material is directed at
helping those interested in lung function testing learn not only how
to do each test but also why a specific test is important. More than
ever, this requires individuals who have a solid understanding of
20
respiratory physiology and the clinical skills to deal with
symptomatic patients in the testing environment. Well-prepared
technologists are more likely to avoid misclassification of disease
states and to relate the results of pulmonary function tests to
important patient outcomes. This edition of the Manual aspires to
contribute to that preparation.
Carl D. Mottram, RRT, RPFT, FAARC, took responsibility as the
author/editor beginning with the tenth edition. He has continued in
this role to significantly expand and improve the eleventh edition.
There is no one better qualified to continue improving the content
and the format of the text. The Manual should continue to be a
useful resource for students of lung function testing, whether they
are therapists, technologists, or physicians.
Gregg L. Ruppel, MEd, RRT, RPFT, FAARC, Division of Pulmonary,
Critical Care and Sleep Medicine, Saint Louis University School of Medicine, St. Louis,
Missouri
21
Preface
The primary functions of the lung are oxygenation of mixed venous
blood and removal of carbon dioxide. Gas exchange depends on the
integrity of the entire cardiopulmonary system, including airways,
pulmonary blood vessels, alveoli, respiratory muscles, and
respiratory control mechanisms. A few pulmonary function tests
assess individual parts of the cardiopulmonary system. However,
most lung function tests measure the status of the lungs’
components in an overlapping way.
This eleventh edition describes the most common pulmonary
function tests, their techniques, and the pathophysiology that may
be evaluated by each test. Topics covered include the following:
• Basic tests of lung function, including spirometry, lung volume
measurements (i.e., body plethysmography, nitrogen washout
and helium dilution), diffusing capacity, and blood gas analysis
• Ventilation and ventilatory control, cardiopulmonary exercise
tests, and pediatric and infant pulmonary function testing
• Specialized test regimens that focus on exhaled nitric oxide
measurements, forced oscillation techniques, metabolic studies,
disability determination, and preoperative evaluation
• Bronchial challenge tests that assist the clinician in characterizing
the hyperreactivity of the airways
• Pulmonary function testing equipment, quality assurance, and
reference values and interpretation
Distinctive features
The eleventh edition includes many of the features from the
22
previous editions:
• Learning objectives for entry-level and advanced practitioners are
again included at the beginning of each chapter.
• Each test section includes criteria for acceptability and
repeatability, as well as interpretive strategies with criteria that
are organized to help those who perform pulmonary function
tests adhere to recognized standards.
• Most of the testing criteria are based on the American Thoracic
Society (ATS) and European Respiratory Society (ERS)
statements, with a few based on the clinical practice guidelines of
the American Association for Respiratory Care.
• The interpretive strategies are presented as a series of questions
that can be used as a starting point for test interpretation. In this
edition, we included a flowchart process for systematically
interpreting the basic lung function tests.
• Case Studies with real-life patient scenarios, questions, and
discussion topics are included at the end of the chapters.
• How To boxes populate specific testing chapters. These are a step-
by-step guide to performing function tests. When possible, we’ve
provided illustrations. These procedures take the guesswork out
of performing an accurate test.
• The Evolve Learning Resources feature updated Case Studies in
PPT format so instructors can utilize them during class
discussions. Clinical Scenario slides, organized by disease
process, provide an in-depth case analysis with figures and charts
noting lab values and treatment options. Instructors and student
study groups can use these to supplement their own clinical
experiences.
As in previous editions, each chapter includes self-assessment
questions. The questions in this edition are divided into entry-level
and advanced categories. The answers may be found in Appendix
A. A selected bibliography at the end of each chapter is arranged
according to topics within the chapter, including standards and
guidelines.
23
users of previous editions, as well as new developments in
pulmonary function testing.
• Updated references and American Thoracic Society and European
Respiratory Society Standards. The test criteria are based largely
on these standards/recommendations.
• Chapter 4 includes additional discussion on the multiple breath
nitrogen washout tests and the lung clearance index.
• Chapter 7 reviews the new ATS-ERS standards for Field Testing.
In this section we discuss the update of the 6-minute walk test
and both the incremental and endurance shuttle walk tests.
Chapter 12 incorporates the new Clinical and Laboratory
Standards Institute’s quality management system model and its
application in pulmonary diagnostic testing.
Evolve ancillaries
Evolve is an interactive learning environment designed to work in
coordination with Ruppel’s Manual of Pulmonary Function Testing,
eleventh edition. For the student, our Evolve Learning Resources
include:
24
• Practice Tests to help students apply the knowledge learned
within the text
• Conversion and Correction Factors
• Helpful Equations
• Reference Tables
• Sample Calculations
For the instructor, our Evolve Learning Resources include:
• PowerPoint presentations of Case Studies and Clinical Scenarios
• Test Bank containing approximately 600 questions
• Electronic image collection consisting of images from the textbook
Instructors may use Evolve to provide an Internet-based course
component that reinforces and expands the concepts presented in
class. Evolve may be used to publish the class syllabus, outlines,
and lecture notes; set up virtual office hours and e-mail
communication; share important dates and information through the
online class calendar; and encourage student participation through
chat rooms and discussion boards. Evolve allows instructors to post
examinations and manage their grade books online. For more
information, visit http://evolve.elsevier.com or contact an Elsevier
sales representative.
25
Acknowledgments
Carl D. Mottram, RRT, RPFT, FAARC
I would like to acknowledge a few key colleagues and friends who
have contributed to my professional success. First, I had the honor
of being educated and mentored by Drs. Fred Helmholtz and
Robert (Bob) Hyatt, both of whom have passed since the tenth
edition. Dr. Helmholtz, along with colleagues, assisted in the
development of the G-suit during World War II and the nitrogen
washout test for measuring lung volumes. After retirement he
continued to have a significant impact on pulmonary medicine
through a variety of professional activities, including spending a
month teaching the respiratory therapy students basic pulmonary
physiology. Dr. Helmholtz was also very active in the NBRC and
AARC, championing the field of respiratory care.
Dr. Hyatt hired me into the pulmonary function laboratory. He
was a soft-spoken, very intelligent man with a commanding
presence when I first met him. He was the first to describe the flow-
volume curve, a discovery that revolutionized the interpretation of
spirometry and had a profound impact on patient care, yet he was
very humble about this fact. I was told the story of a colleague
describing his first encounter of meeting Dr. Hyatt. He queried, “So
you invented the flow-volume curve?” Dr. Hyatt replied, “No, it
was there. I just found it.”
Both these gentlemen were giants in the field of pulmonary
diagnostic testing who shared their passion and knowledge about
respiratory physiology with me during my early and mid-career
development, and contemporary mentors Drs. Paul Scanlon, David
Driscoll, Bruce Staats, and Ken Beck treated me as an equal and
26
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Muutamana yönäpä tunsinkin unissani, että nyt on susi lähellä, ja
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ole tuollaisen maidon lakkijan ollenkaan mentävä kuin sinä penikka
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»Mutta kun ruvettiin siellä katsomaan taas sitä pöytäkirjaa, niin sitä
ei löytynytkään. Aletaan kovistaa siinä sitä tuuheahäntäistä ja
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Oli siinä sitten tiellä vanha jauhokulin kuori ja äijät seisattuivat sitä
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siitä sarvilleen ja niin lähdetään taas kulkemaan.
*****
Kovasti oli nyt sudella nälkä eikä auttanut muu kuin edelleen vain
mennä palan hakuun. Näkipä hän siinä sitten tamman varsoineen,
ihastui taas ja arveli: