Resistance-Volume Chart (R-V Chart) for simplified clinical and visual interpretation ... · 2017-11-27 · Resistance-Volume Chart (R-V Chart) for simplified clinical and visual

Resistance-Volume Chart (R-V Chart) for simplified clinical and visual interpretation of body plethysmography

Hans-Jürgen Smith

CareFusion, Höchberg

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© 2016 CareFusion Corporation or one of its subsidiaries. All rights reserved. Hans-Jürgen Smith

Innovation in bodyplethysmography Visual diagnostics become possible!

Resistance-Volume Chart

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General notes R-V Chart is an innovative concept

The R-V Chart is a new & informative REPORT • No changes in the measurement procedure

• No changes in the current report/interpretation concept

CLINICALLY oriented summary of test results

• Complete and integrated description of body measurement results, e.g. airways resistance & lung volumes

• Airways resistance and lung volumes in one graph

• Predicted area for quick orientation

• Especially informative in pre-post-settings

• Complementary and new intra-breath information

! An innovative novelty on the world market.

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SeS body application window Breathing loops and shutter curves

Breathing loops

(sRaw loops) at spontaneous tidal breathing.

Panting or resting breathing at FRC shutter manoeuvre.

Shutter linked with slow or forced spirometry; launched with

• IC

• ERV

Breathing loops

Shutter curves


R-V transformation

The R-V transformation integrates the sRaw loops recorded during tidal breathing with the FRC shutter measurements.

Hans-Juergen Smith. R-V graph in whole body plethysmography. White paper 2013 CareFusion Corporation.

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FRCpleth linked with SVC

Breathing loops

Raw

DRaw

FRCpleth

Predicted area

R-V loop

Absolute lung volumes - peripheral

Airw

ays r

esis

tance -

cen

tral

Resistance-volume transformation Clinically oriented, based on standard parameters

R-V transformation

Instantaneous course of resistance

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Combination of current

clinical parameters

• Raw (Rcent, Reff, Rtot…)

• FRCpleth

• Linked SVC (TLC, RV…)

• Raw – Central or large

airways

• TLC, FRC, RV – Peripheral

airways

• Predicted area

Absolute lung volumes

Actual

Predicted

FRCpleth

Raw

No

rmal

| ab

no

rmal air

ways

resis

tan

ce

DRaw

Resistance-volume chart (R-V chart)

Predicted area

R-V loop

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Application screen menu SentrySuite SeS 2.15

Breathing loops

R-V chart

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Within breath dynamics of Raw Phenotyping of obstruction

Phenotyping of obstruction, small airways diagnostics!

Static Raw (Reff, Rtot…)

Dynamic Raw Flow type (asthma) D between no-flow and maximal-flow

Hysteresis Raw Volume type (COPD) D between end-expiration and end-inspiration

Exhalation Inhalation

! Scientific approach!

Resistance = Static Raw + Dynamic Raw + Hysteresis Raw

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R-V pattern Within breath diagnostics of tidal breathing

Normal Flow type End-exp. closing Volume type

(Asthma) (Obesity) (COPD)

Exhalation Intra breath variability Inhalation

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Parameters of the R-V tidal loop For phenotyping only!

R-V loop parameters

REmax > maximal (peak) expiratory airways resistance

REmean > mean expiratory airways resistance

REFmax > airways resistance at maximal expiratory flow

RIFmax > airway resistance at maximal inspiratory flow

RImean > Mean inspiratory airways resistance

RImin > minimal (peak) inspiratory airways resistance

RImax > maximal (peak) inspiratory airway resistance

DiffRexM RinM = dR = REmean – RImean > difference of mean airway resistance parameters

PtPR = Peak to Peak R = REmax – RImin > difference of peak airways resistance parameters

Area R/Vloop > Area within the RV-loop

Additional loop parameters

VRmax%VE > percentage of expiratory volume at REmax related to expiratory VT

VRmax%VI > percentage of inspiratory volume at RImax related to inspiratory VT

SBE > slope of the linear regression from start of expiration to REmax

SBI > slope of the linear regression from start of inspiration to RImax


Visual clinical interpretation

The R-V graph identifies changes in the airway resistance as specific to the central components and changes in lung volumes exclusively depending on the peripheral characteristics of the respiratory tract.

Hans-Juergen Smith. R-V graph in whole body plethysmography. White paper 2013 CareFusion Corporation.

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Pre-post assessment (conventional) Questions can hardly or not be answered

Resistance? Lung volumes? Abnormality? Reversibility? Flow type? Volume type?

Pre Breathing loop Post

Shutter curves Pre Post

! Parameter table is needed to answer these questions, including predicted values!

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Pre-post assessment (R-V chart) All clinical questions can be answered easily

Pre

Post

Resistance Gets normal

Lung volumes Improve

Abnormality Border

Reversibility Partial

Additionally Intra breath

variation decreases Volume type Typical in COPD

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Restriction (pre-post)

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COPD (pre-post)

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Obesity combined with obstruction (pre-post)

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End-expiratory inhomogeneity (pre-post)

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R-V classification General principles

Restriction

COPD

End-expiratory inhomogeneity

Obesity

R-V loop Hyperinflation Restriction

Obstruction Combined obstructive & restrictive disease

Obstruction with hyperinflation

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Information material Concept, features, clinical application and integration

White Paper:

HJ. Smith. R-V graph in whole body plethysmography

Powerpoint:

HJ. Smith. Resistance-Volume-Loops (R-V Charts)

Concept & application in daily clinical practice.ppt

Video:

M. Kaldenbach. Resistance-volume graph in whole body

plethysmography.mp4

Digital Posters:

K. Kwiatkowski. CareFusion R-V chart poster 1,2,3,4

List of R-V loop parameters:

HJ. Smith. List of loop parameters.pdf

R-V charts summary Innovation in bodyplethysmography

Relationship between Raw and lung volumes

Differentiation in central airways and peripheral airways

Relationship to normal range

Phenotyping / Small airways diagnostics

Volume type – COPD

Flow type – asthma

Pre-post / hyperresponsiveness

Degree of reaction in Raw and lung volumes

Routine measurement not effected – report

Current or recommended interpretation is kept!

Innovation – Visual diagnostics!

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Document Name: Presentation R-V Chart Version 01 CareFusion Germany 234 GmbH Leibnizstrasse 7 97204 Hoechberg Germany +49 931 4972-0 tel +49 931 4972-423 fax © 2016 CareFusion Corporation or one of its affiliates. All rights reserved. SentrySuite, CareFusion and the CareFusion logo are trademarks or registered trademarks of CareFusion Corporation or one of its affiliates.

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Resistance-Volume Chart (R-V Chart) for simplified clinical and visual interpretation ... · 2017-11-27 · Resistance-Volume Chart (R-V Chart) for simplified clinical and visual