HARD (Gas Dilution) HARDER (Plethysmography) EASIEST (MiniBox+)
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1 Robert Brown, MD Director PFT Lab, Massachusetts General Hospital, Boston, MA Associate Professor of Medicine, Harvard Medical School o o o HARD (Gas Dilution) HARDER (Plethysmography) EASIEST (MiniBox+) Mercy Hospital RT Conference, St. Louis, MO Oct 17, 2017
2 Disclosure NONE ON SAB OF PULM-ONE NO PAYMENT, NO EQUITY
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8 Paths of Helium Loss Solution in H2O (negligible) Equipment leaks (equilibration fails) Leaks around nose clip, mouthpiece Ruptured tympanic membrane Swallowing Absorption into fluids, tissues
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10 HELIUM ANALYZER Range 0-10% Resolution: 0.01% 95% response time of < 15 sec to 2% step change in HE concentration < 0.02% drift for 10 minutes
11 End of Test Criteria Δ [HE] < 0.02% in 30 secs (3x, z 15 seconds) Based on: Limits of resolution of He meter Estimate of Δ [He] of < 0.01% per minute due to He absorption and N2 excretion
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17 Helium vs Plethysmograph NORMAL: results very similar RESTRICTION: results very similar OBSTRUCTION: Pleth>helium but CONTROVERSIAL
18 Helium vs Plethysmograph controversy REFERENCE: Comparison of Plethysmograph and Helium Dilution Lung Volumes: which is best in COPD? O Donnell CR, Brown R, Loring SH et al CHEST 2010; 137:
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21 MiniBox+ Measurements Spirometry FEV1 FEV6 FEF25-75% Lung Volume Measurement TLC and subdivisions Diffusion CO Diffusion capacity Real-time analysis/rapid gas analyzer 21
22 MiniBox+ Key Features Easy to learn, easy to use touch screen tablet Small footprint Low maintenance Low cost per test 22
23 Spirometry Meets ATS/ERS standards Heated pressure differential pneumotach End of test criteria Progress Wheel At least 6 seconds and <25 ml volume change for 1-second 23
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27 Diffusion Meets ATS/ERS standards Multi-gas analyzer for CO, CH 4 Single gas tank 0.300% CO, 0.300% CH 4, 21% O 2, Balance N 2 27
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30 Lung Volume Measurement Traditional Gas dilution Long duration (4-7 minutes) Wait time for repeatability Body Plethysmography Specific panting maneuver No airflow for 4-7 seconds Respiratory maneuver complex Technologist influence 30
31 Lung Volume Measurement MiniBox+ Innovative solution Tidal breathing and slow vital capacity ~90 seconds to complete Respiratory maneuver not complex 31
32 Lung Volume Measurement How it works 6 interruptions during tidal breathing Rapid 100 msec shutter close and open (mouth pressure) Effect of interruptions on internal box Pressure and flow Data Model Proprietary Model and Algorithm Thoracic Gas Volume (TGV) is determined from which FRC is measured spirometrically as the difference between TGV and end-expiratory lung volume 32
33 Lung Volume Measurement Interruption is during inspiration (~1/3 of normal tidal) Interruption counter provides feedback on when interruption segment is complete Slow vital capacity can be performed either IC, VC or ERV, VC method 33
34 Lung Volume Measurement No wait time requirement between efforts No body cabin No complex panting maneuver against an occluded airway 34
35 Lung Volume Measurement Comparison CT scan vs. plethysmography O Donnell, Carl R. (2010). Comparison of Plethysmographic and Helium Dilution Lung Volumes. CHEST, 137(5),
36 Lung Volume Measurement Comparison He dil. vs. plethysmography O Donnell, Carl R. (2010). Comparison of Plethysmographic and Helium Dilution Lung Volumes. CHEST, 137(5),
37 MiniBox+ Lung Volume Measurement N=300 37
38 MiniBox+ Lung Volume Measurement Comparison MiniBox+ vs. Plethysmography 38
39 MiniBox+ Lung Volume Measurement Adj. R2=0.85 Adj. R2=0.85 CV=10.9% CV=9.1% Boston Study Cincinnati Study 39
40 40 MiniBox+ Lung Volume Measurement
41 MiniBox+ Lung Volume Measurement Review Unique and innovative technique Compares well to Body Plethysmography Simple respiratory maneuvers that are easy for the patient to perform Very user friendly for technicians and patients 41
42 MiniBox+ Lung Volume Measurement Review (cont.) Short test time (~90 seconds) Multiple efforts without wait period Small footprint Notably less expensive than body plethysmography 42
43 Q&A
Stikstofuitwas en Heliumdilutie. Eric Derom Universitair Ziekenhuis Gent
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