Tidal Volume question

JDS74 wrote:The calculation gives a range of a minimum of 6L/kg to a max of 10L/kg.

6 to 10 liters per kilogram?

Clown.

NameGoesHere wrote:

Sludge wrote: That's for the ARDS protocol.

You have NFI what you're talking about.

how about educating us?

The ARDSNet protocol is used to establish (among other things) setting the Vt on mechanical ventilators utilizing Low Tidal Volume Ventilation (LTVV) when treating Adult Respiratory Syndrome. These patients are intubated. This technique also requires using high respiratory rates as an overall strategy to reduce barotrauma.

nmbugs wrote: I see my pulm this week so I am trying to get all my ducks in a row and know what to talk to him about.

You might ask him why they didn't use nitric oxide to determine vasodilator responsiveness during the cardiac cath.

Although if you missed the cutoff for PAH perhaps they wouldn't have done it anyway:

nmbugs wrote:...my pulmonary mean artery pressures are high. Sadly my cardio left my oxygen on during my heart cath (which he wasn't supposed to do) so my mean pressure was 23 (above normal) but not the 25 needed to do start PAH meds, which is why I am going to Denver.

Although were you on 100% O2 or just a little bit of nasal O2? If it were the latter, it still might not have given the last little nudge.

Response at 100%:

nmbugs wrote:During those test "diffusing capacity for carbon monoxide is normal" whatever the heck that means.

Got me.

You appear to have a number of factors that would drive it up as well as a number of factors to drive it down, You'd have to look at technique, hemoglobin, what your O2 saturation was at the time, COPD (if emphysematous component) vs. asthma, what the restrictive component is due to...

...anyway, in answer to your original question, in order to figure out what your baseline tidal volume is, you have to take the tidal volume graph and remove all the areas with SBD events (which would initially lower it, then raise it as the compensatory response occurs)(unless it was a central event)(or hypoventilation) then remove all the SWJ (which is artifact), then analyze what's left.

Sludge wrote:

nmbugs wrote: I see my pulm this week so I am trying to get all my ducks in a row and know what to talk to him about.

You might ask him why they didn't use nitric oxide to determine vasodilator responsiveness during the cardiac cath.

Although if you missed the cutoff for PAH perhaps they wouldn't have done it anyway:

nmbugs wrote:...my pulmonary mean artery pressures are high. Sadly my cardio left my oxygen on during my heart cath (which he wasn't supposed to do) so my mean pressure was 23 (above normal) but not the 25 needed to do start PAH meds, which is why I am going to Denver.

Although were you on 100% O2 or just a little bit of nasal O2? If it were the latter, it still might not have given the last little nudge.

Response at 100%:

While waiting for the procedure in the prep area I had on the nasal cannula. When they moved me to the cath lab they switched it to full face mask. My pulm said that if my PAH is being caused by a secondary condition (like hypoxia/copd) rather than idiopathic than the oxygen being left on could greatly throw off the results. Honestly where I live in NM, it is not known for quality of health care. So many of my tests have been screwed up (like one CT where they screwed up the dye timing according to the radiologist) so I don't have much faith in anything they do. I wish my pulm and PCP would have suggested Denver prior to having the cath here as it will probably have to be repeated there.

The test you posted is better explained here: http://content.onlinejacc.org/article.a ... id=1126848# I wish I had found this earlier because this just goes to show how badly the cardio messed up. My pulm was upset that he didn’t even take blood during the test to check my venous oxygen saturation. I do have Right ventricular diastolic dysfunction so maybe that is why NO wasn’t used, I don’t know. It's been very frustrating because this is an illness that the sooner treatment is started the better off you are, for awhile anyways

Thanks for the info!

PS. The cardio that did my cath did it in 5 min. Seriously they took me back and my husband went out in the lobby to get the kids a snack and by the time he got back the doctor had been out already. I wish I could make that kind of money for a few minutes of sloppy work...lol.

Do you have the PFT results and can you post them?

Also, your hemoglobin levels at the time?

Sludge wrote:Do you have the PFT results and can you post them?

Also, your hemoglobin levels at the time?

Sure, will get the PFT photoed and posted in a bit. Also hemoglobin at what time? They didn't take any blood during the cath. The last time I had blood drawn was a few days before the cath and I don't have those results. The tests I had in dec didn't test hemoglobin, tested everything else under the sun but not routine blood panel. So the last hemo I have on me right now is from a year before.

nmbugs wrote:Also hemoglobin at what time?

At the time they did the diffusion.

A "normal diffusing capacity" does not appear to make sense, but there's a lot of things that can mess up the measurement. If you have chronic lung disease, your hemoglobin may have increased, perhaps offsetting the things that should have made the diffusion decrease (this is normally considered during the test, but since you didn't have one handy, they could not have entered it). And your suggested precipitous drop in O2 saturation during exercise suggests that your diffusion should be much lower than normal.

Were all your diffusions "normal"? Were you on O2 immediately prior to the diffusion?

Sludge wrote:

nmbugs wrote:Also hemoglobin at what time?

At the time they did the diffusion.

A "normal diffusing capacity" does not appear to make sense, but there's a lot of things that can mess up the measurement. If you have chronic lung disease, your hemoglobin may have increased, perhaps offsetting the things that should have made the diffusion decrease (this is normally considered during the test, but since you didn't have one handy, they could not have entered it). And your suggested precipitous drop in O2 saturation during exercise suggests that your diffusion should be much lower than normal.

Were all your diffusions "normal"? Were you on O2 immediately prior to the diffusion?

Sorry, I am confused. In diffusion you mean prior to the PFT. Do they typically do blood at the same time? Or is this some other type of measurement that I am confusing with blood measurement? After getting my breaking down in scheduled tests from National Jewish I am finding they do tests WAY different there than here. My heart cath that was done here the doctor was in and out in 5 min. National Jewish has everything broken down from prep to med time to procedure time then recovery. They have my cath lasting 2 hours.

At the PFT my oxygen was on right up until the test was started. She paused the test a few times to put my oxygen back on when she thought I needed it, even though I wanted to just keep going.

I was hoping I could upload the test right on here but it will only take a url so I will type this out:

Spirometry:
FVC Pre: 2.23 Post 2.57
FEV1 Pre: 1.14 Post 1.27
FEV1/FVC% Pre: 51 Post: 49
FEF25-75% Pre: 0.37 Post: 0.36
PEF Pre: 3.50 Post: 3.79
FIVC Pre: 1.69 Post: 2.09

Diffusion:
DLCO 23.7
DL adj 22.1
DLCO/VA 5.76
DL/VA Adj 5.37
VA 4.12
IVC 2.28
BHT 12.95

The lung volumes it's just a bunch of numbers but no columns to tell you what those values mean. I will list them if you need them but I don't know if they are ref values like the other sections give next to pre asthma med or post or what.

Thanks for all the help. I think I need to learn more about the tests I am having done and what they mean.

nmbugs wrote:The test you posted is better explained here: http://content.onlinejacc.org/article.a ... id=1126848#

That's a great article!

They even stole my slide!

nmbugs wrote:

Sludge wrote:

nmbugs wrote:Also hemoglobin at what time?

At the time they did the diffusion.

Sorry, I am confused. In diffusion you mean prior to the PFT. Do they typically do blood at the same time?

I meant prior to diffusion part of the test, which was the one where you held a deep breath for about 10 seconds before you exhaled. The maneuver should have been repeated several times. One needs to correct for abnormal hemoglobin. Also, one needs to be OFF oxygen for at least 15 minutes, so never mind, it's all messed up anyway.

My heart cath that was done here the doctor was in and out in 5 min. National Jewish has everything broken down from prep to med time to procedure time then recovery. They have my cath lasting 2 hours.

The cath lab report could be looked at to see what was done, but it could have been all they did was a Right Heart Cath, but even that takes longer than 5 minutes. Maybe you had a little Happy Juice on board. At any rate, sounds like NJ is doing R&L.

Spirometry:
FVC Pre: 2.23 Post 2.57
FEV1 Pre: 1.14 Post 1.27
FEV1/FVC% Pre: 51 Post: 49
FEF25-75% Pre: 0.37 Post: 0.36
PEF Pre: 3.50 Post: 3.79
FIVC Pre: 1.69 Post: 2.09

Diffusion:
DLCO 23.7
DL adj 22.1
DLCO/VA 5.76
DL/VA Adj 5.37
VA 4.12
IVC 2.28
BHT 12.95

This looks like unresponsive asthma (you got the bronchodilator and didn't improve an iota). What kind(s) of drugs are you/have you been on? Did you try all these:

http://www.mkh-medicine.com/presentatio ... o/001.ppt‎

The wheezing could have driven up the diffusion.

α1-antitrypsin deficiency?

Are you a BOOP? That's almost like winning Lotto.

Meta:

http://www.cmaj.ca/content/182/1/45.full

Musings:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963099/

Diagnostic approach from a noted eastern medical center:

http://medicine.yale.edu/intmed/pulmona ... tests.aspx

Sludge wrote:

nmbugs wrote:

Sludge wrote:

nmbugs wrote:Also hemoglobin at what time?

At the time they did the diffusion.

Sorry, I am confused. In diffusion you mean prior to the PFT. Do they typically do blood at the same time?

I meant prior to diffusion part of the test, which was the one where you held a deep breath for about 10 seconds before you exhaled. The maneuver should have been repeated several times. One needs to correct for abnormal hemoglobin. Also, one needs to be OFF oxygen for at least 15 minutes, so never mind, it's all messed up anyway.

My heart cath that was done here the doctor was in and out in 5 min. National Jewish has everything broken down from prep to med time to procedure time then recovery. They have my cath lasting 2 hours.

The cath lab report could be looked at to see what was done, but it could have been all they did was a Right Heart Cath, but even that takes longer than 5 minutes. Maybe you had a little Happy Juice on board. At any rate, sounds like NJ is doing R&L.

Spirometry:
FVC Pre: 2.23 Post 2.57
FEV1 Pre: 1.14 Post 1.27
FEV1/FVC% Pre: 51 Post: 49
FEF25-75% Pre: 0.37 Post: 0.36
PEF Pre: 3.50 Post: 3.79
FIVC Pre: 1.69 Post: 2.09

Diffusion:
DLCO 23.7
DL adj 22.1
DLCO/VA 5.76
DL/VA Adj 5.37
VA 4.12
IVC 2.28
BHT 12.95

This looks like unresponsive asthma (you got the bronchodilator and didn't improve an iota). What kind(s) of drugs are you/have you been on? Did you try all these:

http://www.mkh-medicine.com/presentatio ... o/001.ppt‎

The wheezing could have driven up the diffusion.

α1-antitrypsin deficiency?

Are you a BOOP? That's almost like winning Lotto.

Meta:

http://www.cmaj.ca/content/182/1/45.full

They did test for α1-antitrypsin mutation and that was negative.

This has been the frustrating thing. My first pulm was like this is just all asthma and I told him, I have had asthma since I was 18 and this is not asthma. He put me on a crap load of expensive COPD meds which did nothing but make my lungs feel like they were on fire! Yes I still have asthma attacks and when I have them my rescue inhaler medicine helps. I still have asthma attacks while on oxygen (which he tried to say oxygen helps asthma, which I haven't noticed any damn difference in number of occurrences- which really are not that many). My shortness of breath happens when I move about or just sitting and off of oxygen for an extended period of time. It just takes a little walking without oxygen to make it drop. Asthma medicine doesn't help that SOB (I tried that before I got on oxygen where I was using my inhaler like 15 times a day!) but if I sit down the SOB gets better within a few minutes. My saturations will start to go back up but will still stay in mid 80s (again without oxygen). I never had an asthma attack where sitting for 3-5 minutes stopped the SOB (not wheezing btw you should have heard my quack pulm explain why with "this asthma" I wasn't wheezing, I about fell out of my chair!) Anyway that's why my PCP put me on oxygen in the first place, because it wasn't my asthma.

I did find this interesting from that article: "64% of patients were responders (≥20% decrease in mean PA pressure or ≥20% decrease in PVR) to 100% oxygen". So I wonder what my Mean pulm pressure would have been had he left the damn oxygen off? Grrrr, this makes me so mad. If NJ gets a different result I am going to fight the doc and hospital over their charges. Neither my insurance or me should be responsible for that payment. Oh and the reason the 5 minutes sticks in my mind is because the nurses were congratulating the doc for such a "record" cath. This of course didn't account for the prep time and med, that took about 30 min. After they put me on the table and he numbed my leg from that time to the time he pulled out the cath it was 5 min!

As for BOOP, nobody has ever done a biopsy and nothing has shown up on xrays that are suggestive of it, or at least nobody has suggested it.

I really appreciate all your help. I have learned so much more about these tests and my lungs just in these last few days from info you posted. I am always scared to be proactive in my health because then I feel like a hypochondriac or afraid the docs will think I am. However it seems if you are not knowledgeable in tests and what they mean you just might end up, well to put it nicely, messed up. Like my new pulm said "your pulmonary artery can only stretch so far"! I just hope this last screw up didn't take a lot of time off my life , trying to stay positive and not think like that but I have my bad days and today is one of those days.

Anyways I hope you have a wonderful weekend, sorry for being a bummer.

Let me see if I can explain why my SOB doesn't feel like asthma. When I take my oxygen off (which I did today to fully document this for myself and my doctors ). First I don't wheeze and second the SOB starts to happen upon exhale not inhale. Because I cannot exhale all the air in my lungs I cannot inhale. Again there is no wheezing and the pain in my chest is on exhale then not being able to empty my lungs out I cannot take enough air in.

Ever since this all started about a year ago I started developing cardiac problem like real rapid heart rate just walking at a shopping pace. It's all been very frustrating as I have given up so many things that I love like macro photography, which I physically cannot do anymore unless my kids catch the insects and bring them to me. Even then it completely wipes me out.

Anyway I am sorry this has gone so far off of a cpap topic. I hope I haven't irked anyone because of it. Again I appreciate your help, you have really helped me think and document exactly what happens, although I think I left my oxygen off a little too long, got one of those low oxygen headaches now- dagnabit they hurt!!