Usefulness of Flow Volume Loops in Emergency Center and ICU Settings

Guntupalli, Kalpalatha K.; Bandi, Venkata; Sirgi, Corinne; Pope, Caryn; Ríos, Alex; Eschenbacher, William L.

doi:10.1378/chest.111.2.481

Cited by 17 publications

(8 citation statements)

References 12 publications

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“…Despite this limitation, spirometry is simple and readily available; therefore, the flow-volume loop is useful if an upper airway lesion is suspected. 8,9 Since then, many authors have proposed qualitative or quantitative criteria for diagnosing UAO. In 1972, Empey used forced expiratory volume in 1 second divided by peak expiratory flow rate (FEV 1 / PEFR) and found the ratio to be significantly higher in different cases of UAO in comparison to controlled and lower airway obstruction groups.…”

Section: Introductionmentioning

confidence: 99%

The Value of Spirometry in Subglottic Stenosis

et al. 2019

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The diagnosis of subglottic stenosis (SGS) is usually made by clinical assessment and definitively by a direct endoscopic examination. This study aimed to evaluate different spirometric values in relation to anatomical grading and severity of subglottic stenosis cases of upper airway obstruction. Cases of SGS that underwent dilatational procedures endoscopically at the otolaryngology department of the King Saud University Medical City, Riyadh, Saudi Arabia, from June 2015 to October 2017 were collected. Pulmonary function test (PFT) pre-and postoperative parameters and the grades of subglottic stenosis were extracted. We compared different spirometric values to the severity of SGS and compared the pre-and postoperative results for each patient. There were 19 cases with a valid PFT study within 7 days preoperatively in addition to a documented intraoperative grading according to the Myer-Cotton grading system; 7 (36.8%) were grade 1, 8 (42.1%) were grade 2, and 4 (21.1%) were grade 3. The actual preoperative ratio of forced expiratory volume (FEV 1 ) in 1 second to peak expiratory flow (PEF) for all 19 patients ranged from 7.34 to 21.40 mL/L/min. We found a significant improvement in all spirometric parameters postdilatation including PEF (P < .001), FEV 1 (P < .001), FEV 1 /PEF (P ¼ .001), forced expiratory flow (FEF) from 25%, 50%, and 75% of vital capacity, respectively, FEF 25 (P < .001), FEF 50 (P ¼ .001), FEF 75 (P ¼ .048), and maximum mid-expiratory flow (P ¼ .002). We did not find any correlation between the severity of stenosis and spirometric values. This study revealed that spirometry is a useful marker in following up patients with subglottic stenosis and is also a good indicator to determine postairway surgery outcomes. However, these markers do not correlate with anatomical grading and the severity of subglottic stenosis.

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Section: Introductionmentioning

confidence: 99%

The Value of Spirometry in Subglottic Stenosis

et al. 2019

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“…Although the usefulness of the F-V curve has been investigated for many types of respiratory diseases, it has been considered the single best pulmonary function test for identifying upper airway stenosis since Miller and Hyatt [ 4 ] reported in 1969 that a plateau shaped F-V curve occurs with progressively smaller airways. Since then, the shape of the F-V curve has been used to clinically diagnose and localize upper airway stenosis [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Changes in the Flow-Volume Curve According to the Degree of Stenosis in Patients With Unilateral Main Bronchial Stenosis

Yoo

et al. 2015

Clin Exp Otorhinolaryngol

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ObjectivesThe shape of the flow-volume (F-V) curve is known to change to showing a prominent plateau as stenosis progresses in patients with tracheal stenosis. However, no study has evaluated changes in the F-V curve according to the degree of bronchial stenosis in patients with unilateral main bronchial stenosis.MethodsWe performed an analysis of F-V curves in 29 patients with unilateral bronchial stenosis with the aid of a graphic digitizer between January 2005 and December 2011.ResultsThe primary diseases causing unilateral main bronchial stenosis were endobronchial tuberculosis (86%), followed by benign bronchial tumor (10%), and carcinoid (3%). All unilateral main bronchial stenoses were classified into one of five grades (I, ≤25%; II, 26%-50%; III, 51%-75%; IV, 76%-90%; V, >90% to near-complete obstruction without ipsilateral lung collapse). A monophasic F-V curve was observed in patients with grade I stenosis and biphasic curves were observed for grade II-IV stenosis. Both monophasic (81%) and biphasic shapes (18%) were observed in grade V stenosis. After standardization of the biphasic shape of the F-V curve, the breakpoints of the biphasic curve moved in the direction of high volume (x-axis) and low flow (y-axis) according to the progression of stenosis.ConclusionIn unilateral bronchial stenosis, a biphasic F-V curve appeared when bronchial stenosis was >25% and disappeared when obstruction was near complete. In addition, the breakpoint moved in the direction of high volume and low flow with the progression of stenosis.

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“…FIF50 <100 L/min as an index showed considerable sensitivity and negative predictive value, but high false positive rates make it less reliable unless combined with other indices. FVL is also subject to limitation of patient performances leading to a poorer sensitivity, particularly in the pediatric age group or in patients with acute sign limiting their ability to perform 15,16 . These overall characteristics of the FVL and the indices reiterate that although these indices are deficiently sensitive for detection of UAO, they can be used as a screening tool for UAO in the correct clinical context.…”

Section: Strengths and Limitationsmentioning

confidence: 99%