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1. 44 Print the calibration report essen 44 Edit the calibration factors sssssssseeeeeeee 44 Turbine calibration L ccce eee e eee ee eee eee eee eee ee een ettet eene eee e sese e eeu 45 The calibration syringe essseeee 45 Turbine calibration for ergospirometry tests 45 Assembling the flowmeter ssssssssesese 45 Calibrating the turbine ssssssseeeeee 46 Turbine calibration for the RMR test 47 Assembling the flowmeter sese 47 Calibrate the turbine 47 Checking the system signals ecce ee eee e eee ee eee eee eren esee neue 48 The control patel ui err a ne td 48 Using the control panel 48 Database Management 50 Exercise testing patient s database ss 51 Enter a new patient once tiere dente 5 Find a patient 5 Edit patient data 2 usos e AERE Rind 51 De lete a patient incen tert tee 51 Archive maintenance ssssssssccosssecosssescosseseosssssosssesoosssseosssesosssee 52 Reorganise the archive 52 Delete the archive uie rere rt eere 52 Deleted test iie entree eet adi 52 Backup and restore 52 Back p eer bte e n DRE oe dsl 52 RestOte 55 2505 nn ne es sn testet 52 Spirometry patient s database 53 Patient Card 53 Visit Card oce tinh e e E Ne inrt as t
2. 84 Resting metabolic rate test using the canopy option 84 Performing a test using the face mask 85 Calibrations 5522 getan eire dom e mE TS 85 How to prepare a patient 85 Start the TEST rh rm mn nt p ood ees 85 Viewing tlie test inest desiit see eben repeat eie tee 87 How to modify the average interval 87 Prnt eee eh ei te ee ti ire Se 88 Performing a test using the canopy option 89 Calibrations reiecit ees 89 How to prepare the canopy and the patient 89 Replacement of the power plug 89 Connecting the Canopy ss 89 How to prepare the patient 90 Performing the test 90 Viewing tlie test s ide ce peto Ne la edendis 9 How to modify the average interval 9 Print ento Hep t etre i Ode ies era eave 9 Sub maximal Exercise Testing 92 Introductions eee o been a s ose vea o Yee aa so eV ee eau ea Va sape pae see 93 Pre test Screening cu eiecti erbe eu co 93 Sub maximal exercise testing ecce ee ecce eee eee eee ee eee eene e eeae 94 Considerations with sub maximal exercise testing 94 Stano EE 95 estterminatiOr uet ertt docete Matth tetes 95 Considerations for accuracy sers eee e eee ee eee ee eene see ees tees o ose 96 Performing the test eei eeee ses eee en eode oe vo a eoe ua on ao So ee pe noa oso eno oe ge ens 97 Chapter 11
3. Value G Value c Correction IV All steps C Offset C Formula Save settings Load settings Formula Steps smoothing Cancel 3 Option Function Delete steps deletes the steps meeting the selection criteria Smoothing applies a moving average to the selected parameter Edit parameter edits a parameter according to the selected criteria Edit parameter Specifications Value replaces the value of the selected parameter with a new one Correction applies a percentage correction to the value of the selected parameter Offset adds an offset to the value of the selected parameter Formula replaces the value of the selected parameter with a mathematical function Time range Specifications From To specifies the time range All steps applies the editing from the beginning to the end of the test Chapter 6 Exercise Testing 69 Apply to Specifications Parameter specifies the reference parameter gt gt 5 lt lt lt gt higher than higher or equal equal to lower than lower or equal different Value Formula specifies the value mathematical expression compared with the value of the specified parameter All steps do not use any selection criteria Restore the original test To cancel all the editing in the Edit Test dialog box press the Restore button confirm your choice by pressing yes Overwrite the original test To save all the editing
4. Chapter 5 Database Management 51 Archive maintenance The software allows to manage files selecting Archive from the File menu It is advisable to perform the archive reorganisation every month in order to free space on the hard disk and or to correct possible errors present within the database It is possible also that your have no more hard disk space So you have to delete all the data In this case it is useful to perform the initialising Reorganise the archive 1 Select Reorganize archive from the File menu 2 Wait for the end of the operation before performing any other function Delete the archive 1 Select Initialize Archive from the File menu 2 Wait for the end of the operation before performing any other function Delete a test To delete an ergometry test select Test Delete test To delete a spirometry test press the proper button in the Test Card Backup and restore It is strongly recommended to backup files a warning message will be displayed monthly This function allows the user to restore the data if the PC or the HD will not work anymore Backup 1 Select Backup archive from the File menu 2 Selecting the destination path with the Browse key or press New to create a new directory Press OK to confirm 3 In the dialog box it will appear an estimate of the number of floppy disks you need in order to back up the archives Press OK Backup v 5 4 x Restore v 5 4 x r Statistics Backup to
5. The O2 Saturation event is useful to check the quality of SpO2 signal acquired by the on board Oxymeter if available during the test O2 Saturation during the test 1 Start with normal Exercise test and begin the memorisation of breath values F2 2 Select O2 Saturation from Test Event 3 As soon as 5 or 6 complete pulses have been acquired press F3 to stop the acquisition Spirogram The spirogram event allows to display and store the volume time plot BW F V LOOPS F Event Spirogram Vil tbh anise 00 00 06 Spirogram during the test 1 Start with normal Exercise test and begin the memorisation of breath values F2 2 During a steady state select Spirogram form Test Event 3 Acquire volume time plot until the window is filled and press F3 to stop the acquisition Chapter 6 Exercise Testing 79 View the events after the test Raw data 80 Quark b User Manual 1 Select Data from the View menu 2 Select the test during which spirogram event has been carried out in the list box and press OK 3 Select View from the Events menu choose the desired event and press OK 4 Select Print Current Window from the File menu to print the F V curve page It is possible to edit the F V loops event in the following way 5 Select Edit from the Event menu to change the F V loop at rest the list contains all the FVC test carried out by the same Patient with the Spirometry soft
6. 0 Chapter 6 Exercise Testing 59 Parameters to view Manual protocol a vvv LOAD Tip pressing the Shift key while choosing the marker option will allow you to enter the label for that marker KA Automatic protocol PRO Set the BPM alarm 60 Quark b User Manual View graphs in real time 1 Choose Graph from the View menu 2 Follow the instructions described in data management section to edit the graphs While the test is running it is possible to choose the parameters to view 1 Select Parameters to view Test execution from the Options menu 2 Select the parameters and confirm Parameters to view LX Select parameters to view If you are using the Quark with a treadmill without serial interface it is possible to enter manually from the PC the event the phase and the marker Enter Load and Phase 1 During the test select Load from the Events menu 2 Select the phase and or type the value of the load and press OK to confirm Set the markers Select Marker from the Events menu The software allows to automatically control the ergometer according to the protocol previously selected Anyway it is allowed to change it even after the test is started Modify the load during the test 1 During the test choose Ergometric protocol from the Events menu 2 Selectthe row corresponding to the desired load and press OK to confirm The software allows the user to set the alarm level for the heart ra
7. 2 Pressthe Right key of the mouse and select Smart Edit 3 Select the parameter that you want to modify Set a Noise Threshold as a percentage of the parameter value above which any peak will be considered an artefact 5 Press Execute and eventually Undo if you are not satisfied 6 Press OK to confirm Customise the parameters The software allows the user to create customised parameters and predicted values derived from the standard parameters the ones that are calculated by default through any mathematical formula All the customised parameters can be used freely for viewing and printing purposes Formula Editor 1 4b Parameters ml min 2 Qv wm Formula voz Ve Cancel Calculator Create a new parameter vuoz P XyUCO2 UE A HR Choose Customise parameters from the Options menu Press the New button if you want to create a new parameter or Modify if you want to modify an existing one ow ow Type the desired value in the fields Name unit of meas integers decimals and summary to present the parameter in the summary and press the Formula button Insert the mathematical formula by using the appropriate tools and press OK twice to confirm Create a new predicted parameter 1 2 Choose Customise predicted from the Options menu Press the New button if you want to create a new parameter or Modify if you intend to modify an existing one Type the desired v
8. Gas Weight Kg 88 0 C ECG C Gas ECG Rest EGG Simulated test Ergometer no one Protocol no one M ther data Le Le ER Workspace User 1 Details thas dua BE Iles Cancel 3 Enter or modify the antropometric data of the patient and select the options you need to carry out the test To use a specific protocol choose it in the list box and press OK to confirm Select the ergometer you need to control 5 The software environment will change showing a new Menu bar and toolbar while the first data will be displayed in a table format File Test View Events ECG Window Demo bi His e ad d 8 j F a Ske a 6 At this point the software starts showing data on the monitor but without saving them this in order to monitor the patient before starting the test To start storing data press F2 voz v UCO2 MHR I A If Y 9 REC QRS Abort the test without saving data Choose Abort from the Test menu or press Alt F3 End the test saving data 1 Choose End from the Test menu or press F3 2 Choose Yes to end the test or No to continue View data in real time The visualisation features and capabilities of the data and graphs are identical to the ones described in the Data management chapter Starting the test a small window will appear on the right corner displaying time bmp and if selected before the ergo protocol and trainer
9. Sub maximal exercise testing Considerations with 94 Quark b User Manual Heart rate varies linearly with VO to the point of maximum exertion thus VOomax may be estimated using the relation between heart rate and VO without subjecting the individual to maximum levels of physical stress During sub maximal exercise testing predetermined workloads are used to elicit a steady state of exertion plateau of heart rate and VO The steady state heart rate at each work level is displayed graphically and extrapolated to the VO at the age predicted maximal heart rate HR 220 age A variety of protocols for different exercise modalities i e treadmill stationary cycle and step increments can be used as long as the VO requirements of each selected workload can be estimated with accuracy The objectives of cardiorespiratory fitness assessments in the apparently healthy population are as follows e Determine the level of cardiorespiratory fitness and establish fitness program goals and objectives e Develop a safe effective exercise prescription for the improvement of cardiorespiratory fitness e Document improvements in cardiorespiratory fitness as a result of exercise training or other interventions e Motivate individuals to initiate an exercise program or comply with an established program e Provide information concerning health status A few assumptions regarding testing are necessary to ensure the highest degree of
10. r Smoke To move within the database use the following buttons Move to the first patient in the archive Move to the previous patient in the archive Move to the next patient in the archive Move to the last patient in the archive Find a patient in the archive Enter a new patient in the archive Delete current patient from the archive a 22 9 EAEE Edit the current patient card Visit Card It collects all information relative to the visit diagnosis visit description and to the patient information subject to change between one visit and another height weight smoke Each patient can be related to several Visit Cards provided they have been created in different days Before carrying out any spirometric test it is necessary to create a new Visit Card or to open the today s Visit Card To move within the database use the following buttons Move to the first visit in the archive Move to the previous visit in the archive Move to the next visit in the archive Move to the last visit in the archive SEULE Find a visit in the archive Chapter 5 Database Management 53 ES Enter a new visit card in the archive x Delete current visit card from the archive Edit the current visit card Test Card It contains all the information about the test To move within the database use the following buttons x Delete current test from the archive Edit the current test Import export a Tests
11. 60 files 2 Mb Restore from l f PO Description Browse PE UK Cancel UK Cancel Restore 1 Select Restore archive from the File menu 2 On the Restore dialog box specify the drive source and press OK a dialog box will appear indicating all data of the backup processed 52 Quark b User Manual Spirometry patient s database ig vvv Note after having deleted a record patient visit or test it is recommended to reorganize the archive in order to free disk space The Patients database consists of a Patient Card a Visit Card and a Test Card in which are listed all tests performed by the patient Select Archive Navigator from the File menu or press the button by side The Archive Navigator x Patient Card Tests to Display mo ia phle r 09 10 1935 FVC FYC Name 1001 Last 1001 GE ip 1001 Birth 0170171975 ES 441 Visit Card J s PEF y p gt rff Date 0971071885 7 e XT ME um UR Rs Height cm 180 Weight Kg 70 Age 20 Drug DRUG No Yes Ex Y afo Cig Da o aa g ay Diag Borderline Obstruction Description Quality Control Diagnosis j Blow out longer FET100 lt 6 sec chec Notes 3 Patient Card It collects all the information of a patient first name last name date of birth which remain the same for each visit For each patient there is only one Patient Card which is created the first time the Patient performs a test
12. Body Mass Index BMI and interpretation Graph of the energetic expenditure for all the data acquisition interval highlighting the selected average interval In order to verify the goodness of the test check that the ventilation and respiratory frequency are similar to the predicted ones 12 breaths min for the respiratory frequency and 6 litres min for the ventilation and the heart rate is the rest heart rate of the patient How to modify the average interval If the average interval automatically identified by the software is not satisfying for example because the patient was speaking in the first minutes it is possible to modify the interval of the average Right click and select Edit RMR It is possible to move the start and the end lines EM FLU J test n 3 Fale Ea EEkc Kcal day 3500 04 3000 0 4 2500 2000 1500 1000 LE RESERVED a a Or PS nui ss 00 00 01 15 02 30 03 45 05 00 06 15 07 30 08 45 10 00 11 15 12 30 13 45 15 00 16 15 17 30 18 45 To move the start line left click on the exact time in which you want to start the calculations for the end line right click Chapter 7 Resting Metabolic Rate Test 87 rin The print of the current window generates a report similar to the one in the following page v2 0613 14d ss uu uu 7 00 81 ST LT O 9T Sv GI 00 eBeg ST SI vI O T Sv ZTI 00 2I STI II O 0T SvP 60 00 60 SI 80 0 L
13. Quark b User Manual Chapter 4 Calibration 49 Exercise testing patient s database The exercise testing software uses a different interface for presenting patient information The patient database allows to e Enter a new patient e Find patient data e Edit patient data e Delete patient data Select Patients from the File menu Enter a new patient NI 1 Press New to show the Patient dialog box 2 Enter data of a new patient and press OK button to confirm Patients in archive x Search for 1 Find last name eel New CID code F Progressive Ema List Cancel Patient f 7 Progr 5 ID code 3 Previous Last name GAS ECG First name INCREMENTAL Modify Sex M Delete OK 2 Find a patient Enter a search string into the Find field and press Find to view the data concerning a subject already in the database You can search for Last name ID code or Progressive Or Press List to view the list of patients in the database Press Next or Previous to view the data corresponding to the next or to the last patient Press OK to confirm The Next and Previous buttons allow to move to the next or the previous patient in the database Edit patient data Select the patient Press Modify in order to edit the patient s data 3 Edit the desired values and press OK to confirm Delete a patient Select the patient to be deleted 2 Press Delete
14. inspect the cylinder valve for damaged threads dirt oil or grease Remove any dust or dirt with a clean cloth If oil or grease is present on the valve of a cylinder which contains oxygen do not attempt to use Such combustible substances in contact with oxygen are explosive 6 Be certain that the materials of the pressure regulators are chemically compatible with the intended gas service before installation Inspect the regulator for the proper Chapter 1 Getting started 13 14 Quark b User Manual 10 11 12 13 14 oo 6 OP5 connection and note the ranges of the pressure gauges Also examine the physical condition of the regulator including threads and fittings Remove any dust or dirt from the regulator or cylinder valve with a clean cloth Do not install a regulator on a cylinder valve containing oxygen if grease or oil is present on either Such substances in contact with oxygen are explosive Cleaning residue particulates and other contaminates including pieces of torn or broken components in the breathing circuit pose a safety risk to the patient during testing procedures Aspiration of contaminates can potentially be life threatening Use disposable anti bacterial filters or disinfect each part in contact with the patient before each test You must follow all the cleaning procedures in System Maintenance and you must thoroughly inspect the components after cleaning and before each patient tes
15. 00 21 10 8 1 043 11 3 403 372 28 30 5 30 0 92 16 62 4 01 66 6 1 0 15 54 00 00 26 iiv 0 725 8 5 271 243 31 35 3 56 0 89 17 10 3 48 66 4 1 0 18 64 00 00 32 10 8 0 721 7 8 259 234 30 33 3 41 0 90 16 93 3 66 65 3 9 0 15 59 00 00 37 11 3 0 805 9 1 288 270 31 33 3 80 0 93 17 12 3 62 65 4 4 0 15 63 00 00 43 10 1 0 823 8 3 284 260 29 31 3 73 0 91 16 82 3 81 62 4 5 0 15 58 00 00 48 11 5 0 769 8 8 285 260 30 33 3 75 0 91 17 05 3 59 63 4 5 O 15 57 00 00 54 9 4 0 796 7 4 249 225 30 33 3 27 0 90 16 96 3 67 63 3 9 0 15 56 00 01 00 10 0 0 840 8 4 299 261 28 32 3 94 0 87 16 73 3 77 63 4 7 0 15 27 00 01 07 9 1 0 722 6 5 237 203 27 32 3 11 0 86 16 65 3 78 63 3 7 0 15 16 00 01 14 8 9 0 721 6 4 234 199 27 32 3 09 0 84 16 64 3 77 63 3 7 0 15 25 00 01 20 10 0 0 726 7 2 263 227 27 32 3 46 0 86 16 63 3 80 64 3 1 0 14 97 00 01 25 11 4 0 798 9 1 349 288 26 31 4 59 0 82 16 44 3 83 65 5 3 0 15 12 00 01 30 10 5 0 947 10 0 376 316 26 31 4 95 0 84 16 51 3 85 66 5 7 0 15 15 00 01 36 10 8 0 888 9 6 339 294 28 32 4 46 0 86 16 72 3 74 65 5 2 0 15 25 00 01 42 10 8 0 917 9 9 352 309 28 32 4 63 0 87 16 73 3 77 64 5 5 0 15 35 00 01 47 10 9 0 846 9 2 323 283 28 32 4 25 0 87 16 77 3 74 64 5 0 0 15 29 00 01 53 10 9 0 848 9 2 315 274 29 33 4 15 0 87 16 86 3 61 64 4 9 0 15 63 00 01 58 10 7 0 881 9 4 329 292 28 32 3 32 170 88 1 16 78 3 97 64 5 1 0 15 33 00 02 04 11 0 0 761 8 4 289 249 29 33 3 80 0 86 16 86 3 61 65
16. 1 Select Reference Values from the Calibration menu 2 Type the correct values for the O and CO room air concentration i e 2093 for 20 9394 and do the same for the gas concentration of the calibration cylinder Cylinders x100 r Environment x100 o2 iw ga 2033 C02 sue co2 3 Syringe ml Cancel Volume Default Help 3 Type the volume of the calibration syringe i e 3000 for a 3 litres calibration syringe 4 Press OK button to confirm changes Chapter 4 Calibration 43 Calibrating analysers vvv Note After turning on the unit wait 30 minutes warm up time before starting the calibration procedure Print the calibration This calibration must be repeated at least daily A new calibration before any ergospirometry test is strongly recommended 1 Remove the sampling line from the flowmeter 2 Ensure that the O CO cylinder is properly connected to the rear panel of the Quark b and check that the pressure of the gas is in the range 5 6 bar 3 Check if the reference values for the calibration gas specified in File Reference values correspond to the certified composition of the mixture 4 Connect the sampling line to the CAL port placed on the front panel of the Quark b 5 Select Calibration Gas Gas and wait until the procedure is completed The software performs automatically the calibration procedure After 90 seconds the graph wi
17. 4 4 O 15 51 00 02 09 10 5 0 817 8 6 286 261 30 33 3 77 0 91 16 95 3 69 64 4 4 O 15 62 00 02 15 11 2 0 876 9 8 320 283 30 34 4 21 0 88 17 06 3 50 65 4 9 015 65 00 02 20 11 1 0 907 10 1 337 286 29 35 4 44 0 84 16 97 3 46 66 5 1 0 15 69 00 02 25 10 9 0 795 8 6 275 246 31 35 3 62 0 89 17 14 3 46 65 4 2 0 15 68 00 02 31 11 5 0 795 9 1 312 269 29 34 4 10 0 86 16 89 3 57 65 4 8 0 15 58 00 02 36 10 7 0 829 8 9 303 269 29 33 3 99 0 88 16 87 3 67 65 4 6 0 15 50 00 02 42 10 9 0 736 8 0 269 234 30 34 3 54 0 86 16 96 3 53 64 4 2 0 15 57 00 02 47 10 7 0 821 8 8 299 260 29 34 3 94 0 86 16 89 3 59 65 4 6 O 15 45 00 02 52 11 3 0 875 9 9 335 297 29 33 4 41 0 88 16 91 3 65 65 E o e n ees an 222 202 2n 2 4 24 0 00 12 06 ce er an n 15 50 ES nar z m ay The software is provided with powerful functions for creating charts You can add custom graphs to create exactly what you need View data in graph form 1 Choose Graph from the View menu 2 Select the tests to visualise from the list and press OK 3 Choose the parameters you require on the X Y1 and eventually for Y2 select if necessary some of the following options by pressing the more button and press OK to confirm It is possible to access quickly 5 common graphs from the View Graph dialog box Chapter 6 Exercise Testing 61 lolx VCOZ n1l min VO2 VC02 t BOND J test n 2 3249 3004 2758 2513 2268 2023 1778 1533 1
18. Alt F3 to stop the acquisition discarding the results Repeat the test until it is correctly performed ATS recommends 3 times Press Exit to visualise the test list carried out during current session together with the results of the main parameters Select the test that you want to save the Best Test according to the ATS criteria is highlighted as default and press OK During FVC manoeuvre you might experience some lack of collaboration with kids or with other patients In this case you may find a good help in using the encouragement software tool 108 Quark b User Manual Perform the FVC test with the encouragement 1 Select Encouragement from View menu 2 Perform the test as explained in the previous paragraph A Kit for Windows DINE IS Real Time Test FVC Aa E P Tes View Window Help A8 xl I lt s olo f EE c Jer repo stop asort F is 14 134 124 Po 11 10 FE 8 PEF s4 74 erre 64 m 5 44 herso 34 34 hi az ferae 14d 24 LIN T mi T Ae T T T 1 4 1 AR ON Kg 4 5 6 7 sv RH cd 3 x 24 lt LZ 34 oF T T T T 4 0 1 2 3 4 s4 64 a 3 For Help press F1 27 07 2001 DINE IS NUM Chapter 9 Spirometry 109 Slow Vital Capacity Important test for assessing COPD chronic obstructive pulmonary disease patients affected by this disease might present a the Slow Vital Capacity could be higher than
19. Appendix 7 An example of testing protocol 97 The mixing chamber 98 The mixing chamber ecce e eee eee eee eee eee eese tees esee esset esse eesooe 99 OVERVIEW naera tonon ie E IUE EPUM a DERE PENES IRIS PU EDEN 99 Preparing the mixing chamber for a test 99 Two way non rebreathing valve description 99 Patient s preparation 100 Performing the test 100 Spirometry 102 Setting spirometry options ecce eee eee ee eee eee eee eate eee o ee ooeeoe 103 SDIFOmeltDy3 ide xr rta e e ee se ru e eer ra 103 Automatic Interpretation 103 Quality control tee tenes 103 Parameters Manager eset co esee beo doe eee E 104 Predicted values manager 104 Predicteds Setonin oiaoi ertet sees 104 Set the current predicted ssssssssssss 105 Formula definition sse 105 Page Set Up ssec t e PEU ESFERA ON RITIENE luIeS 106 Spirometry tests 1 eroe ee eee eres n oaa eos a dona ros abo a eren aan er s sdb e are ada n na tue 107 Forced Vital Capacity pre 4 e eee eee eee e eee ee eee ee eene soe 108 Recommendations neret e te ett 108 Perform a FVC pre test 108 Test encouragement sesssssssssseee eene enne 108 Perform the FVC test with the encouragement 109 Slow Vital Capacity ecce ee eee ee eee ee eene neon ene e eese tees ette sae eoo 110 Performa S VG test ueteres
20. Bronchial provocation protocol in the archive 1 Select Bronchoprov protocols database from the File menu 2 Type the Protocol name the Bronchoprovocator name and the unit of measurement in the proper input fields 3 If the bronchoprovocator has a cumulative effect select the cumulative check button 4 Enter the quantities for each step and press the button E Chapter 9 Spirometry 113 Viewing results it All the visualisation functions refer to the test carried out by the Current Patient whose name is indicated on the left side of the status bar To view tests results 1 Select the Patients from the File menu 2 Select the patient corresponding to the test you want to view 3 Select in the list box of the tests up to 5 tests of the kind FVC VC IVC or MVV and press OK To switch between graph and or data use the following buttons on the toolbar view Flow Volume graph F5 view Volume Time graph F6 view data of the test F7 view bronchial provocation response If you need more than one visualisation meantime use the New Window function from the Window menu If you need to display a list of visits e Select Visits list from the File menu e Type the name of the Company and or the time interval desired or simply confirm for the complete list Tests of the current patient If a current patient has been selected you can quickly view his tests selecting Test current patient from the Vie
21. Data management Lee ee e eee eee eee eee ee ee estet see etos teet o esee esee oe eoee 61 Viewing data heat tende easet nt Tr 61 View data in table form sssssssseeee 61 Creating graphs eren enne 61 View data in graph form 61 Customise the graphs sese 62 Switch from graph to data and vice versa 62 Viewing predicted values 63 View predicted values 63 Anaerobic Lactate Threshold detection 63 View the Lactate Threshold sss 63 Detect the Lactate Threshold ssssss 63 Customise graphs for the LT viewing 63 Fittings uisa tinte Eta SO SEPA Ee iur aise 64 Fit a graph with a linear regression sss 64 Fit a graph with a Mono exponential regression 64 Calculate the Mean Value 65 Oxygen Kinetic eere rite rote nent 65 Run the O2 Kinetic function 65 Information about the Test 66 View the Information 66 Modify the information 66 Nini ETE 66 Chapter 11 Appendix 5 View the summary 4 66 Printith data ses sit een et nt ss en 66 Print the current window 67 Print the report etr onions 67 View the Teport sara Er tr Cea ast Yee oe e Eee 67 Data Editing PERITI TL 68 Editing values and input numerical values 68 Data filtering 2 2 ote eee units 68 Using the Us
22. Expenditure Energy Expenditure Body surface area Energy Expenditure pro Kg Fats Carbohydrate Protein Fat Carbohydrate Protein Respiratory quotient not protein Description Lactate Anaerobic Threshold STPD Respiratory Quotient LT Time LT CO2 output LT STPD Ventilation LT BTPS Chapter 2 Measurements 29 O2 Kinetics HR Parameter O deficit O debt Spirometry Tests option 30 Quark b User Manual bpm UM Vm l m Heart Rate LT Calculation VO2 work tau VO2 work tau FVC Forced Vital Capacity Symbol FVC FEVI FEV1 FVC PEF FEVO S FEV6 FEVI FEV6 FEV6 FVC Best FVC Best FEV1 Best PEF Vmax25 Vmax50 Vmax75 FEF25 75 FET100 FEV2 FEV3 FEV2 FVC FEV3 FVC FEV1 VC FEF50 75 FEF75 85 FEF0 2 1 2 FiVC FiF25 75 FiVI PIF VEXT PEFT l sec l sec l sec L l sec l sec l sec ml Parameter Forced Expiratory Vital Capacity Forced Expiratory Volume in 1 sec FEVI1 as a percentage of FVC Peak Expiratory Flow Forced Expiratory Volume in 0 5 sec Forced Expiratory Volume in 6 sec FEV as a percentage of FEV6 FEV6 as a percentage of FVC Best Forced Expiratory Vital Capacity Best Forced Expiratory Volume in 1 sec Best Peak Expiratory Flow Expiratory Flow when 75 of the FVC remains to be exhaled Expiratory Flow when 50 of the FVC remains to be exhaled Expiratory Flow when 25 of the FVC remains to be exhaled Mid exp flow betw
23. View Move the parameters to view into the Selected parameters list Print Move the parameters to print into the Selected parameters hist Sort Drag the parameter up or down with the mouse Customise Add modify and delete custom parameters If it is necessary to restore the default parameters press the button in the left corner of the window to initialise the parameters database Predicted values manager Predicteds Lx Predicteds set Formula definition Q NORMS Description Set current predicteds Name of the predicteds New Save Knudson 83 Age ITS LAM Male 0 Copy Mc Barcelona Female Delete EZ Import Export Modify predicteds Cancel Aow He The program contains a preset of predicted equations but the user is allowed to customise its own predicted sets Select Predicteds from Options menu The window is divided into two forms Predicteds set and Formula definition Predicteds set This form allows the user to manage the set of predicteds The following information define a set 104 Quark b User Manual Name identifies the set and cannot be duplicated Description free field Age the adult predicteds start since this age To enter a new set of predicteds click on the New button The field Name must be filled and must be unique To stop without saving click on the Cancel button To save the set click on the Save button To delete a
24. after a period of storage in unfavourable environmental conditions Referring to the electrical safety it 1s important to check the conditions of insulation materials of cables plugs and any other visible part by means of simple inspection when the equipment is switched off and adapters or electrical feeders are disconnected from the supply mains Mechanical parts to check are the turbine and breathing circuits Follow these instructions e extract the turbine from the optoelectronic reader e verify by inspection that the turbine axis fits correctly its seats and the blade is strongly fastened on the axis itself 1t can be useful to shake slightly the turbine in order to note any anomalous movement Check if there are any torn or broken components in the breathing circuits remember that they can create safety risk to patients during tests The fuses can be replaced easily in the following way 1 Open the power supply cover using a screwdriver as shown in the picture 2 3 Replace the damaged fuse s 122 Quark b User Manual ad Note Be careful to use proper fuses A 680 013 630 Time Lag Fuses 5x20 250V T 630 mA for 220 240V supply A 680 024 125 Time Lag Fuses 5x20 250V T 1 25A for 100 120V supply Select the proper power supply voltage The power supply voltage can be changed in the following way 1 Open the power supply cover using a screwdriver 2 Rotate the voltage selector in orde
25. at 121 C 250 F e Hetilene oxide method ETO 120 Quark b User Manual The hetilene oxide doesn t deteriorate the face masks Sterilisation by this method is not advised unless sufficient data is available regarding the time required for complete out gassing of residual ETO If you use this method follow carefully the instruction provided by the maker of the sterilising product e Pasteurisation The disinfecting with hot water 1s a sterilising method that may be used with the silicone masks Canopy bubblehood option cleaning The Canopy bubblehood must be cleaned after each usage with a soft cloth and a non aggressive as well as not alcoholic detergent RMR reader option cleaning The disinfecting procedure is easy and may be performed any time the user needs to do It by keeping attention to some precautions 1 Disconnect the sampling tube from the reader 2 Plunge the reader only in a vessel containing disinfectant solution for 20 minutes circa as per the picture below paying attention of not wetting the sampling tube NO OK 3 Rinse the turbine in a vessel filled of clean water shaking gently to remove the disinfectant do not clean the turbine by putting 1t under running water 4 Letit dry to air 5 After cleaning the turbine check if the turbine propeller rotates freely even with a low speed air flow Precautions during the cleaning of the turbine e Do not expose the turbine to high heat and do n
26. card m UE Diagnosis Database 54 Quark b User Manual This function allows to import export a test card with the respective visit and patient card 1 Select the patient 2 Choose the test and press the key by side All data will be imported exported in the XPO file format Cosmed proprietary The program allows to manage a diagnosis database whose records are composed by a diagnosis ID code and a string of text The report of the visits can be done either by typing the desired text in the field Diagnosis of the Visit Card or more quickly retrieving from the diagnosis database the desired one If you want to insert modify or delete a diagnosis from the database select Database Diagnosis from the File menu Spirometry program settings The software allows to configure some options selecting Configure from the Option menu Test options x Preferences Spirometry Graphs Curve n 1 CC gt r Serial Port Curve n 2 ERE C COM 1 Curve n 3 MEE cou 2 Curve n 4 M i Curve n 5 z Unit of meas 007 Cm kg Iv Grids Iv Show InfoTest C Inch Lbs 2 ae User Free Fields Patient Card Visit Card Test Card User Text user Text user Text User Text User Text user Numeric User Text User Text User Numeric Cancel Graphs All the graphs visualised and or printed can be customised in colours and appearanc
27. connector RH TA probe connector RS232 Serial Port for PC connection RS232 for future extensions HR probe connector RS232 Serial Port for ergometer connection Sampling pump input Power cable connector Switch 110V 220V Chapter 3 Installation 35 Cables and Tubing installation sequence 36 Quark b User Manual l 2 3 Connect the power cable of the Quark b to the trolley Connect the power cable of the PC and the printer to the trolley Connect the RS232 cable from the Quark b PC RS232 to the PC COMI or COM2 If the PC does not have a RS232 port please use the USB RS232 adapter A 388 410 001 available as an accessory Connect the O CO calibration cylinder to the Quark b and adjust its pressure between 5 and 6 bar Connect the Flowmeter to the front panel of the Quark Assemble the turbine vyv Notice It is advisable to lubricate periodically the O rings inside the optoelectronic reader with sylicone grease for its good maintenance Assemble the mask and the flowmeter 1 2 Insert the turbine in the optoelectronic reader in the way indicated by the arrow in the turbine Insert the turbine plug on the front panel Connect the external anti moisture filter to the sampling plug and joint the Permapure sampling line to the filter It s strongly suggest to use the filter always and we recommend to replace it every 3 months Using the Ultimate Seal 1 Headcap 2 M
28. contraindications 15 Contraindications for Exercise testing sssssssssesee 15 Environmental condition of use eee ecce eee ee eee eee eere eene nn ee 16 d o esestanee 17 Safety and conformity eee e e eee e ee eee ee eee eee eee ee eese sete soe t ees ooe 20 Safety r mbi aetate idee hate 20 EM He ehh ermine ees 20 Quality Assurance 20 Medical Device Directive CE mark 20 Keynol s 11 ori eee 0In 1e etri eese oe ses eee da eve s Vie seges e eoo eee s ttes reset osoa Soie 21 Typographic keynotes sees 21 Graphic keynotes 4 ge enter Ee iS 21 System Overview eee iec reete sede ens n eos n Pase oaa abs aeos nonsed aba einen anet sente 22 Main features 22 Flowmeter srne 20H a bons nmbra vernis 22 Gas analyser eene e e eee edes 22 Environmental conditions measurements 22 Before starting eroe o soe e pa eoe o eroe ee seno eae e e ee b e ea ane so eo Pe ea eo ea aae so eo cesse 23 Checking the packing contents 23 Quark b standard packaging e 23 Warranty registration eee e eee eee e eee eee eee eee e eee e hee e hee see esee eeeoe 24 Register the product via software sss 24 How to contact COSMED sese 24 Complain feedback and suggestions 24 Options Acces
29. in adults e Recent myocardium infarct e Recent vascular cerebral accident e Known arterial aneurysm e Incapacity for understanding the provocation test procedures and its implications Relative contraindications e Bronchial obstruction caused by the respiratory manoeuvre e Moderate or serious bronchial obstruction For ex FEV1 lt 1 51 in men and FEVI in women than 1 21 e Recent infection in the superior air tracts e During the asthmatic re acuting e Hypertension e Pregnancy e A pharmacology treatment epilepsy Contraindications for Exercise testing Read carefully the exercise testing chapter Chapter 1 Getting started 15 Environmental condition of use 16 Quark b User Manual COSMED units have been conceived for operating in medically utilised rooms without potential explosion hazards The units should not be installed in vicinity of x ray equipment motors or transformers with high installed power rating since electric or magnetic interferences may falsify the result of measurements or make them impossible Due to this the vicinity of power lines is to be avoided as well Cosmed equipment are not AP not APG devices according to EN 60601 1 they are not suitable for use in presence of flammable anaesthetic mixtures with air oxygen or nitrogen protoxide If not otherwise stated in the shipping documents Cosmed equipment have been conceived for operating under normal environmental temperatures and cond
30. in volume for 1 second with at least 6 seconds of collected volume Accumulation time the maximum time allowed for volume accumulation during the VC manoeuvre should be at least 30 seconds and at least 15 seconds during the FVC The spirometer should be store at least 8 FVC maneuvres FEVI should be calculated by using the back extrapolation method to detect the start of the test extrapolated volume must not be higher then 5 FVC or 150ml The graphic resolution of the printed report must be as in the following Volume 10 mm l Flow 5 mm l sec Time 20 mm sec F V ratio 2 1 The total number of error FVC e FEVI gt 3 5 FEF25 75 gt 5 5 during the measurement of the 24 standard waveforms must be lower than 4 Chapter 11 Appendix 135 Predicted values ERS93 Standardized Lung Function Testing Official Statement of the European Respiratory Society The European Respiratory Journal Volume 6 Supplement 16 March 1993 Compilation of reference values for lung function measurements in children Ph H Quanjer J Stocks G Polgar M Wise J Karlberg G Borsboom ERJ 1989 2 Supp 4 184s 261s KNUDSON 83 Changes in the Normal Maximal Expiratory Flow Volume Curve with Growth and Anging J Knudson D Lebowitz J Holdberg B Burrows ARRD 1983 127 725 734 ITS Intermountain Thoracic Society Clinical Pulmonary Function Testing second edition 1984 pp 101 144 LAM A survey of ventilatory capacit
31. list box and press OK Type the name and the format of the file in the dialog Save as If the ASCII format Is selected the Text button in the dialog box Save as allows you to configure the separators for character based files With the xpo Cosmed file format it is possible to import data from another Quark archive Press OK to confirm Select the folder for the export and type the file name Press OK to confirm A status bar will show the file creation Chapter 9 Spirometry 117 System maintenance All service operations which are not specified in this user manual should be performed by qualified personnel in accordance with the service handbook to be required to the manufacturer Rubber mouthpieces face masks breathing valve and the other parts are not shipped sterile They should be disinfected before using according to the following instructions All materials used in the construction of the Quark b are non toxic and pose no safety risk to the patient or operator Prior to the device cleaning disinfection and inspection it is necessary to switch off the device and to disconnect adapters from the supply mains In order to guarantee the highest accuracy of measurements we recommend you to disinfect the turbine periodically Use disposable anti bacterial filters or disinfect each part in contact with the patient before each test Cleaning and disinfection Cleaning and disinfecting instructions are of fundamental imp
32. need it 5 Enabling the option Relative Increments the loads refer to the previous step Press Generate and enter the values to generate a protocol from only one load i e 30 Watt each minute for a total of 20 steps and press OK to confirm Press Add if you want to add a new step 8 To edita step select it from the list and change the relative values in the Edit boxes below the list Press the Tab button to save changes 9 To delete a step highlight the step and press Delete Steps 1 SE Ergometer COSMED Treadmill zl t Speed Elevation Phase Command 00 00 02 0 0 0 1 no one Xa 00 01 00 0 0 0 2 no one 00 02 00 5 0 0 3 no one x Protocol 00 02 20 10 0 0 no one Name iE Ae lt New 00 02 40 15 0 0 no one El 00 03 00 20 0 0 no one x Message Time sec 5 Delete D du zd p D a ps 00 04 00 35 0 0 no one x Messages 00 04 20 40 0 0 no one x Iv Drive ergometer Generate Edit Add Delete Relative Increments Initial command no one Final command no one Ti Chapter 6 Exercise Testing 73 Software configuration Data viewing Steady State 74 Quark b User Manual The software can be customised as you wish Most of the feature are easily editable to be tailored according to different purposes The software allows to calculate a huge number of parameters it is advisable in order to simplify the analysis of the results view in the
33. of a ventilated bubblehood system is that a stream of air is forced to pass across the face of a subject and mixes with the air which is collected by a transparent hood placed over the subject s head A measurement system knowing the flow rate calulates the oxygen consumption and the CO production and starting from these values the energy expenditure Calibrations Before the test it is necessary to perform an ergo calibration see Calibration chapter and it is advisable to perform also a turbine calibration see Recommendations in this chapter How to prepare the canopy and the patient Replacement of the power plug If the power plug does not fit into the mains socket replace it with the one in the packaging In order to replace the plug 1 Extract the plug from the battery charger 2 Insert the proper plug in the battery charger Connecting the Canopy 1 Connect the Canopy unit to the mains by means of the medical grade AC DC adapter provided 2 Fixthe vail to the bubblehood through the velcro strips 3 Insert the bubblehood adapter into the bubblehood from the outside and fix it screwing the ring from the inside being careful to insert it in the proper hole as shown in the following picture 4 Connect the bubblehood to the wrinkled tube interposing a bacterial filter 5 Connect the wrinkled tube to the unit through the Flow in connector 6 Connect the optoelectronic reader of the K4 b to the Flow out c
34. of the original test 4 Press the button Filtering select the option Smoothing and type the desired value for points This feature doesn t reduce the size of the original test although it smoothes the fluctuation of data Using the User fields The software is provided with three free fields in which the user may enter values coming from others devices such as lactate blood pressure etc To define the user fields 1 Choose User Fields from the Options menu 2 Type the desired text in the input fields and press OK To enter values in the user fields 1 Choose Edit test from the Test menu 2 Scroll horizontally until the fields USER 1 2 and 3 3 Enter the desired values and press OK to confirm Deleting steps This feature 1s useful whenever some steps acquired during the test are to be discarded steps acquired before the start of the test patient disconnected from the face mask 1 Choose Edit tests from the Test menu 2 Position the cursor on the step you want to delete and press the button Delete step Advanced Editing This feature allows to perform some advanced editing of the data stored in the software 1 Choose Edit test from the Test menu 2 Press the Advanced button and select from the following options Edit test Advanced x mae m Time Range i Delete steps From 00 00 02 E El C Smoothing To 00 05 16 Kil H e IV All steps Edit parameter Apply to Parameter Ti
35. printout desired parameters only l 2 3 In the report configuration window select Parameters Select the parameters you require to be printed in the data printout The number of parameters which can be printed depends upon the size of the paper in use see Printer Layout and from the orientation of the sheet Press OK to confirm the selected configuration Customise the printout header 1 2 3 Choose Printout header from the Options menu On the Report Header dialog box type the text of the header To insert an image click the Logo button An image editor will be opened draw the own logo and close the image editor to save changes Press OK to save the Printout header Chapter 6 Exercise Testing 75 Electronic reports pdf If an Adobe PDF writer Printer Driver is installed and set as the default printer it 1s possible to store the printout report automatically in any location of the HD or eventually LAN paths according to a customizable filename format It is possible to define the created filename format selecting Options Printout header and then Name format Printed file name x ss b date of birth Zi ID 2d date of test Xl last name Zf first name Zn test Zh time of test Zs sex Cancel Print the current window The print current window function is enabled when the active window is a graph or a data report 1 Select Print current
36. replacing the original test with the modified one in the Edit Test dialog box press the Overwrite button confirm your choice by pressing yes Customise the desktop Smart edit 70 Quark b User Manual Customise the display colours 1 Select Colors from Options menu 2 Select the item to be modified 3 Press Change and select the desired colour This function is useful to correct data from artefacts the noise affecting the measured data can be reduced in 2 different ways Graphical noise suppression using the mouse Threshold noise suppression applying a filter to the measured data SmartE dit SmartSmooth Parameter Noise X no corr max Corr Ti EZ sas or Sho Bl El Cancel ip Value I i Execute Undo Find Fiz Apply the graphical noise suppression 1 Make active a graph or a data window corresponding to the test that you want to modify 2 Pressthe right key of the mouse and select Smart Edit 3 Select the parameter that you want to modify 4 Point the mouse on the position where the graph presents the artefacts click the Right key and keeping pressed the key drag the point on the desired place 5 Ifyou want to cancel the edit press the Left key of the mouse 6 Repeat the above mentioned procedure for the all parameters and press OK Apply the threshold noise suppression 1 Make active a graph or data window corresponding to the test that you want to modify
37. report in data form it is possible to view very quickly the data or the graph corresponding to that test Choose Current test data if the active window is a graph or Current test graph if the active window is a data report from the View menu 62 Quark b User Manual Viewing predicted values For some parameter it is possible to compare the maximum value measured during the test with its predicted value and the LT value both in percentage and absolute View predicted values 25 Choose Predicted from the View menu NORNS BOND J testn 1 Predicted EEE t hhzmm ss Load Watt Real Load Watt Revolution RPM pees VO2 Wass ml min MES VO2 Kg Wass ml min Kg UNE VE 1 min T Rf b min Run VTI pes Et Ters VO2 HR m1 bpm 16 3 150 93 VE VO2 CE CM VE VCO2 pru INE HM P Sist mmHg ES P Diast mmHg Pete HEN M HR max bpm 181 84 53 HRR bpm e Sica BR esse EMEN x REE keal day lt n 1738 7 VOZBLT ml min c 1274 aoe VO2 Jones ml min 3059 115 54 VO2 Eg Jones ml min Kg es 40 25 115 54 Anaerobic Lactate Threshold detection The software allows to detect the Lactate Threshold Anaerobic Threshold according to the Modified V slope method reference The LT can be detected both manually and automatically View the Lactate Threshold Choose Lactate Threshold from the View menu Detect the Lactate Threshold 1 Choose Calculate LT from the Test
38. tests performed on another Quark equipment 4 Select the folder type the file name and press OK to confirm Export test n 1 2 x File name Folders testit25 xpo c cosmed k4b2_en cc EJ cosmed CX k4b2 en C1 drivers C1 test Save file as type Drives amp c hard disk c Cosmed format xpo available only if the user PC DDE with Excel has Microsoft Excel installed 72 Quark b User Manual If Microsoft Excel is installed on your PC you can export a test simply pressing a button on the toolbar To send a test to Excel select Send to Excel from the Test menu The program will show a status bar indicating the data transmission to Excel At the end of the process a new sheet with all test data will be opened ready to be edited with the powerful functions of Microsoft Excel Creating Test Protocols The software allows to create different exercise protocols to use during the test The load of the ergometer is automatically controlled by the software that change it according to the defined protocol Create a new protocol 1 Choose Real Time gt Ergom Tests Protocols from the Options menu 2 Press New and enter a name for the protocol 3 In the field Message Time type a number that means to get a message to advise when switching to the next load 4 Enable the Drive Ergometer check box to let the software control the ergometer Select the Initial Command if the ergometer
39. the percentage error in the reading 5 At the end of this operation the software displays the new calibration factors Press OK to store the new value 46 Quark b User Manual Turbine calibration resuits xi _ Default im es los Type mm i Turbine calibration for the RMR test The turbine used for resting metabolic rate tests is different from the standard one used for ergo spirometric tests Since the correction factors for the two turbines are different before using this turbine it is necessary to select and calibrate the turbine used In the calibration program select File Turbine results and enter 18 in the field Type mm Turbine calibration results x Actual Acceptable Rang Type mm 18 Gain Exp 1000 Gain Exp 2900 1100 Gain Ins 1000 Gain Ins 300 1100 Cancel _ Factory Settings Hep At the end of the RMR tests before starting using the standard turbine set 28 in the Type mm field and perform a turbine calibration with the standard turbine Assembling the flowmeter Connect the RMR reader to the syringe by means of the proper adaptor Calibrate the turbine Perform a turbine calibration according to the procedure described above Since the ventilation is very low normally lt 10 litres min the turbine calibration has to be performed with very slow manoeuvres each complete manoeuvre in about 10 15 seconds to obtain the best
40. the Forced one FVC The main parameters measured during SVC tests are EVC Expiratory Slow Vital Capacity IVC Inspiratory Slow Vital Capacity ERV Expiratory Reserve Volume IRV Inspiratory Reserve Volume If th e inspiratory expiratory maximal manoeuvre is preceded by a some breaths at tidal volume the software allows to measure the Respiratory Pattern represented by the following parameters VE Ventilation per minute Vt Tidal volume Rf Respiratory frequency Ttot Breath time Ti Ttot Inspiratory time Ttot Vt Ti VUTi Perform a SVC test 1 Select Slow Vital Capacity from the Test menu and wait for the green led is ABORT z BACK The 110 Quark b User Manual prompted on the right side of the screen Press F2 and instruct the Patient to breath normally until the message carry out is prompted then ask to perform a Slow Vital Capacity deep inhalation maximal slow expiration and deep inhalation again Press F3 or wait for automatic interruption 5 seconds without flow in order to visualise the V t graph together with the main parameters compared to the predicted values To visualise the V t graph and the main parameters press the follow buttons view Volume Time graph DRTR view data of the test Press Alt F3 to stop the acquisition discarding the results Repeat the test until it is correctly performed ATS recommends 3 times Press Exit to visualise the test list carried out during curr
41. valve from the high pressure surge that can be generated when the cylinder is opened 1 Make sure that the regulator is turned off before opening the cylinder valve 2 Open the cylinder valve by turning the valve counter clockwise vvv 3 Adjust the regulator pressure by turning the adjustment knob clockwise in order to Notice The cylinders must be reach a value between 5 and 6 atmospheres bar provided with a calibration certificate indicating the gas composition Notice The gas cylinder must be replaced when the primary pressure gauge falls below 10 bar f t 1 Cylinder valve Pressure reducer attachment Inlet pressure gauge Background pressure gauge 5 Hose attachment Manometer output Adjusting screw 34 Quark b User Manual Connecting cables and tubing The assembling procedure will be shown in the following illustrations TH COX gt Q o Flowmeter connector Power switch Sampling tube connector Calibration plug Oxymeter plug Cardiac Output plug 060 o G H LN Auxiliary analog inputs cdiuunmpovoztu Calibration gas 16 O2 5 CO2 connector Cardiac Output gas
42. window from File menu 2 Press OK to print or Setup to customise the print Print the customised report This function is enabled only after having customised a report 1 Select the customised report from File menu 3 Set the sheet format and press OK 76 Quark b User Manual Events management during exercise testing Cardiac Output option The test is a non invasive method based on the measurement of the carbon dioxide during an exercise test for the indirect measurement of the Cardiac Output the manoeuvre is composed by two different phases e Measurement of the metabolic parameters during a steady state condition both at rest or during exercise usually at the end of the 3 minute of a 5 minutes step e Rebreathing in a bag previously filled with a high CO mixture and measurement of the CO concentration reached at the equilibrium The method is base on the hypothesis that the PCO in the alveolar gas is approximately equal to the one of the lung capillaries The rebreathing phase consists in making the patient breathing into a bag typically 5 litres containing an high concentration of CO in O balance that mixing with the expired breath brings to constant average value The optimum value of the CO concentration of the cylinder and the bag depends on the workload and can be desumed from the following table Load W CO concentration 96 50 10 5 11 5 100 11 0 12 0 150 12 0 13 0 200 13 0 14 0 Balanc
43. 0 Sv 90 00 90 SI S0 0 v0 Sv EO 00 0 SI ZO OE TO GP 00 00 00 vz SL o02 zo 02 RI LU LLL LE ET pe RAS iQ Top meras ee P Rg Dans creed ne GO OO er cro A M dt oed E t pL 07000 PocorrE 0n90S 070 OOST 000 00S Op Ssejo Ajiseqo 6 6 0G ssejo Ayseqo 6 v 0 0 Ssep Ayseqo 6 6c 0 Sc 1uBIeMISAO G rc S 8l JEWJON G 8L gt juBlenuepun SJu9W9 e S INE AY 0S ACV AT VOL 962 LOL 8 96 REVLE 0 G6 Pad JEWJON 0 9 0L 9cc 99 S8 0 61 2L 00 01 P91d ARP TEOM oxss BES 60r G 6G e 06 Leb Sec 98c c8 0 L L86L 0 60 JS94 Zyw Sy ING OHO 96 LWA wdq YH ulw 3 utuu q JH uuu zoo utu ZO 4 Aep 189M HW ss ww SUL Jo Jouweled Sez cyu 8y INE 6b cy vsg 0Z0 L dxe Sd14 00 91 00 ss uuruuy uogeng 180 V dsui Sd18 ze sdeis Jo N 6670 ddlS 00 00 9u soL 42 9 seeiBep ainjesadwia L 166L 0 E AP 1S81 4 4 Brjuul sseid oujeuiojeg equnu jse SANVT aueu JSI QNO aweu Jse71 pousos oyu ew 3 3r peursoo MMWy d31u 0861 L 690 6 XEJ Z67S1E690 6E 19 Ajey swoY 07000 XOG O d Trs q3Wsoo2 08 uidq xew YH 092 5 1JBieM 0 844 Wo 1YBIEH Or o0y N xes 0001 6po AI JejeuioBueojofo esioJex3 peo JUEJSUOT S9JON Q03WSOD 88 Quark b User Manual Performing a test using the canopy option The principle
44. 02 PRO B dd 9 3 E SES A Pee SS T E i L TEST DATA GRAPH 7A NORMS vHR VO02 Kq nl min Edq VO2Kg extimated 40 56 1 i i Pred 34 21 45 004 24 i d 1 i ePred 118 5 SISINNI EMANUELA If the predicted HR max calculated as 220 age is not suitable for the patient tested it is possible to edit the HR max value from the View Information page An example of testing protocol An example of protocol is reported here The YMCA cycle ergometry protocol is defined as follows 1 step workload 150 kgm min 2 step if the HR at the end of the 1 step is lt 80 80 89 90 100 gt 100 set the workload at kgm min 750 600 450 300 3 step if the HR at the end of the 2 step is 80 80 89 90 100 gt 100 set the workload at kgm min 900 750 600 450 4 step if the HR at the end of the 3 step is 80 80 89 90 100 gt 100 set the workload at kgm min 1050 900 750 600 Chapter 8 Sub maximal Exercise Testing 97 The mixing chamber The mixing chamber Overview The mixing chamber is a 7 litres plexiglas box for exercise or resting VE 40 l min tests For resting tests only a part about 2 3 litres of the mixing chamber is used The mixing chamber is shown in the following picture LR tnn rnt i j 6 e e 3 4 e 7 5 e e e Te 1 Connector for the sampling line for resting tests or tests with VE lt 40 l min 2 Connector for the sampling line for exercise tests or tes
45. 20 seconds from the beginning of the rebreathing 7 Close the Cardiac output event with the corresponding button on the Toolbar Note The values of VO VCO and R during the rebreathing and in the following 2 minutes are not reliable because of the high concentration of CO Flow Volume loops ET 78 Quark b User Manual ES NICO N Event Cardiac Output Bie Es FeC02 8 t hh mm ss 00 00 38 Feqco2 x 2X8 PeqcO2 mmHg 51 Qt l min 3 5 This test is useful during exercise to detect abnormalities in the mechanics of ventilation in patients with pulmonary ventilatory limitations to exercise The test consists in acquiring some flow volume loops during exercise at different workloads and overlapping them on the rest maximal flow volume loop of a Forced Vital Capacity test The majors information that you can get from this manoeuvres are the flow reserve flow distance from the peak flow of the F V loop during exercise to the corresponding flow on the superimposed F V loop at rest and the volume reserve volume distance from the maximum volume of the F V loop during exercise to the corresponding volume on the superimposed F V loop at rest The manoeuvre consists in the following phases e Acquiring some Flow Volume loops during the exercise e Making the patient inspire completely up to TLC level this is necessary to place the loop correctly into the rest F V loop of the forced Vital Capacity test e Overl
46. 288 1043 797 552 vyv Note Double click in the graph window to open the edit test t hh mm ss 00 30 01 57 03 24 04 51 06 19 07 46 09 13 10 40 12 08 13 35 15 02 16 29 Right clicking the graph can be exported in bmp file format Customise the graphs 1 With a graph on the screen choose Customise graph from the View menu 2 Onthe Customise graph dialog box select options to obtain the wished graph Customize Graphs X v Autoscale Cancel From 00 00 15 X gt Options V02 VCO2 Ignore 0 Grid Points only r FN Autoscale v Autoscale Markers mo um Min 628 692 Min 513 853 a nmn Max 3950 29 Max 4519 84 Mark points Step 0 0000 Step 0 0000 Option Function Grid on X Y axes show the grid lines in correspondence with x or y axes that make the graph easier for you to analyse data Autoscale maximum and minimum values of the graph will be measured automatically Ignore 0 points with 0 value measured won t be shown Not interpolated make the graph scattered Marker highlight with a symbol all steps of the test in which the marker button was pressed Squared makes the graph a square Without recovery exclude from the graph all points of the recovery phase Mark points marks each point with a symbol Min Max allows to set manually the axes values Step Set the axes scale step Switch from graph to data and vice versa When the active window is a graph or a
47. 3 to stop the acquisition discarding the results RBORT I BACK 6 Repeat the test until it is correctly performed ATS recommends 3 times 7 Press Exit to visualise the test list carried out during current session together with the results of the main parameters 8 Select the test that you want to save the Best Test according to the ATS criteria is highlighted as default and press OK Chapter 9 Spirometry 111 Bronchial Provocation Test Bronchodilator test vvv Note Read carefully the contraindications in Chapter 1 Bronchodilators are administered routinely in the b laboratory to determine whether airflow obstruction is reversible Bronchodilators increase airway calibre by relaxing airway smooth muscle The test consists of comparing results between the reference FVC FVC PRE and the FVC POST performed after the administration of the drug Increasing value of 13 15 of FEVI respect to the basal value FVC Pre is considered as a reversible condition Main parameters are the following DFEV1 pre Change of FEV1 as a percentage of test PRE DFVC pre Change of FVC as a percentage of test PRE DPEF pre Change of PEF as a percentage of test PRE Some authors states that the above mentioned parameters are too dependent from the FVC Pre hence latest reference ERS93 A comparison of six different ways of expressing the bronchodilating response in asthma and COPD reproducibility and dependence of pre bronchodi
48. 34 4 1 904 70 1 2074 2148 30 31 30 96 0 97 16 77 3 90 160 12 4 15 76 4 66 Trend 46 3 2 659 123 2 3158 3704 37 32 47 13 1 17 17 50 3 80 187 16 8 16 80 4 71 Phase n 3 Recovery Start 00 07 07 End 00 10 43 Speed 0 Load2 0 Load3 0 Min 25 2 1 170 34 0 477 834 33 28 7 13 1 16 16 95 3 02 130 3 3 16 09 3 82 Max 43 2 2 799 118 0 3143 3647 74 41 46 92 1 87 18 87 4 43 190 16 5 18 21 5 42 Average 34 6 1 880 66 3 1368 1910 51 35 20 42 1 45 18 11 3 57 156 8 3 17 41 4 45 Trend 30 6 1 268 38 8 770 968 47 37 11 50 1 25 18 10 3 29 132 5 8 17 50 4 12 T It is possible to print graphs and data by means of two functions Print report and Print current window The last one is active only if the active window is a graph or a data report Print the current window 1 Be sure that the current active window is the graph or the report you desire to print 2 Select Print current window from File menu 3 Press OK to print or Setup to customise the print Print the report 1 Select the report to be printed from File menu 2 Press OK to print or Setup to customise the print 3 Toonly view the report without printing it press Shift during the selection View the report This function allows to show a preview of a selected report 1 Select Report from the View menu 2 Select the test and the report to visualise and press OK to confirm Visualizzazione Report Elenco dei test in archivio Haas Elenco ID Data Durata C Paziente a
49. 45 8113 Fax 1 773 645 8116 email usa sales cosmed it To ensure that you receive efficient technical assistance please specify as precisely as possible the nature of the problem as it is specified on the assistance information form We advise you to save the original packaging You may need it in case to ship the unit to a technical assistance centre Chapter 11 Appendix 127 Privacy Information Dear Customer we inform you that your personal data are gathered and will be used by Cosmed Srl in conformity with the requirements of the Italian privacy law Decreto Legislativo 196 2003 We believe it is important for you to know how we treat your personal data Personal data treatment and purposes We request and process your personal data a to place an order register a product request a service answer a survey enter a contest correspond with us all of the above in the following service and if necessary to supply the Competent Authorities with the required information in order to define your commercial profile in order to use your commercial profile for own marketing and advertising purposes for accounting purposes including e mailing of commercial invoices for providing your information to selected business partners also abroad in order to supply the service How your personal data are treated Your personal data will be stored in electronic format and protected at the best from destru
50. 8 jesse ne dada Mi cae i eee D S RE 2724 i 1 r 2502 2280 2058 1836 1614 1392 1170 948 726 504 282 tihh mm ss 00 01 00 52 01 44 02 35 03 27 04 18 05 10 06 01 06 53 07 44 08 36 09 27 10 19 11 10 12 02 _ MO2 1819 1409 1 expl t 546 33 1 R 1 O2debt ml 7798 Tau 33 1 sec Chapter 6 Exercise Testing 65 Information about the Test Summary vvv Tip double clicking on the Summary window the function Options Summary is activated by which you may configure the structure of the data Print the data 66 Quark b User Manual The Test Information dialog box shows all the information concerning environmental data patient data and some data about the test View the Information Choose Information from the View menu Test information xi Patient r Calibration 1 ID code 1TEST Temperature C 22 STPD 0 802 Last name BABETSIS Humidity 61 BTPS insp 1 103 2 y Temp flow C 34 BTPS exp 1 020 deese Ee Hum flowm 2 100 Press mmHg 740 m Patient data r Test Sex M FVC I 0 00 Date of test 13 09 2002 Age 34 FEV1 I 0 00 Time of test 16 15 Height cm 182 0 IC I 0 00 Testn 21 Weight Kg 88 0 MVV l min 0 0 O eee BSA m 20 O2max ml 0 Duration hh mm ss 00 16 15 HRmax bpm 186 User A 0 00 LT time hh mm ss UN g day 00 User B 0 00 VD ml 60 User C 0 00 Notes
51. Analog Digital auxiliary inputs eee e e eee e eee ee eene nenne 130 AUX RS232 mme ne Lors abel tst 130 Pin out assignment 130 Handshaking protocol configuration 130 AUX1 AUXA analog Inputs 130 Enable the AUX input 130 Converting factors configuration eee e e eee ee eee e eee ee eee e nnne 132 Pin out assignment 132 Heart Rate TTL input csccssccsscssccssccssscssscssscssccssccssccsscoesces 133 Calculations references ses 134 Chapter 11 Appendix 9 NOS aid VOD tatit ceat seu litus 134 Anaerobic threshold modified V Slope 134 O Kinetics sise 134 Cardiac Output minette ma ae 134 ATS 94 recommendations sessssseeseseseoessesooscsseesoocesseoccee 135 ATS recommendations 135 Predicted values ssssssssssscieseseesesencsitensteienessneietesstesetosensitesssee 136 Automatic diagnosis algorithm 137 Quality Control Messages 137 REPETEN COS p 139 Gas Exchange References 139 Indirect calorimetry essen 139 Cardiac Outp t etse eie t aeien esos 139 Njelire tita EET 139 Sub maximal testing essere 139 10 Quark b User Manual Chapter 11 Appendix 11 Important notices Inte
52. COSMED all the signals inputs are disabled as default before connecting any external device you need to enable the reading of the channel you have decided to use To enable the reading of a channel AUXIA proceed as follows other channels can be enabled in the same way 1 Switch off the Quark b system and open the front Panel removing the 4 screws Which fix it to the chassis 2 Remove the AUX BOARD 5 board from left to right and configure the dip switches S1 and S2 as shown in the following diagram AUXIA enabled all the channels disabled 3 Connect the open terminals of the Auxiliary Input cable to the external device respecting the labels GND AUXA 0 5Volts AUXB 0 10Volts 4 Connect the Auxiliary Input cable on the corresponding port on the rear panel of the Quark b 130 Quark b User Manual Aux 2B Aux 1B Aux 3B Aux 1A Aux 2A Chapter 11 Appendix 131 Converting factors configuration Once completed the connection between the Quark b and the external system you must configure the options to convert the raw data mV into a physical parameter Blood pressure skin temperature You can access the configuration window by selecting Control Panel from the Calibration menu in the calibration program then p
53. COSMED does not assume any liability for end user interpretation of this user manual or for casual or consequential damages in connection with the provision representation or use of this documentation No parts of this manual may be reproduced or transmitted in any form without the expressed written permission of COSMED Srl Each copy of the COSMED Software can only be installed on one computer Excel is a registered trademark of Microsoft Corporation DBIII is a registered trademark of Bordland International Inc Lotus 123 is a registered trademark of Lotus Development Corporation Quark b User manual XVIII Edition 05 2008 Copyright O 1999 COSMED Copyright O 2003 COSMED COSMED Srl Italy http www cosmed it Part N C00827 02 91 Table of contents Getting started 12 Important notices 5 1 2 co sane ses esas oda esae sese seas esos asa eoa e aoa si 13 Intended use i eat ane en le earth nette 13 Warnnpgsz au iet eth tnt nt dede etaed ee bees 13 Contraindication Leere e eee etes es ete peas p e Deae ebat ea o en ese a Re eb erba nea see oae 15 Contraindications for the Spirometer tests 15 Absolute contraindications 15 Relative contraindications 15 Contraindications for Bronchial provocation tests 15 Absolute contraindications 15 Relative
54. Cables and Tubing installation sequence 36 Assemble the turbine eee ee eee ee eee eee ee eere eene eee nennt ette soot 37 Assemble the mask and the flowmeter 37 Using the Ultimate Seal 37 Apply the seal to the mask 38 To remove seal on mask 38 Assembling the flowmeter for spirometry tests 38 Cardiac Output Module 39 Connecting PC ane editt i e e ie det tios 39 Software installation ccccccssscccsssssscccssssssccecssssccssesssccsesescosees 40 Installing the software 40 Run the Softwares i eet cree tentent e e re E RES des 40 PC port configuration 40 Software main features e eee eee eee eee ee eee eee eee e ee eee sette eso ette e sooo 41 Display iuste ete nete ie nb te Ee ete LER ae Ex 41 Toolbar nine a et reprend ede 4 Show hide the toolbar 41 Dialog windows 4 41 Use of the keyboard 41 Use of the mouse sssssseeeeeeeenenns 4 Scroll bars estie ee et rte eme tea 41 On line help 41 Software Version ararnir RE ED IE ERE gene ect 41 Calibration 42 Chapter 11 Appendix 3 Calibrating sensors e eee eee eee e ee eee tenen eee esee ees tees sette sse eeos 43 Running the Calibration program 43 Logfile rt oc ie eee 43 Setting reference values ssssssssseeeeeeeene 43 To set the reference values 43 Calibrating analysers
55. Comments Modify LT M Calibration 7 il i Modify the information 1 Press the Modify button on the Information dialog box 2 Change the values you want to modify and press OK to confirm The software allows to assess the energy expenditure and metabolism substratum In order to measure FAT and CHO type the UN Ureic Nitrogen value into the field All the nutritional parameter will be recalculate considering the UN value The summary feature allows to summarise test results according to the workload and phase during the test View the summary 1 Choose Summary from the View menu 2 The summary of the current test active window will be displayed Rf VT VE voz vcoz VE VO2 VE VCO2 VO2 Kg R Feo2 FeCO2 HR VO2 HR FetO2 FetCo2 b min l l min ml min ml min ml min Kg bpm ml bpm Phase n 1 Rest Start 00 00 00 End 00 01 08 Speed 0 Load2 0 Load3 O Min 14 6 0 586 8 6 212 157 28 35 3 16 0 73 16 51 2 49 88 2 2 15 09 4 12 Max 21 0 0 971 20 3 619 489 39 52 9 24 0 82 17 68 3 58 107 6 6 15 90 4 76 Average 16 8 0 747 12 7 349 272 33 43 5 22 0 77 17 23 2 95 94 3 6 15 60 4 29 Trend 19 8 0 853 16 9 542 429 28 36 6 09 0 79 16 65 3 47 106 5 1 15 21 4 65 Phase n 2 Exercise Start 00 01 10 End 00 07 05 Speed 4 Load2 0 Load3 O Min 17 5 0 811 16 7 540 420 23 28 8 06 0 72 15 75 3 54 110 4 7 14 34 4 37 Max 51 5 2 883 138 1 3367 3978 45 36 50 25 1 32 17 99 4 37 196 18 7 17 20 5 36 Average
56. D Press Alt F3 to stop the acquisition discarding the results Repeat the test until it is correctly performed ATS recommends 3 times 9o x Press Exit to visualise the test list carried out during current session together with the results of the main parameters 9 Select the test that you want to save the Best Test according to the ATS criteria is highlighted as default and press OK Bronchial Provocation protocols Database The response to a bronchoprovocator is usually assessed in terms of change in the FEVI vital capacity or airways resistance on the basis of serial measurements FVC manoeuvres in which the results of the initial test constitute the reference values The international literature proposes several standardised protocols in order to address the methodological issues of the various available techniques The possibility to store a bronchoprovocation protocol in a database is useful to simplify and automate the sequence of operations that the Physician need to execute during the bronchoprovocation tests The typical sequence of activities to carry out a bronchoprovocation test are 1 Typing and storing a bronchoprovocation protocol in the database usually only once 2 Selection of protocol among the list of the ones already present in the database before carrying out the FVC post tests the selection of manual protocol allows to execute the test fully manually 3 Performing the Post tests Enter a new
57. EF within 10 96 MVV time less than 12 sec References Gas Exchange References On line computer analysis and breath by breath graphical display of exercise function tests Beaver Wasserman Whipp JAP 34 1 128 132 1973 Measurement and analysis of gas exchange during exercise using a programmable calculator Sue Hansen Blais Wasserman JAP 49 3 1980 456 461 Principles of exercise testing and interpretation 2 edition Wasserman et Al 1994 Clinical Exercise Testing 3 edition Jones 1988 ERS task force on standardization of clinical exercise testing Clinical exercise testing with reference to lung disease indications standardization and interpretation strategies J Roca B Whipp S Anderson R Casaburi J E Cotes P Palange ERJ 1997 10 2662 2689 Indirect calorimetry Energy Expenditure and Fuel Selection in Biological Systems The Theory and Practice of Calculations Based on Indirect Calorimetry and Tracer Methods M Elia G Livesey World Rev Nutr Diet Basel Karger 1992 vol 70 pp 68 131 Nutritional Assessment in Critical Care A Training Handbook Donald C Zavala Cardiac Output Cardiac output estimated non invasively from oxygen uptake during exercise William stringer James E Hansen and K Wasserman JAP 82 3 908 912 1997 Clinical Exercise Testing Third Edition 1988 Norman L Jones Spirometry ATS 794 Standardization of Spirometry 1994 Upda
58. MED equipment users 1 This user manual is to be considered as a part of the medical device and should always be kept on hand 2 Safety measure accuracy and precision can be assured only e using the accessories described in the manual or given with the device Actually non recommended accessories can affect safety unfavourable Before using non recommended accessories it is necessary to get in touch with the manufacturer e ordinary equipment maintenance inspections disinfection and cleaning are performed in the way and with the frequency described e any modification or fixing is carried out by qualified personnel e the environmental conditions and the electrical plants where the device operates are in compliance with the specifications of the manual and the present regulations concerning electrical plants In particular grounding reliability and leakage current suppression can only be assured when the device three wire receptacle is connected to a yellow green return connected to earth ground Attempting to defeat the proper connection of the ground wire is dangerous for users and equipment 3 Before powering the system check the power cables and the plugs Damaged electrical parts must be replaced immediately by authorised personnel 4 Large gas cylinders which may be given by the manufacturer or purchased by the customer should be secured with cylinder safety chains or safety stands 5 When removing the protective cap
59. accuracy Chapter 4 Calibration 47 Checking the system signals The control panel The Control Panel which can be activated from the Calibration Control panel menu item is a useful tool to check the main hardware functions of Quark b By using the controls on Control Panel you are able to do the following 1 Reading the signals acquired by the system both as voltages and processed data 2 Activating Disactivating the valves the sampling pump and other installed components for example oxymeter Control panel x mv 8 a li i 8 l i x VERE fx Analyzers Press mv 3964 mx coztmvyy 2639 r purs x Sampling Flow mv 488 ix 02 Imv 322 r EDICTUM MN x Relative Humidity mV 4155 Turbine Flow mV v r Flow PNT1 RAW mV x Ambient Press mv 3432 r Turbine Volume mv 0 r Fesser S E RUE EE r ae r IE RE BET C HR TTL m or Inpudt1 RS232 mV 7 Shared device mV n Press RAW mV ofr Input 2 RS232 mV aI Free mV Analog inputs clear m Aux1A mV or Aux1B mV E Aux2A mV 0 Aux2B mV r Aux3A mV or Aux3B mV m Aux4A mV 9 p fAux4B mv I Using the control panel Sampling pump on off Air valve mV real values RAW switch Deselect all Signal refresh display on off Oxymeter channels time mV 8 z Hiao E y Ax Era Analog Bag filling Select all input channels Calibration Bag valve cylinder On Off 48
60. accuracy when using sub maximal exercise testing to estimate VOomax e Selected workloads are reproducible A steady state heart rate is obtained during each stage of the test Usually workload durations of 3 minutes or more are used to ensure steady state e The maximal heart rate for a given age is uniform HR 220 age e Heart rate and VO have a linear relation over a wide range of values thus the slope of HR VO regression can be extrapolated to an assumed maximum heart rate e Mechanical efficiency 1 e VO at a given work rate is consistent Although if done correctly sub maximal exercise tests provide valuable information concerning cardiorespiratory fitness they have extremely limited diagnostic capabilities and should not be used as a replacement for clinical exercise tests or other clinical treatment or management modalities Health care professionals should avoid detailed interpretation beyond the scope of the information obtained sub maximal exercise testing Considerations for selection of protocol and equipment include any physical or clinical limitations that may preclude certain types of exercise Le age weight arthritis orthopaedic complications individual comfort level of fitness type of exercise training that will be performed and individual preference For example some individuals may perform better on a non weight bearing modality cycle versus treadmill while others may not have the required ran
61. al Care A Training Handbook Donald C Zavala Anaerobic threshold modified V Slope O kinetics Cardiac Output The break point or intercept of the two slopes can be selected by a computer program that defines the VO2 above which VCO2 increases faster than VO2 without hyperventilation During an incremental exercise above the Lactate Threshold the net increase in lactic acid production results in an acceleration of the rate of increase in VCO2 relative to VO2 When these variables are plotted against each other squared graph without recovery points the relationship is composed of two apparently linear components the lower of which has a slope of slightly less than 1 0 whereas the upper component has a slope steeper than 1 0 The intercept of these two slopes is the LT or AT point measured by gas exchange The increase in VCO2 1n excess of that derived from aerobic metabolism must be generated from the buffering of lactic acid This is an obligatory gas exchange phenomenon seen in all subjects who exercise to work levels above their LT This technique is referred to as the V Slope method OVS Original V Slope method A new method for detecting anaerobic threshold by gas exchange Beaver Wasswrman Whipp JAP 1986 60 2020 2027 MVS Modified V Slope method Metabolic acidosis during exercise in patients with chronic obstructive pulmonary disease Sue Wasserman CHEST 1988 94 931 938 Delayed Kinetics of VO2 in the Transi
62. alcoholic based for about 20 minutes 3 Rinse the turbine in a vessel filled of clean water shaking gently to remove the disinfectant do not clean the turbine by putting it under running water 4 Let it dry to air 5 After cleaning the turbine check if the turbine propeller rotates freely even with a low speed air flow 6 Connect the turbine to the reader Precautions during the cleaning of the turbine 1 Do not expose the turbine to high heat and do not put it under running water 2 Do not ever dip the optoelectronic reader in any kind of solution the liquid infiltration would damage the internal circuit 3 Donotuse alcoholic solutions to clean the turbine Masks cleaning and disinfection The face masks should be cleaned and sterilised after each test Disassembling the different parts of the mask 1 Remove the valves from their place 2 Remove the adapter for the optoelectronic reader Cleaning the mask 1 Clean the mask with hot water and a soap solution to remove the impurities 2 Rinse the mask with energy in running hot water Warning Do not use synthetic or petroleum based products for the masks cleaning Disinfecting the mask It s possible disinfecting the mask following these procedures e Standard autoclaving method Rapid cycles of autoclave lasting 10 minutes at 132 C 270 F Heavy cycles of autoclave lasting 30 minutes at 121 C 250 F Pre vacuum cycles of autoclave lasting 30 minutes
63. alue in the fields Name unit of meas integers decimals Select the group of the predicted values from the options boxes Select the reference parameter in the Compared to list box Press the buttons in the calculation group and insert the mathematical formulas for men and women adults and paediatrics Press OK twice to confirm Once you create the new predicted you can see it in the predicted window Delete New List Find Copy Import Unit of meas Males limit age Tu Female adult Females limit age Related to no parameter Fl Export r Calculation FE Hale paediatric Integers 5 Male adult 4 Decimals m Female paediatric 7 Close 2 Chapter 6 Exercise Testing 71 Exporting data vvv Note The DDE function is With this function you can export the tests data and parameters in different file formats e xpo Cosmed proprietary file format txt ASCIT xls Microsoft Excel wkl Lotus 123 Export a test 1 Choose Export Tests from the Test menu 2 Select the test to export from the list box and press OK to confirm 3 Select the file output format from the list box click on xpo txt xls or wkl If you selected ASCII format by clicking on Text button you can then select the Thousands sep and Column sep according to the program you want to use With the xpo Cosmed format you can import export the
64. ams of Ureic Nitrogen in 24 hours You can modify this value selecting View Information gt Modify At the rend of the test it will be opened automatically a window with the test results L Eile Test Events View Options Window rrr AE FAT PRO y SITS d s ERE Lus Af ED TIO ro 7 Parameter Rest Pred Pred BMI Statements Time mm ss 09 30 10 00 95 0 Underweight 18 5 RMR Kcal day 1981 1 1731 9 114 396 Normal 18 5 24 9 R 0 82 0 85 96 8 Overweight 25 0 29 9 VO2 ml min 286 266 107 7 Obesity class 30 0 34 9 VCO2 ml min 235 226 104 2 Obesity class Il 35 0 33 9 Rf b min 13 7 12 0 114 2 Obesity class Ill gt 40 VE l min 9 0 5 0 150 496 HR bpm 72 FAT 96 59 5 CHO 95 40 9 BMI Kg m 2 23 9 Normal Elke Keal day 3500 0 1 ee ee en ee eee b2amsdestechzssshemres eec i odin ee Wee osietbosdttcaeatcsssd 3000 04 2500 0 2000 0 1500 0 1000 04 Boob RE TE ES be o MM TU T MEN E NIA ROME QUSE UPC ONCE RE NN NA EE SEN wii EE EE 00 00 01 00 02 00 03 00 04 00 05 00 06 00 07 00 08 00 09 00 10 00 11 00 12 00 13 00 14 00 15 00 16 00 17 00 18 00 19 00 20 00 At the end of the test or if it is selected View RMR the main results are shown e The average time interval default 10 minutes e Average values of VO VCO R RMR RE VE HR FAT and CHO and predicted values if available
65. apping the F V loop acquired during exercise and the F V loop performed at rest Flow Volume loop during the test 1 Start with normal Exercise test and begin the memorisation of breath values F2 2 During a steady state select F V loops form Test Event 3 As soon as 2 or 3 complete loops have been acquired ask the patient to inspire completely up to TLC level and press F3 to stop the acquisition O2 CO2 vs Time The O2 CO2 event is useful to check the real time readings of the O2 and CO2 signals during the test O2 CO2 vs Time during the test 1 Start with normal Exercise test and begin the memorisation of breath values F2 2 During a steady state select O2 CO2 vs Time from Test Event 3 As soon as 5 or 6 complete breaths have been acquired press F3 to stop the acquisition p p Event 02 C02 Graph lolx 0215 coz 25 oo 1 1 1 1 i I 1 1 1 1 i 1 1 i 1 i 1 1 1 1 1 1 i 1 i 1 1 1 1 i 1 1 i 1 bod TE 12 00 i 1 1 1 1 1 1 1 i 1 vt 4 1 Y y 1 y Y y 1 E i 20 00 Sod de A EE f il j 1 n 1 ji 1 h in h 3 00 il 1 Vi h QM JI rt QM 1 h QS f 1 wi 1 1 1 1 i 1 1 1 f i 1 i i 1 i 1 1 1 i 1 i 1 ans es EE 29 mo Wo 4e Cu 6 00 ieoa Lcx e Meo de Tl abo 4 DL 1 1 1 L 1 L I 1 1 1 1 1 i 1 1 i 1 i 1 1 1 i 1 1 i 1 3 00 i 1 1 1 1 i 1 f i 1 1 J Li 1 DU L i Jj 10 00 t hh mm ss oo 02 04 06 08 10 t hh mm ss 00 00 53 O2 Saturation optional
66. arising from the use of any COSMED s products whether said products are used alone or in combination with other products or substances Determination of the suitability of any of COSMED s product s furnished hereunder for the use contemplated by Buyer is the sole risk and responsibility of Buyer and COSMED has no responsibility in connection therewith Buyer assumes all risks and liabilities for loss damage or injury to persons or property of Buyer or others arising out of the use or possession of COSMED s products The limited warranty as herein above set forth shall not be enlarged diminished modified or affected by and no obligation or liability shall arise or grow out of the renderings of technical advice or service by COSMED its agents or employees in connection with Buyer s order or use of the product s furnished hereunder Return goods policy for warranty or non warranty repair Goods shipped to COSMED for repair are subject to the following conditions 1 Goods may only be returned after your receipt of a Service Return Number SRN from COSMED S r l 2 Place your SRN report and Packing List outside the package 3 Goods returned must be shipped with freight and insurance charges prepaid Collect shipments will not be accepted 4 The following list of goods are not eligible for return unless proven defective Special order items Expendable products Goods held over 30 days from COSMED s invoice date Used g
67. as components of the equipment e do not steam autoclave any parts of the equipment unless it is clearly specified e do not immerse the optoelectronic reader Preparing the disinfecting solution The following recommendations are retrieved from APIC Association for Professionals in Infection Control and Epidemiology Inc APIC Guidelines for Selection and Use of Disinfectants William A Rutala PhD MPH CIC American Journal of Infection Control vol 24 N 4 pp 313 342 August 1996 http www apic org pdf qddisinf pdf As disinfecting solution it is suggested e Sodium hypochlorite 0 5 5000 ppm prepared fresh for use within 24 hours e Sodium hypochlorite 1 10000 ppm prepared fresh for use within 30 days The first solution can be easily prepared by adding 1 part household bleach sodium hypochlorite 5 25 to 9 parts water the second one by adding 1 part household bleach to 4 parts water Chapter 10 System maintenance 119 Cleaning the turbine flowmeter vvv Warning Do not use alcoholic solutions for the turbine otherwise there can be damages to the plastic material It is necessary to disinfect periodically the turbine for sanitary measures or and for the correct device function The disinfecting procedure is easy and may be effected every time the user needs keeping attention to some precautions Turbine Optoelectronic reader Take out the turbine 2 Dip itin a disinfectant solution non
68. ask 3 Inspiratory valve 4 Turbine 5 Optoelectronic reader 6 Sampling adapter 7 Sampling plug The ultimate seal is a moulded of Elasto Gel a glycerine based hydrogel This product is a unique polymer gel that forms an intimate seal between the face and the mask It has to be used for mask applications on hard to seal faces and where leaks are not tolerated Will not irritate the skin Contains no adhesives Has no odour Will not dry out Single patient use Chapter 3 Installation 37 vyv Notice Avoid the exposure to the sun Do not put the seal into the water Apply the seal to the mask Apply seal to clean residue free mask only and follow the instructions below 4 Remove the plastic tray from the bag Peel off clear film and retain for later use While holding tray align the nose area of mask to nose area of Ultimate Seal gel Press together and roll mask down over the surface of the gel seal attaching it to the mask and releasing it from the tray If needed adjust the position of the seal aligning it with the outer perimeter of the mask sealing surface The mask is now ready to be placed on the subject s face To remove seal on mask The Ultimate Seal have been conceived for a single patient use only it can not be cleaned or sterilised If mask requires cleaning for a new patient application then pull off and dispose of the Ultimate Seal To keep the seal clean between use ke
69. at height properly adjusted recorded and standard for each test e The time of day for repeat testing consistent e All data collection procedures standardized and consistent e Test conditions standard e Subjects free of infection and in normal sinus rhythm e Prior to the test no intense or prolonged exercise for 24 hours smoking for 2 3 hours caffeine for 3 hours or heavy meal for 3 hours e Room temperature 18 20 C 64 68 F with air movement provided Performing the test In this chapter it is supposed that the user is able to e perform an exercise test e create exercise protocols e view edit and print tests If this 1s not the case please read the Exercise testing chapter To perform a sub maximal test follow these instructions 1 Create a proper protocol procedural guidelines for several sub maximal testing protocols are provided in ACSM s Guidelines for Exercise Testing and Prescription 6 Edition Philadelphia Williams amp Wilkins 2000 22 29 2 Start an exercise test 3 Perform the test as it were a maximal exercise test ending it when the heart rate reaches the 8596 of the Hrmax or it happens an event listed in the section Test termination 4 Display a VO Kg vs HR plot 5 Right click on the graph and select VO submax from the pop up menu PFT Ergo VO2 Kg HR SISINNI E test n 4 p zs TAl Eile Test Events View Options Window Je U
70. ated more rapidly by clicking with the mouse on the corresponding icon in the tool bar Positioning the mouse cursor on one of the buttons of the toolbar if the option Hints is enabled the description of the corresponding function 1s shown in a label Show hide the toolbar Select Toolbar from Options menu in order to show or hide the toolbar The typical operating environment of Microsoft Windows is the Dialog box This window is provided with a series of fields in which input the information Use of the keyboard e To move the cursor among fields press the Tab key until you reach the desired field e Press the Enter key to confirm the information input on the dialog box or press the Esc key to cancel changes Use of the mouse e To move the cursor among fields move the mouse on the desired field and left click e Click on the OK button with the Left button of the mouse to confirm the information input on the dialog box or click on Cancel button to cancel changes Some windows are provided with scroll bars that help to see data exceeding the window space available e To move the scroll bar row by row click the scroll arrows at the end of the scroll bars e To move the scroll bar page by page click on the grey area at both sides of the scroll fields COSMED Quark Help is a complete on line reference tool that you can use at any time Help is especially useful when you need information quickly or when the Quark user manual i
71. ce to measure RMR A knowledge of the RMR is very helpful in order to understand the nutritional needs and to properly manage it Measure of the rest metabolic rate with indirect calorimetry Energy expenditure can be measured directly by putting a person in a calorimeter and measuring the amount of heat produced by the body mass This is expensive and very impractical in the clinical setting Energy expenditure can be measured indirectly with a metabolic cart by analysis of respired gases usually expired to derive volume of air passing through the lungs the amount of oxygen extracted from it 1 e oxygen uptake VO and the amount of carbon dioxide as a by product of metabolism expelled to atmosphere CO output VCO With these measurements the resting energy expenditure RMR and respiratory quotient RQ can be calculated The RQ represents the ratio of carbon dioxide exhaled to the amount of oxygen consumed by the individual RQ is useful in interpreting the results of the RMR The abbreviated Weir equation is probably the most common calculation of RMR Abbreviated Weir equation RMR 3 9 VO2 1 1 VCO2 1 44 How to perform a RMR test For best results when having a REE done there are certain conditions that need to be controlled and others that just require documenting at the time of the test During the test the individual is interfaced with a metabolic measurement system by means of a facemask A mouthpiece with a
72. ced mid Expiratory Flow The two representative plots are the Flow Volume and Volume Time loops By comparing FVC FEV1 and FEV1 FVC values the software allows an automatic interpretation concerning the levels of obstructive and or restrictive disorders The flowmeter has to be disconnected from the breathing valve The patient should wear the nose clips The turbine has been recently calibrated ATS recommends a daily calibration The paper mouthpiece or the antibacterial filter is properly connected to the flowmeter through the corresponding adapter For hygienic reasons we strongly recommend the use of a bacterial filter If a kid must perform the test it is recommended to enable the encouragement function which shows exactly the manoeuvre of the FVC test Perform a FVC pre test E BACK Test encouragement Select Forced Vital Capacity pre from the Test menu and wait for the green led is prompted on the right side of the screen Explain the manoeuvre to the patient and press the F2 key Wait some seconds and perform the test After having performed the test press F3 or wait for the automatic end 5 seconds without flow so that the software displays the F V and V t graphs the main parameters and the predicteds values In order to visualise the F V and V t graph and the main parameters press the following buttons view Flow Volume graph view Volume Time graph DATA view data of the test Press
73. ction loss even accidental not authorized accesses not allowed treatment or use not in conformity with the purposes above listed The consent is optional but If you deny the consent we regret we cannot supply the service Holder of the treatment The holder of the treatment is Cosmed Srl Via dei Piani di Monte Savello 37 Pavona di Albano Laziale RM The responsible of the personal data treatment is indicated in the documentation stored by Cosmed Srl itself Customer rights In accordance with art 7 of the Law you can a c obtain confirmation of the existence of your personal data and their communication in intelligible form obtain e updating correction or integration of your data e deletion or transformation in anonymous form of your personal data deny your consent to the treatment of your personal data These rights can be exercised directly requesting in writing to the holder of the treatment 128 Quark b User Manual Waste of electrical and electronic equipment Quark b is an electronic equipment and can not be disposed as unsorted municipal waste Electric and electronic equipment according to European Directive 2002 96 EEC must be collected separately Otherwise it can cause dangerous consequences for the environment and human health The crossed out wheeled bin means that the product must be taken to separate collection at the product end of life Chapter 11 Appendix 129 Anal
74. d separation Z distance in metres m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey should be less than the compliance level in each frequency range Interference may occur in the vicinity of equipment marked with the following symbol o Notes 1 At 80 MHZ the higher frequency range applies 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people a Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the Quark b is used exceeds the applicable RF compliance level above the Quark b should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as reorienting or relocating the Quark b b Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m 18 Quark b User Manual Recommended separation distances between portable and mobile RF communications equipment and the Quark b The Quark b is i
75. data window the only desired parameters Select the parameters to view 1 Choose Parameters to view Test visualisation from the Options menu 2 Selectthe parameters you require to view 3 Press OK to confirm the selected configuration Select the parameters to view during the test 1 Choose Parameters to view Test execution from the Options menu 2 Selectthe parameters you require to view 3 Press OK to confirm the selected configuration Sort the parameters It is possible to sort the parameters both for viewing and printing purposes according to the desired order 1 Select Sorting parameters from the Options menu 2 Move the parameters in the order you want by pressing and holding the left mouse button 3 Press OK to maintain the current configuration The program has an algorithm to tag sets of steps as Steady State The algorithm considers belonging to the Steady State the only consecutive steps that meet the following conditions e The value of VO2 VE and R do not vary from their mean values more than Threshold 9 e The number of consecutive steps that met the preceding criteria are at least Minimum number of steps Steady State x Hinimum n of steps Cancel a El gt OO am 2 O2 threshold Z VE threshold Z R threshold 2 Restore Customise the Steady State detection criteria 1 Choose Steady State from the Options menu 2 Type the desired values f
76. dis seeded eee repe 110 Maximum Voluntary Ventilation 111 Perform a M VV test i ie dtr tease din eese det ad eve epe iu 111 Bronchial Provocation Test ccccccccssssscccssssscccecsessccssessscosees 112 Bronchodilator test 112 Methacholine and Histamine Bronchial provocation Tests 112 Perform the test 113 Bronchial Provocation protocols Database 113 Enter a new Bronchial provocation protocol in the arc hiV6 i de e uero e ORAE REPRE er DEA 113 Viewing cl rz 114 Tests of the current patient 114 Delete atest ioco te p e ERU ined 114 Printing results district e one epos eene Fe restes posae nene e gave e pa ru 115 Printing Reports sssesseseeseseeeeeee eene ener nnn 115 Printing the active window 115 To print the active window 4 115 Printing a series of reports sss 115 Electronic reports pdf ssssssssseeeeere 115 8 Quark b User Manual Export data sin eee eoe tert 116 Export a test epe ne Rennes 116 System maintenance 118 System maintenance cccccrcsccsscresccssccesccesccssccesccescosscoescoescoesees 119 Cleaning and disinfection essen 119 Preparing the disinfecting solution 119 Cleaning the turbine flowmeter sse 120 Precautions during the cleaning of the turbine 120 Masks cleaning and disinfection s
77. discarded 10 minutes with data acquisition of which the software will make an average at the end of the test automatic end of the test after the 16 minute e Selection of the RMR workspace windows placement The test is fully automatic the software will stop it and save the data at the end of the 16 minute The real time view is as shown in the following picture PFT Ergo 1 InfoCenter BE File Test View Events ECG Window Demo vu p sl gt 2 oe LOUER be STO START STOP EVENT 8 MARK LORD P eRec ors AAA LE BS v02 vc02 BOND J test n 8 PI E3 IX VE R4 BOND J test n 8 _ oj x vo2 V02 ml min VC02 n1 nin VE 1 nin HR bpn vco2 321 287 R 0 83 077 Rf 150 148 EEkc 2677 7 2529 0 00 00 01 00 02 00 03 00 04 00 05 00 06 00 07 00 ME BOND J test 1 8 nl xj t Rf VE Voz vcoz VO2 Kg R FeO2 FeCO2 HR VO2 HR Loadi Ti Ttot VD VT al hh mm ss b min l min ml min ml min ml min Kg bpm ml bpm 00 00 31 15 0 10 6 386 321 5 08 0 83 16 57 3 78 72 5 3 o 0 38 0 28 0 N umb 4 Pb mmHg 741 RH 56 Temp C 25 Mixing chamber 00 30 a 09 28 i stee ag O SA 9 Ta YE 3 Espora risorse K Posta in arrivo m S QPFT chapttt do prt Ergo I vasc Paint Shop Pr Gc d Viewing the test vvv Nota The percentage of used Proteins PRO is calculated assuming 12 gr
78. e 1 Select the desired colours of the curves 5 curves max can be overlapped on the same graph 2 Enable or disable the Grid option 3 Enable or disable the Show Info Test option Serial port You must select the serial port RS 232 that will be used to connect the Quark b with the PC To select the serial port click on the proper COM button the selected port must be different from the mouse one Units of measurements It is possible to configure the units of measurements weight and height for printing and viewing To select the units of measurement click on em Kg or in Ib according to the desired format Using extra fields The Patient s database is organised in 3 different cards Patient card Visit Card and Test card where it is possible to store the information about patients and visits Besides the standard information it is possible to customise some fields user free fields entering and labelling measurements coming from other devices The customisable free fields are e 3 fields in the Patient Card Patient s information e 3 fields in the Visit Card information about the visits e 3 fields 2 numeric in the Test card information about Test Customise the fields In the group User free fields type the desired text in the 9 fields available Chapter 5 Database Management 55 Recommendations for the exercise testing The evaluation of the cardiorespiratory function The physical training requ
79. e 53 Test Card inea sete a e GU OE GET 54 Import export a Tests card sss 54 Diagnosis Database sss 54 Spirometry program settings ccce eee e eee e eee eee eee eee osten etes eeooe 55 Graphiste mnt o e te trece 55 Serial porti ih e er irt e VIE Oe detis 55 Units of measurements 55 Using extra fields 55 Customise the fields 55 Exercise testing 56 4 Quark b User Manual Recommendations for the exercise testing se 57 The evaluation of the cardiorespiratory function 57 Pr cautions etes urnes o e e entre 57 Laboratory inniit nantais eisean 57 Ending the testiera nomeu eoi n VERE 57 Preparing the patient 57 Beforetesting ee o e el ee les 57 Patient assent pco e dernieres 58 Ending the test 58 Start Testing 1 rette esce esee eese soa Dos sposa aos agone Doa aU b a aora TP a Pea Dese aere 59 Startatest s caso ei ttt ttes 59 Abort the test without saving data ssssssss 59 End the test saving data sss 59 View data in real time 59 View graphs in real time esse 60 Parameters to VIEW 60 Manual protocol 60 Enter Load and Phase sse 60 Set the markers ice deti eerte teen 60 Automatic protocol 4 60 Modify the load during the test 60 Setthe BPM al rm iere eee tet 60 Enter the BPM 5 these eet cie eer eene esa 60
80. e Op The volume of the mixture filled in the bag must be 1 5 2 times the Vt of the patient Note The Cardiac Output must be carried out only with the mask without inspiratory valves or with the mouthpiece otherwise the results are not reliable Setting up the Quark b for the cardiac output 1 Connect and open the Cardiac Output cylinder to the corresponding input port on the rear panel the output pressure of the gas must be between 4 and 5 bar 2 Connect the valve to the corresponding connector of the front panel of the system 3 Connect the rebreathing bag to the valve assembly Chapter 6 Exercise Testing 77 loli EVENT Performing a Cardiac Output test 1 Select Execute Test from the Test menu or press F2 and start the test as for an ergometry test 2 During the desired phase rest or exercise in a steady state select Cardiac Output from Test Event menu 3 By using the corresponding buttons of the Toolbar prepare the bag by refilling it starting from completely collapsed otherwise the initial concentration of CO will be lower than expected value and the results could be unreliable 4 Connect the valve assembly to the output port of the turbine flowmeter trying not to affect too much the performance of the patient 5 Atthe end of the expiration press F2 to start the rebreathing 6 Stop the test by pressing F3 when the equilibrium is reached or wait for the automatic interruption after
81. e inconsistencies that are inherent may increase variability e Sub maximal heart rate is influenced by time of day eating smoking and familiarization with test procedures e Prediction equations for estimating VOX may overestimate trained individuals and underestimate untrained individuals e The efficiency of motion during walking running and cycling varies e Cardiac output and VO have a test retest variability of 3 495 Psychological factors such as pre test anxiety may influence the heart rate especially at rates below 120 beats per minute and at low workloads It is not unusual for the heart rate and or blood pressure to be higher at rest than during the initial stages of exercise in these cases Having the subject repeat the first test may improve reliability particularly if the subject has never previously performed such a test Factors that can cause variation in the heart rate response to testing e Dehydration e Prolonged heavy exercise prior to testing e Environmental conditions e g heat humidity ventilation e Fever e Use of alcohol tobacco or caffeine 2 to 3 hours prior to testing Because of these inherent inconsistencies standard procedures for each test must be strictly followed to ensure the greatest accuracy and reproducibility possible e Standard testing protocol e The same testing modality and protocol for repeat testing e A constant pedal speed throughout cycle ergometry testing e Cycle se
82. e only if the active window is a VO2 vs time graph and it has a sense only with Constant Load Exercise Tests The aim of this function is to find the dynamic response of the rising and falling edges of the VO2 together with the Oxygen Deficit and Oxygen Debt Init Fact O2def Init Fact O2debt Selection 7 1 Al iz NW a2 1657 Tc a 00 03 50 xj Cancel B1 735 WC B2 2393 Fc t 00 11 30 al r Iaul 400 40 0 fe Max attempts 100 ii Run the O2 Kinetic function 1 Make active a VO vs Time graph window 2 Press the right key of the mouse and select O2 Kinetic 3 Select the beginning of the exercise phase t1 moving the mouse on the desired place in the graph pressing the Left key or using the and keys 4 Select the beginning of the exercise phase t2 moving the mouse on the desired place in the graph pressing the Right key or using the and keys 5 Enter if necessary the initial values for A B and Tau these are the values from which the iterative algorithm starts in order to reach the best values the closer are the initial coefficients to the best ones the higher is the possibility to reach the best fit and press OK You can lock data checking the relative field V02 t BRUGNOLS H test n 4 Jol x VOZ ml min 1455 W022452 1453 1 exp t 178y29 4 4278 S f 4056 102 def ml 713 3834 Tau 29 4 sec H 3612 4 5 t 3390 k i 1 316
83. e to the customers assistance service For further information please refer to the enclosed registration and warranty form If the form is not enclosed in the packaging please contact directly COSMED Register the product via software Together with the PC software a registration software is supplied With this software it is possible to fill in an electronic form with the customer information 1 To run the software double click on the icon Registration or select Registration from menu 2 Type the requested information and click Send to send the form via e mail to COSMED How to contact COSMED For any information you may need please contact the manufacturer directly at the following address COSMED S r l Via dei Piani di Monte Savello 37 P O Box n 3 00040 Pavona di Albano Rome ITALY Voice 39 06 931 5492 Fax 39 06 931 4580 email customersupport cosmed it Internet http www cosmed it Complain feedback and suggestions If you have any complain feedback information or suggestion please inform us at complain cosmed it Options Accessories The following options are available to enhance or to complete the Quark b system Code A 860 000 004 C01500 01 04 C01700 01 04 A 870 150 001 C00689 01 30 C01278 01 30 C01277 01 30 A 800 900 004 C01396 01 11 C01234 01 11 C01402 01 11 C02150 01 11 C01380 01 12 A 180 015 001 1 1 1 1 1 1 1 1 1 1 1 1 1 1 Quantity Descri
84. een 25 75 FVC Forced expiratory time Forced Expiratory Volume in 2 sec Forced Expiratory Volume in 3 sec FEV2 as a percentage of FVC FEV3 as a percentage of FVC Tiffenau index Mid exp flow between 50 75 FVC Mid exp flow between 75 85 FVC Mid exp flow between 0 21 1 21 Inspiratory Forced Vital Capacity Forced mid inspiratory flow Forced Inspiratory Volume in 1 sec Peak Inspiratory Flow Extrapolated Volume back extrapolation msec Time to PEF 10 90 VC IVC Slow Vital Capacity and Ventilatory pattern Symbol EVC IVC ERV IRV IC UM Parameter Expiratory Vital Capacity Inspiratory Vital Capacity Expiratory Reserve Volume Inspiratory Reserve Volume Inspiratory Capacity VE l min Expiratory Minute Ventilation Vt 1 Tidal Volume Rf l min Respiratory Frequency Ti sec Duration of Inspiration Te sec Duration of Expiration Ttot sec Duration of Total breathing cycle Ti Ttot Ti Ttot ratio Vt l sec Vt ti ratio MVV Maximum Voluntary Ventilation Symbol UM Parameter MVV l min Maximum Voluntary Ventilation MVt 1 Tidal Volume during MVV MRf l min Maximum Respiratory frequency MVVt sec MVV duration time Bronchoprovocation Response Symbol UM Parameter FallFEV1 Fall in FEV1 from baseline or post diluent FallVmax50 96 Fall in Vmax50 from baseline or post diluent P10 Provocative dose causing FEV to fall 10 from baseline P15 Provocative dose caus
85. ent session together with the results of the main parameters Select the test that you want to save the Best Test according to the ATS criteria is highlighted by default and press OK reference for the ERV calculation is displayed on the V T graph Maximum Voluntary Ventilation Test for assessing the maximum ventilatory capacity In the past it was commonly performed during routine PF tests however its clinical use declined over the years Today MVV test is most commonly performed as part of the exercise tolerance tests where it is used as an index of maximum ventilatory capacity Test consists in breathing in and out deeply and rapidly for 12 15 seconds The expired volume during this short period is then extrapolated The most important measured parameter is the following MVV Maximum Voluntary Ventilation Perform a MVV test 1 Select Maximum Voluntary Ventilation from the test menu and wait for the green led is prompted on the right side of the screen 2 Press F2 and make the Patient breath as much deeply and rapidly as possible for at least 12 seconds 7 3 Press F3 or wait for automatic interruption 5 seconds without flow in order to D ress visualise the V t graph together with the main parameters compared to the predicted ERE values 4 To visualise the V t graph and the main parameters press the follow buttons PA X wer view Volume Time graph DATA view data of the test 3 5 Press Alt F
86. ep it attached to the mask and place the clear film against the Ultimate Seal gel on the mask When the seal becomes discoloured or opaque approximately two weeks dispose of the current seal and replace it with a new one Assembling the flowmeter for spirometry tests In case the spirometry kit option is purchased assemble the turbine as shown in the illustration below 38 Quark b User Manual ELLE D Cardiac Output Module The Cardiac Output Module is provided with the Cardiac Output option and it consists of a special valve together with a bag that has to filled in with a different gas concentration see Chapter 6 for further information Connecting PC Before operating the system make sure the unit is connected to the PC as described in the following illustration J Ej pora el EXE AE AE AE AE AE PIER HE Ler dicil i ds Chapter 3 Installation 39 Software installation Note The software can be installed on Windows XP or Vista It will not work on any previous versions of Windows The software consists of two programs a spirometry program uses a green CD labelled PFT option and the program for ergometry uses a blue CD labelled CPET The programs share the same archive and system calibration program One or both software programs may need to be installed depending
87. er 9 Spirometry 105 e calculated according to the predicteds in the list Use the predicteds formulae e customised by the user with the option or the customised formulae The Delete button deletes the selected parameter The Copy button stores the selected parameter in memory The Paste button inserts a new parameter from the one copied If the name is not unique the user is asked whether to specify a new name or to replace the existing parameter Page set up Page setup Select Page Setup from the File menu Header All the printouts carried out by the program are preceded by 3 rows of customisable header usually they contain the name and the address of the Hospital using the spirometer Data Patient and visit information are printed below the header These data are reported on 3 columns and 5 rows the user may configure the disposition change and eventually cancel the fields as he prefers Margins Configures the print margins from the borders of the paper The unit of measure is decided in Units of measurements Footer Configures information at the bottom of the page Printed file name Defines the automatic name to be asssigned to the pdf file if the report will be printed in this format Page setup x Header Data Margins Footer Printed file name Format zaziz Available fields Zb date of birth Zi ID Zd date of test Zl last name Zf first name s
88. er fields 69 Deleting Steps iter deret enne tne 69 Advanced Editing 4 69 Restore the original test essssssssseeeee 70 Overwrite the original test esses 70 Customise the desktop 70 Customise the display colours ssssssss 70 SMAI Cita ce e RR b e re o ege e CUR VP ea 70 Apply the graphical noise suppression 70 Apply the threshold noise suppression 70 Customise the parameters cccccesccessceseceseceseceeeceeeeeeeeenseenaes 7 Create a new parameter sse 7 Create a new predicted parameter 7 Exportmg data RE E rise or doa 72 Export a testeurs element teste 72 DDE with Excel 72 Creating Test Protocols ssccccsscscssscssssccssssccsssccssssccssccssscssscees 73 Create a new protocol 73 Software configuration c eee ecce e eee ee eee ee eee ee eene nettes o tees noe 74 Data VIS Wi qm 74 Select the parameters to view sss 74 Select the parameters to view during the test 74 Sort the parameters ssssssssssseeeeenenenns 74 Steady State ihe dote ee beet e ETUR cedo ls 74 Customise the Steady State detection criteria 74 Printout reporls 5 1 1 coe ie rece caos eoe s coge sa e os sepa co R eaa e c Re en cs este es dise 75 Set up the printout ss 75 Selec
89. esidual Capacity and Total Lung Capacity ATS workshop on Lung Volume measurements official statement of the European Respiratory Society J Stocks Ph H Quanjer ERJ 1995 8 492 506 Single Breath Oxygen Test Buist SA Ross BB Quantitative Analysis of the Alveolar Plateau in the Diagnosis of Early Airway Obstruction ARRD 108 1081 1973 Mansell A Bryan C Levison H Airway Closure in Children JAP 33 711 714 1972 Buist SA Ross BB Predicted Values for Closing Volumes Using a Modified Single Breath Test ARRD 107 744 751 1973 Rint Lombardi E Sly PD Concutelli G et al Reference values of interrupter respiratory resistance in healthy preschool white children Thorax 2001 56 691 695 Mip Mep Leo F Black Robert E Hyatt Maximal Respiratory Pressures Normal Values and Relationship to Age and Sex American Review of Respiratory Disease Volume 99 1969 Vincken W Ghezzo H amp Cosio MG 1987 Maximal static respiratory pressures in adults normal values and their relationship to determinants of respiratory function Bull Eur Physiopathol Resp 23 435 439 Automatic diagnosis algorithm Reference Lung Function Testing selection of reference values and interpretative strategies A R R D 144 1991 1202 1218 LLN Pred 0 674 SD ATS 50 percentile LLN Pred 1 647 SD ERS 95 percentile LLN Pred 0 8 80 Pred Message interpretation Criterion Normal Spirometry FVC and FEV1 FVC gt LLN Obstructi
90. est has been performed To enable disable the automatic diagnosis 1 Click on Enable Automatic Interpretation checkbox to enable or disable the calculation and the visualisation of the automatic interpretation 2 Select the LLN Lower Limit of Normal Range criteria among the ATS LLN Pred 0 674 SD ERS LLN Pred 1 647 SD or 80 Pred LLN Pred 0 8 specifications Quality control Quark b allows a quality test control The calculation has been carried out referring to Spirometry in the Lung Health Study Methods and Quality Control A R R D 1991 143 1215 1223 The messages concerning the quality control are shown at the end of the test To enable disable the quality control click on Enable Quality Control checkbox Chapter 9 Spirometry 103 Parameters manager Parameters x View Print Soit Customize Not selected parameters Selected parameters H Best FYC aD D2575Zpre Date DFEV1Zposs Date time DFEV1Zpre ERV DFEV1Zpred EVC DFVCZpre FEF25 75 DPEF FET100 DPEFZpre FEV1 Ic 4 gt FEV1 FVCZ Te FEVI VCZ Ti FRC VEXT FRC TLC FYC m All tests FYC Post Show description Show X Pre Show SD Iv Show X Pred Cancel Apply Help The program allows to calculate a huge number of parameters it is advisable in order to simplify the analysis of the results to view to print and to sort the desired parameters only Select the menu item Options Parameters
91. for 30 dip in Ur for amp commended that the Quark 25 cycles 25 cycles b be idee from d lt 5 Ur lt 5 Ur SIT e power supply 95 dip in Ur 29596 dip in Ur for 5 sec for 5 sec Power frequency 3 A m 3 A m Power frequency magnetic 50 60 Hz magnetic fields should be at levels field characteristic of a typical IEC 61000 4 8 location in a typical commercial or hospital environment Note Ur is the a c mains voltage prior to application of the test level Chapter 1 Getting started 17 Guidance and manufacturer s declaration electromagnetic immunity The Quark b is intended for use in the electromagnetic environment specified below The customer or the user of the Quark b should assure that it is used in such an environment Immunity test Test level Compliance Electromagnetic environment level guidance Portable and mobile RF communications equipment should be used no closer to any part of the Quark b including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended separation distance d 1 17VP Conducted RF 3 Veff 3V d 1 17 4 P 80 MHz to 800 MHz IEC 61000 4 6 150 kHz to 80 MHz d 2 33 4 P 800 MHz to 2 5 GHz where P is the maximum output power 3 V rating of the transmitter in watts W Radiated RF is 3 V m according to the transmitter manufacturer IEC 61000 4 3 p to and d is the recommende
92. forts values till 26 C can be considered acceptable in presence of an efficient air ventilation Ending the test The patient should be monitored with ECG for at least 8 minutes in resting conditions or until he returns to the pre exercise conditions Preparing the patient To enhance the value of a diagnostic test it s very important patient collaboration In most cases a well informed patient will make a better effort in relation to his conditions and will allow a reliable interpretation of the test For this reason every ergometric test must be preceded from a precise training of the patient Before testing The physician applying the exam must be provided with a written request including a brief description of the diagnosis confirmed or suspected the request s reason and the patient therapy carried out showing the dose and time of the drug assumption To standardise the response to the test and reduce the patient s anxiety it s suggested to provide him either written before the exam or oral at the same time of the test information At the scheduling time detailed instructions should be delivered to the patient consisting in smoke and food abstinence three hours before an ergometric test or eight hours before a scintigraphic test Test are usually executed supporting the therapeutic outline in progress but sometimes it could be necessary to stop some drugs such as b block or calcium antagonist which could impair the effor
93. ge of motion in the hip or knee to pedal and may perform better walking Deconditioned weak or elderly persons may have to start the test at a low work level and increase the workload in small increments Also field tests may not be appropriate for those who require strict supervision during testing who do not understand the concept of pacing or who cannot be expected to put forth a good effort More consistent results may be obtained by testing in a controlled environment such as a laboratory setting Creativity when selecting protocols may allow adaptations of commonly used protocols to accommodate athletes competing in specific sports Regardless of the type of exercise and protocol selected the same type of exercise and protocol should be used for repeat testing if between test comparisons are important Staffing Test termination Staff members should be able to do the following Establish rapport with the subject and make him or her feel comfortable Recognize normal acute and chronic responses to exercise Recognize abnormal signs and symptoms during exercise Provide basic life support measures competently Adhere to established procedures and protocols NE D DE Clearly explain test results to the individual Sub maximal tests should be terminated according to ACSM or other accepted guidelines see table in the following In the event of an abnormal response the test should be terminated the medical director of the facilit
94. ght seal around the subject s face Performing the test 100 Quark b User Manual Complete the patient preparation as indicated in the chapter Exercise testing Calibrate the analyzers as described in the Calibration chapter Select Test Execute Test or press the icon a or press F2 Select Mixing chamber in the Execute test window and perform the exercise resting test as illustrated in the chapter Exercise testing The mixing chamber 101 Spirometry Setting spirometry options Spirometry The software allows to configure some options selecting Configure from the Option menu Test options x Preferences Spirometry Automatic Interpretation 1 i LLN Calculation ARE v Enable Automatic Interpretation Iv Enable Quality Control IV Response graph in logarithmic scale Print active window FVC in ATS format 2 pages Reduce scale on small curves Cancel Automatic Interpretation Quark b has the function of interpreting each test performed by a patient visualising an automatic diagnosis The algorithm has been calculated basing on Lung Function Testing selection of reference values and interpretative strategies A R R D 144 1991 1202 1218 The automatic diagnosis is calculated at the end of the FVC Test 1f e the automatic diagnosis option is enabled e the patient s anthropometric data allow the calculation of the LLN Lower Limit of Normal range e at least one FVC t
95. he calibration syringe through the adapter 2 Connect the flowmeter to the syringe with the rubber cylinder supplied in the standard packaging Chapter 4 Calibration 45 1 Syringe 2 Silicone tube 3 Adaptor for calibration syringe Note If a bacterial filter is used for the tests do use it also during the turbine calibration Calibrating the turbine After having run the calibration program ASAP eis a sow 1 Select Reference Values from the File menu If your syringe has a different value PC we recommend to set from the default one 3 litres please enter the correct value SH cee 2 Select Calibration Turbine 3 When the Calibration Turbine dialog box appears with the syringe piston initially pushed all the way in move the piston in and out for 5 inspiratory strokes and 5 expiratory strokes in order to get the first values appearing on the display Then move the syringe piston for other 10 strokes IN and EX Turbine Calibration x Syringe volume 3000 ml Results Exp Gain Ins z Gain 3002 07 1046 2993 0 23 1027 0 17 1028 0 93 1052 3010 0 33 1026 0 23 1052 2993 0 23 1027 3019 0 63 1051 2984 0 53 1027 2992 0 27 1051 2990 0 33 1028 2994 0 20 1051 3004 0 13 1027 3009 0 30 1050 3008 0 27 1027 2988 0 40 1051 2996 0 13 1027 2974 0 87 1051 3006 0 20 1027 x 0 2985 0 50 1048 2995 0 0 4 At each of the 10 steps the software displays the results of the manoeuvre and
96. he optional trolley ideal for the Quark b the cylinders the PC the printer The system uses a bi directional digital turbine It opposes a very low resistance to flow 0 7 cmH O l s to 12 l s The air passing through the helical conveyors takes a spiral motion which causes the rotation of the turbine rotor The rolling blade interrupts the infrared light beamed by the three diodes of the optoelectronic reader Every interruption represents 1 6 turn of the rotor this allows to measure the number of turn in the time The O and CO analysers are temperature controlled and the internal pressure and expired flow are monitored for an higher reliability if the measurements The Quark b uses Nafion Permapure which is a semipermeable capillary tube capable of removing the humidity in excess without altering the gas concentrations The analysers calibration is automatic and shows both graphically and numerically the flow and concentration signals and the accuracy of the baseline gain Environmental conditions measurements 22 Quark b User Manual The Barometric pressure is measured by an electronic pressure sensor inside the unit It has a measuring range between 400 mmHg and 800 mmHg Ambient temperature and relative humidity are measured by two sensors contained in the RH TA probe The above measurements are used to calculate BTPS and STPD correction factors Before starting Before operating the Quark b system we strongly recom
97. i M Dias RM Zim W I Consenso Brasileiro sobre Espirometria Jornal de Pneumologia 1996 22 105 164 Scalambrini Costa F Scueiri CEB Silva Jr WC Pereira CAC Nakatani J Valores de refer ncia para espirometria em uma amostra da popula o brasileira adulta da raga negra J Pneumologia 1996 22 165 170 Neder JA Andreoni S Castelo Filho A Nery LE Reference values for lung function tests I Static Volumes Brazilian Journal Medical and Biological Research 1999 32 703 17 Neder JA Andreoni S Lerario MC Nery LE Reference values for lung function tests II Maximal respiratory pressures and voluntary ventilation Braz J Med Biol Res 1999 32 719 27 Thai Wanchai Dejsomritrutai Khun Nanta Maranetra Kittipong Maneechotesuwan Nitipatana Chierakul Jamsk Tscheikuna Tasneeya Suthamsmai Arth Nana Benjamas 136 Quark b User Manual Chuaychoo Phunsup Wongsurakiat Suchai Charoenratanakul Wilawan Juengprasert Chana Naruman Reference Spirometric Values for Healthy Lifetime Nonsmokers in Thailand J Med Assoc May 2000 83 457 466 DLCO Standardized Lung Function Testing Official Statement of the European Respiratory Society The European Respiratory Journal Volume 6 Supplement 16 March 1993 Compilation of reference values for lung function measurements in children Ph H Quanjer J Stocks G Polgar M Wise J Karlberg G Borsboom ERJ 1989 2 Supp 4 184s 261s Reference Values for Residual Volume Functional R
98. ing FEV1 to fall 15 from baseline P20 Provocative dose causing FEV1 to fall 20 from baseline Chapter 2 Measurements 31 Unpacking the system On receipt of your system you should immediately inspect your package for shipping damages in case damage is suspected please contact the reseller immediately Your system has to be installed by COSMED or by an authorised reseller Excessive amount of dust and miscellaneous clutter around the instrument can eventually cause malfunctions due to overheating of components we strongly suggest to keep the unit in a clean environment and well ventilated as possible Quark b and accessories can have place on the trolley as shown in the following illustration Quark unit Printer Calibration cylinder Keyboard Mouse pad Table arm Breathing valve PC Trolley 10 Bag SOOO ISSN UA od G3 D Chapter 3 Installation 33 Setting up the system Before starting operating with the system make sure to meet the environmental and operational conditions reported in Chapter 1 Calibration Gas Cylinder In order to calibrate the sensors you need to have available calibration cylinder with the following gas concentration Cylinder Recommended Gas mixture Calibration O3 16 CO 5 N Bal Gas pressure adjustment procedure The gas regulator has an adjustable second stage that must be adjusted only when used for the first time This is necessary to protect the internal demand
99. ires the interaction of physiological mechanisms that allow the cardiovascular and respiratory systems to supply the increasing demand of energy due to the contraction of the muscles During the training the systems are both engaged an adequate answer to the effort is the measure of theirs health state The increase of the metabolic rate during the exercise needs an appropriate increase of oxygen in the muscles At the same time the CO muscles production must be removed in order to avoid the lactic acid making To satisfy the increase in the gas exchange necessary to the muscles during the exercise is requested the intervention of many physiological mechanisms This process involves lungs the pulmonary circulation the heart and the peripheral circulation Precautions The physician has the responsibility that the patient subjects to the test 1s a suitable person able to execute an effort test Laboratory The room in which the test is performed must be big enough to contain the whole necessary equipment allowing an easier accessibility to the patient in case of emergency In the room should be placed a thermometer and a hygrometer the heart frequency and the perceived values of the effort rise as much as the ambient temperature increases and the variability of the cardiovascular response grows for humidity values higher of 60 Generally it is considered 22 C the temperature adequate for the test execution even for short ef
100. itions IEC 601 1 1988 EN 60 601 1 1990 e Temperature range 10 C 50 F and 40 C 104 F e Relative humidity range 20 to 80 e Atmospheric Pressure range 700 to 1060 mBar e Avoid to use it in presence of noxious fumes or dusty environment and near heat sources e Do not place near heat sources e Cardiopulmonary resuscitation emergency equipment accessible e Adequate floor space to assure access to the patient during exercise testing e Adequate ventilation in the room Guidance and manufacturer s declaration electromagnetic emissions The Quark b is intended for use in the electromagnetic environment specified below The customer or the user of the Quark b should assure that it is used in such an environment Emissions test Compliance Electromagnetic environment guidance RF emissions Group 1 The Quark b uses RF energy only for its internal CISPR 11 function Therefore its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment RF emissions Class B The Quark b is suitable for use in all establishments CISPR 11 including domestic establishments and those directly connected to the public low voltage power supply network that supplies buildings used for domestic purposes Harmonic Emission Class A IEC 61000 3 2 Voltage Fluctuations Complies Flicker Emission IEC 61000 3 3 Guidance and manufacturer s declaration electro
101. lator FEV1 E Dompeling C P van Schayck et Al ERJ 1992 5 975 981 recommend the following parameters DFEV1 pred Change of FVC as a percentage of predicted value DFEV1 poss Change of FEV1 as a percentage of possible value Methacholine and Histamine Bronchial provocation Tests The most common indication for performing methacholine and histamine bronchial challenges is to diagnose hyperresponsive airways Some patients demonstrate normal baseline pulmonary function despite complaints of tightness wheezing cough and a little or not response to bronchoconstrictor Other patients demonstrate spirometric improvement after use of bronchoconstrictor have diurnal variation in peak flows In this groups aerosolised bronchial challenges are used to confirm a diagnosis of Asthma We can summarise the use of the test as follows 1 Diagnose asthma 2 Confirm a diagnosis of asthma 3 Document the severity of hyperresponsivness 4 Follow changes in hyperresponsivness When patients with hyperresponsive airways inhale certain pharmacologic agents i e Methacholine or histamine the airways respond by constricting Test consists of executing repeated FVC following the pharmacologic agents inhalation according to an established protocol The fall of the FEV1 parameter is used to calculate the bronchial hyperresponsivness The most important parameter is the PD20 that is amount of drug mg ml that causes a reduction of 20 of the FEV1 respec
102. ll be displayed In this way the user can check the calibration procedure both graphically and numerically At the end of the procedure the software displays the new calibration factors vs the old ones report In the Calibration program choose Print from the File menu Edit the calibration factors 44 Quark b User Manual The last sensors calibration factors can be either edited or viewed To do this choose Gas Results from the File menu To view or edit the last Turbine calibration factor choose Turbine results from the File menu Note To restore factory setting press Default button in the dialog box Once you press the default button you must run a new calibration before testing Turbine calibration The system uses a turbine flowmeter It opposes a very low resistance to flow 0 7 cmH 0 I s to 12 l s The air passing through the helical conveyors takes a spiral motion which causes the rotation of the turbine rotor The rolling blade interrupts the infrared light beamed by the three diodes of the optoelectronic reader Every interruption represents 1 6 turn of the rotor this allows to measure the number of turn in the time There is a constant ratio between air passing through the turbine and number of turns This allows an accurate measure of flows and volume The turbine flowmeter doesn t need daily calibrations as it is not affected by pressure humidity and temperature To work properly the turbine only
103. lls within the range 0 7 1 3 and adjust the flow rate of the pump as necessary If the FeCO is too low you should decrease the flow rate and if the FeCO is too high you should increase the flow rate A low FeCO may result in unreliable measurements while a high FeCO could be dangerous for the patient 2 Do not place Canopy hood over a patient s head before the tube is properly connected and a continuous flow is applied from Canopy Blower 84 Quark b User Manual Performing a test using the face mask Calibrations Before the test it is necessary to perform an ergo calibration see Calibration chapter and it is advisable to perform also a turbine calibration see Recommendations in this chapter How to prepare a patient Start the test The patient interfaces with the equipment by means of a face mask as depicted in the following image The mask has to be tight to the face in order to avoid any air leakage Make sure that the subject health status is acceptable according to what stated in the guidelines Make the subject sit or lay on a comfortable chair or bed Fix the mask to the subject as illustrated in the above picture pull the elastic strings Point A and B accurately in order to eliminate possible leaks The mask must be perfectly sealed to the face of the subject especially in correspondence with the nose point C The mask adapt differently according to the face shape of the subject The perfect
104. m Phase Time rmi Te Iv VT 02exp Cus Ci Res 00 00 03 2 35 0 69 0 912 154 4 ds Hest RS 4 4 2 Warm up 00 00 06 140 2 22 0 93 1 133 192 0 SHSESCIENE 00 00 11 1 39 2 49 0 90 1 121 190 5 PA Recovery 00 00 15 1 41 2 40 0 86 1 018 i 172 8 I Marker 10 00 00 19 1 40 i 2 54 0 87 1 020 172 9 00 00 23 1 48 2 57 0 90 1 041 176 3 ok 00 00 27 141 2 61 0 84 0 935 159 0 Cancel 00 00 30 1 44 2 43 0 82 0 919 156 5 3 RER ASE anea RS Y hi ire dr E Preview 00 00 34 1 43 2 46 0 84 0 947 161 6 1 1 Filtering 00 00 38 1 46 2 29 0 83 0 960 164 5 Delete step 00 00 41 1 40 2 25 0 80 0 936 160 7 Locos f ai conu Advanced 00 00 45 1 44 2 25 0 78 0 956 163 6 mms Restore 00 00 49 1 39 2 27 0 77 0 921 157 4 Overwrite 4 di m ee Eee Test n 21 Stepn 1 230 Duration 00 16 15 Data filtering Select Filter Type x Filter Y C Discard invalid steps Averaging 00 24 o C Smoothing Points e Cancel Choose Edit test from the Test menu 2 Press the button Filtering and choose the option Discard invalid steps to automatically eliminate all the invalid steps 3 Press the button Filtering and choose the option Averaging and type the desired value for points Ave smooth to perform an averaging of the all acquired steps This feature reduces the size
105. magnetic immunity The Quark b is intended for use in the electromagnetic environment specified below The customer or the user of the Quark b should assure that it is used in such an environment Immunity test Test level Compliance level Electromagnetic environment guidance Electrostatic 6 kV contact 6 kV contact Floors should be wood discharge ESD 8 kV air 8 kV air concrete or ceramic tile If IEC 61000 4 2 floors are covered with synthetic material the relative humidity should be at least Electrical fast 2 kV for power 2 kV for power Mains power quality should transient burst supply lines supply lines be that of a typical IEC 61000 4 4 1 KV for 1 KV for commercial or hospital input output lines input output lines Environment Surge 1 kV differential 1 kV differential Mains power quality should IEC 61000 4 5 mode mode be that of a typical 2 kV common 2 kV common commercial or hospital mode mode environment Voltage dips short lt 5 Ur lt 5 Ur Mains power quality should interruptions and 29596 dip in Ur gt 95 dip in Ur be that of a typical voltage variations on for 0 5 cycles for 0 5 cycles commercial or hospital power supply input 40 Ur 40 Ur environment If the user of the lines 60 dip in Ur for 60 dip in Ur for Quark b requires continued IEC 61000 4 11 5 cycles 5 cycles operation during power mains interruptions it is 70 Ur 70 Ur 2 30 dip in Ur
106. mend to check the equipment and register you as a customer Checking the packing contents Make sure that the package contains the items listed below In case of missing or damaged parts please contact Cosmed technical assistance Quark b standard packaging Code C00930 01 04 C02120 01 05 C02170 01 11 A 800 900 001 C00243 01 06 C02210 02 08 C01399 02 12 C02910 01 10 C02911 01 10 C02912 01 10 C00861 01 06 A 661 200 001 A 661 200 002 A 182 310 001 C01804 02 11 C01348 01 06 A 388 010 004 A 362 060 001 A 362 300 001 A 680 013 630 A 680 024 125 C01790 01 36 C01999 01 DC C00067 02 94 C01340 02 91 Description Quark b ergo unit Turbine 28mm Kit optoelectronic reader Quark ergometry Head cap for the adult masks Calibration Syringe 3L Permapure L2m Cable in HR TTL Mask mouth nose breath adult S Mask mouth nose breath adult M Mask mouth nose breath adult L HR probe HR elastic belt HR polar transmitter Anti moisture filter Calibration tube External RH TA probe Filtered serial adapter Power cord Schuko 2m RS232 cable DB9 M F Time lag fuses 5x20 250V T630mA Time lag fuses 5x20 250V T1 25A PC software Conformity declaration Registration card Quark b User Manual Chapter 1 Getting started 23 Warranty registration 24 Quark b User Manual Before using the system please take a moment to fill in the registration form and the warranty and return them to COSMED by doing this you are eligibl
107. menu 2 For calculating it automatically on the Lactate Threshold dialog box click on the Auto detect button 3 For adjusting manually the point you want to detect move the scroll bar on the dialog box by pressing the arrow buttons Data and graph of the LT will be automatically redrawn 4 Press Ok button to save your choices Lactate Threshold xi VCO02 ml min Fet02 5 Fetcoz vvv 3991 4 18 004 i 18 00 Li 3592 16 20 E ed 16 20 k z 5 tet n Note Double click in the 3139 ELE M window to open the 2794 12 60 12 60 corresponding dialog box 2395 10 80 10 80 1996 4 9 00 i 9 00 15965 7 20 H 7 20 ptm 1197 5 401 5 40 7984 i 3 60 i 3 60 3994 1 80 i 1 80 ip 02 nl sin 0 00 V02 n1 min 0 798 1596 2395 3193 3992 0 798 1596 2395 3193 3992 VE VO02 VE VCO2 Parameter Values LT Max Max 53 I 53 t hh mm ss 00 05 30 00 11 00 50 0 48 48 Load watt 30 450 20 0 VN i di Real Load watt 0 0 00 sarl i 2 Revolution RPM 0 0 0 0 A VO2 ml min 1217 3032 401 32 i a2 V02 Kg ml min Kg 16 01 39 90 40 1 2 i E 27 VCO2 ml min 1060 3991 26 5 aud ck gi VE l min 247 1307 18 9 RM ag HR bpm 87 152 57 2 i9 au R 0 87 1 68 51 6 5 H 5 V02 ml min LT af fa OK Cancel 0 798 1596 2395 3193 3992 Customise graphs for the LT viewing The software allows to customise two
108. nd select the Canopy mode Confirm and start the test by pressing OK In the first part of the test the flow rate of the pump has to be adjusted by means of the Flow adjustment handle on the front panel of the Canopy unit in order to measure an FeCO between 0 7 and 1 3 FeCO values can be read on the right side of the PC monitor When the FeCO remains within the acceptability range press F2 to start the data acquisition Verify also during the test that the measured FeCO is within the 0 7 1 3 range Otherwise adjust it by means of the Flow adjustment handle Viewing the test vvv Note The percentage of used Proteins PRO is calculated assuming 12 grams of Ureic Nitrogen in 24 hours You can modify this value selecting View Information gt Modify Warning If the green led turns off during the test the red led flashes and the alarm beeps abort the test because the pump does not work or the mains does not power the system In the last case the pump works only because of the backup battery The test is fully automatic the software will stop it and save the data at the end At the rend of the test it will be opened automatically a window with the test results At the end of the test or if it is selected View RMR the main results are shown e The average time interval default 10 minutes e Average values of VO VCO R RMR VE HR FAT and CHO and predicted values if available e Body Mass Inde
109. nded use Warnings Quark b is an electrical medical device designed to perform pulmonary function tests It is to be used by physicians or by trained personnel on a physician responsibility Caution Federal law restricts this device to sale by or on the order of a physician This equipment has been conceived with the aim of providing an auxiliary instrument allowing e the formulation of lung pathology diagnosis e important studies concerning human physiology e the collection of important information in sport medicine No responsibility attaches COSMED Srl for any accident happened after a wrong use of the device such as e use by non qualified people e non respect of the device intended use e non respect of the hereunder reported precautions and instructions The device the programme algorithms and the presentation of measured data have been developed according to the specifications of ATS American Thoracic Society and ERS European Respiratory Society Other international references have been followed when these were not available All bibliography references are reported in Appendix The present handbook has been developed with respect of the European Medical Device Directive requirements which sort Quark b within Class II a It is recommended to read carefully the following precautions before putting the device into operation The precautions reported below are of fundamental importance to assure the safety of all COS
110. nose clip is also sometimes used but it may create overly stressful conditions to a subject patient Important considerations or conditions to improve the RMR measurement e No food for at least 12 hours and no smoke for at least 2 hours before the test e Maintain quiet surroundings when the test is in progress and normal temperature The individual should not move arms or legs during the test e Medications taken should be noted such as stimulants or depressants e The first 5 minutes of acquisition should be discarded by the computation of RMR e Steady state should be achieved which would be identified clinically by the following criteria 5 minute period when average minute VO and VCO changes by less than 10 average RQ changes by less than 5 e Stable interpretable measurements should be obtained in a 15 to 20 minute test e Renal failure patients requiring hemodialysis should not be tested during dialysis therapy Chapter 7 Resting Metabolic Rate Test 83 Recommendations Before starting an RMR test it is necessary to select and calibrate the turbine used Read carefully the calibration procedure in the Calibration chapter Resting metabolic rate test using the face mask Use the following correction for the dead space VD 50 ml for the small mask 60 ml for the medium mask 70 ml for the large mask Resting metabolic rate test using the canopy option 1 Verify before and during the test that the FeCO fa
111. nt B 0 93 M Constraint Tau 40 0 Constraint Max attempts 100 Cancel 2 Make active the graph window any Y vs any X graph Right click and select Fitting Choose Mono exponential in the type combo box 1 2 3 4 Select the first point X1 moving the mouse on the desired place in the graph pressing the Left key or using the and keys 5 Select the second point X2 moving the mouse on the desired place in the graph pressing the Right key or using the and keys 6 Enter if necessary the initial values of A B and TAU these are the values from which the iterative algorithm starts in order to reach the best values the closer are the initial coefficients to the best ones the higher is the possibility to reach the best fit 7 Press OK to confirm Oxygen Kinetic Calculate the Mean Value 1 Make active the graph window any Y vs any X graph 2 Right click and select Fitting 3 Choose Mean value in the type combo box 4 Select the first point X1 moving the mouse on the desired place in the graph pressing the Left key or using the and keys 5 Select the second point X2 moving the mouse on the desired place in the graph pressing the Right key or using the and keys 6 Press OK to confirm Note The results of the O2 Fittings function are not stored therefore in order to keep the information print the page using File print Active Window This function is availabl
112. ntended for use in an environment in which radiated RF disturbances are controlled The customer or the user of the Quark b can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and the Quark b as recommended below according to the maximum output power of the communications equipment Rated maximum Separation distance according to frequency of transmitter output power of m transmitter W 150 kHz to 80 MHz 80MHzto800 MHz 800 MHz to 2 5 GHz d 1 17 4 P d 1 17 4 P d 2 33 4 P 0 01 0 12 0 12 0 23 0 1 0 37 0 37 0 74 1 1 17 1 17 2 33 10 3 70 3 70 7 38 100 11 70 11 70 23 33 For transmitters rated at a maximum output power not listed above the recommended separation distance d in metres m can be determined using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer Notes 1 At 80 MHz and 800 MHz the separation distance for the higher frequency range applies 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people Chapter 1 Getting started 19 Safety and conformity 20 Quark b User Manual Safety IEC 601 1 1988 EN 60 601 1 1990 Find reported below the c
113. of the three graphs for the LT visualisation 1 Choose Lactate Threshold from the Options menu 2 Choose the parameters you want to be shown on the LT window and press OK to confirm your choices Chapter 6 Exercise Testing 63 Fittings 64 Quark b User Manual The purpose of the fitting function is to find the function that fits as better as possible the measured data The software allows to fit data according to 3 different functions Model Function Algorithm Available for Linear Y A X B Least squares Any Y vs any X graph Mono Exp Y A B exp t to tau Levemberg Marquardt Any Y vs Time Graph Mean value This function is available only if the active window is a single Y graph i e VO vs time or VO vs Load Fittings Selection or Z x1 00 00 03 ES Type CNE Iv Add EE uim ok Cancel rd Fit a graph with a linear regression 1 Make active the graph window any Y vs any X graph 2 Right click and select Fitting 3 Choose Linear in the type combo box 4 Select the first point X1 moving the mouse on the desired place in the graph pressing the Left key or using the and keys 5 Select the second point X2 moving the mouse on the desired place in the graph pressing the Right key or using the and keys 6 Press OK to confirm Fit a graph with a Mono exponential regression Insert initial factors for the formula Y B A l exp t Tau J A DAE Constrai
114. og Digital auxiliary inputs AUX RS232 With the eight analog inputs the auxiliary RS 232 port and the digital TTL input for external ECG signal Quark b offers the possibility to integrate data coming from many equipment such as ECGs and ergometers This bi directional serial interface is used to connect ergometers such cycloergometers and treadmills in order to read and or control workload data during an exercise test Pin out assignment pin Signal Shield RX TX GND RTS shortcut with pin 8 CTS shortcut with pin 7 Oly nm wl NR Handshaking protocol configuration Quark b is compatible with any ergometer incorporating a RS232 serial interface The handshake protocol can be configured according to the specification supplied by the manufacturer of the ergometer by using the program Ergoman exe contained in the installation disk of the exercise program Note to receive the last update file containing all the handshake protocols already implemented contact directly COSMED or an authorised dealer AUX1 AUX4 analog Inputs The Quark b has 8 analog inputs for acquiring analog signals coming from external devices blood pressure ECG the range of the analog inputs is 0 to 5 Volts for channels AUXIA AUX2A AUX3A and AUX4A 0 to 10 Volts for channels AUX1B AUX2B and AUX3B You can order the Aux interface cable with the P N C01557 01 12 Enable the AUX input When you receive the Quark b system from
115. omplete classification of the device e Class I type B device e Protection against water penetration IPOO ordinary equipment unprotected against water penetration e Non sterile device e Device not suitable in the presence of flammable anaesthetics e Continuous functioning equipment EMC The system meets the EMC Directive 89 336 EN 60601 1 2 EN 55011 Class B emission IEC 1000 4 2 IEC 1000 4 3 IEC 1000 4 4 Quality Assurance UNI EN ISO 9001 2000 Registration n 387 A Cermet UNI EN ISO 13485 2003 Registration n 387 M Cermet Medical Device Directive CE mark MDD 93 42 EEC Notified Body 0476 Class IIa Here are the keynotes used to make the manual easier to read Typographic keynotes Graphic keynotes These are the typographic keynotes used in the manual Style Description Bold indicates a control or a key to be pressed Ttalic indicates a messages shown by the firmware These are the graphic keynotes used in the manual Illustration Description STRRT mp shows the button to click in the software to activate the related feature Chapter 1 Getting started 21 System overview Main features Flowmeter Gas analysers The Quark b unit contains the main items analysers electronic controls valves It is connected to the PC through an RS232 interface The modular architecture allows to replace the boards without any other technical service The unit can be used on a desktop or on t
116. on the device configuration Installing the software Run the software Note The software is copyright protected and should be installed only from the original disk 1 Insert the installation CD into the CD ROM drive 2 The installation will begin automatically If the disc does not start automatically you will need to run Setup exe 3 Follow the instructions given by the dialog boxes to complete the installation 4 When the installation is finished the program will alert you that the installation has been successfully completed Note If both programs are installed the directory for the CPET software should be the same as the PFT directory default is C PFTSUITE 1 In the Windows Start menu open the Program Group in which the software was installed 2 Click the CPET or the PFTSuite icon PC port configuration 40 Quark b User Manual The first time the software 1s used it is necessary to configure the communication port with the PC USB COMI COM2 For further details see the chapter Database management Software main features Display Tool bar Dialog windows Scroll bars On line help Software version The program may contain several windows The active window is highlighted with a different colour of the caption Some functions of the program are active window sensitive Print right key of the mouse Many of the functions that may be selected from the menu can be activ
117. onnector of the Canopy unit Chapter 7 Resting Metabolic Rate Test 89 Performing the test STRRT 90 Quark b User Manual How to prepare the patient 1 Switch on the Canopy unit If there are no problems the red led on the front panel of the unit flashes for few seconds and the alarm beeps If the led does not flash and or the alarm does not beep the test cannot be performed because the backup battery is exhausted or there is no backup battery When the green led turns on the test can start If the green led does not turn on the red led flashes and the alarm beeps the test cannot be performed because the pump does not work or the mains does not power the system After these checks put the patient in a supine position Place the bubblehood with the vail on the patient s head The tube has to be placed near the patient s mouth Warning Do not place Canopy hood over a patient s head before the tube is properly connected and a continuous flow is applied from Canopy Blower 1 2 3 Enter in the ergometry program Select a patient or add a new one File Patients Select Start test from Test menu Execute Test Height cm 180 Mode C Bas Weight Kg go C ECG C Gas ECG C RMR Canopy Simulated test Ergometer no one Protocol RMR Other data Details Le Le Le Workspace RMR Cancel Other data Bee tme Enter the patient s data a
118. oods not in original shipping containers Goods which have been altered or abused in any way 5 The following parts are not covered by warranty consumables fragile glass or plastic parts rechargeable batteries damages at the damages due to use of the device not conforming to the indication reported in this manual 126 Quark b User Manual Repair Service Policy Goods returned to seller for Non Warranty repair will be subject to conditions 1 2 3 4 The returned goods need to re enter COSMED together with the customs documents Pro forma Invoice and Customs Paper as requested by the Italian law e The shipment has to be qualified as a Temporary Export e All the goods returned to COSMED without the customs papers will not be accepted For European Community members Pro Forma invoice complete with e Number e Description of the goods e Quantity e Serial Number e Valuein e Number of parcel e Gross weight e Net weight e Reason for resent i e Resent for repair In case you should send the system for repair please contact the nearest service centre or contact COSMED at the following address COSMED S r l Via dei Piani di Monte Savello 37 P O Box 3 00040 Pavona di Albano Rome Italy tel 39 06 9315492 fax 39 06 9314580 E mail customersupport cosmed it For USA customers only please contact COSMED USA Inc 2211 North Elston Suite 305 Chicago IL 60614 USA Phone 1 773 6
119. or Minimum number of steps VO threshold VE threshold and R threshold The steps which satisfy these conditions will be highlighted with a yellow bar Printout reports The software allows the user to printout data and graphics according to 4 customisable reports Further it allows the user to customise a printout header that will be printed in each page Set up the printout l 2 3 ET r Report n Printed pages ad C2 C3 C4 Test data Iv Predicted values II M Lactate threshold Test summary 5 Parameters Comments v Graphs in one page M Graphs Print Y1 Axis Y2 Axis X Axis Nil ve Loadi ft x More N2 HR vo2zuR m t More N 3i vn2 vco2 x More Na is T Tu s vo N Zlv yt ino graph VE zx More N 8 v n M no graph M t M More NSM Pet02 Petco2 fe x More N30 n EM no graph ET A More NIIT nr EM no graph E Ej Mores NAT Rf E no graph Mt x we Cancel Restore 2 Choose Reports from the Options menu Define the desired features of the report and confirm Enabling the option Graphs in one page all the graphs selected in the report will be printed in one page Type the name you want apply to the report and press OK to save changes Select parameters to be printed Quark allows to print a large number of parameters it is advisable in order to simplify the analysis of the results to
120. oregoing warranty unless 1 COSMED is promptly notified in writing by Buyer upon discovery of defect 11 the defective product 1s returned to COSMED transportation charges prepaid by Buyer 1i1 the defective product is received by COSMED no later than four weeks after the last day of the one 1 year limited warranty period and iv COSMED s examination of the defective product establishes to COSMED s exclusive satisfaction that such defect was not caused by misuse neglect improper installation unauthorised repair or alteration or accident If the product is manufactured by a third party COSMED shall make available for the Buyer s benefit only those warranties which COSMED has received from the third party manufacturer s COSMED hereby specifically disclaims any and all warranties and or liabilities arising from defect s and or damage s to and or caused by products manufactured by third party manufacturers Buyer must obtain written authorisation from COSMED prior to the repair or alteration of COSMED products s Failure of Buyer to obtain such written authorisation shall void this warranty COSMED hereby specifically disclaims any and all other warranties of any kind whether express or implied in fact or by law including but without limitation any and all warranties of merchantability and or fitness for a particular purpose COSMED shall not be liable for special indirect and or consequential damages nor for damages of any kind
121. ortance to control infections and assure patient safety In fact aspiration of residue particles and contaminated agents are life threatening In this handbook we strongly recommend you to follow the rules worked out by ATS and ERS see Lung Volume Equipment and Infection Control ERS ATS WORKSHOP REPORT SERIES European Respiratory Journal 1997 10 1928 1932 which are summarised as follows e Accessible internal as well as external surfaces of equipment exposed to expired gas should be washed and disinfected prior to testing of subsequent patients e Liquid disinfection can be used if the equipment is well cleaned first no droplets of saliva sputum remain e Disposable gloves should be worn when handling mouthpieces when cleaning equipment exposed to saliva or sputum and especially when drawing blood e Laboratory staff should wash hands prior to testing of each patient e Adopt particular precautions when testing patients with recognised high risk communicable diseases e g tuberculosis multidrug resistant staphylococcus In these cases the clinical need for such testing should justify the risks During the disinfection e do not use alcohol or other liquids containing gluteraldehyde on the exterior surfaces of the equipment Actually they can damage polycarbonates plastics and may produce unhealthy substances e do not use abrasive powders or glass cleaners containing alcohol or ammonia on the plexigl
122. ot put it under direct water spout e Do not wet neither the sampling tube nor the connector on the other end of the cable e Donotuse alcoholic solutions to clean the turbine Two way non rebreathing valve cleaning option Refer to the indications reported in the sheet shipped together with the valve The valve must be disinfected after each usage on a patient Mixing chamber cleaning and disinfection option Before disinfecting the mixing chamber disassemble it unscrewing the screws in the top cover Note do not use alcohol solvents or other abrasive substances for cleaning the mixing chamber For disinfecting the mixing chamber plunge each part in the disinfecting solution for 20 minutes Rinse and wipe After the cleaning carefully close the mixing chamber Permapure maintenance e Do not bend squash or deform it e Do not keep it in open air if not used especially in crowded or smoky places Chapter 10 System maintenance 121 Inspections Replace the fuses e If saliva is entered in the tube replace it immediately because it lost its functions e Periodically grease the o ring on the connector in order to simplify the flowmeter connection e Replace it every 100 test 6 month The equipment requires easy inspections to be carried out in order to assure a proper electrical and mechanical safety level in the years These inspections are highly recommended after a rough use of the equipment or
123. pe B EN60601 1 Equipment type BF EN60601 1 Danger high temperature OFF ON Protective earth ground Alternating current Contraindication The physical strain to execute the respiratory manoeuvre is contraindicated in case of some symptoms or pathology The following list is not complete and must be considered as a piece of mere information Contraindications for the Spirometer tests Absolute contraindications For FVC VC and MVV tests e Post operating state from thoracic surgery For FVC tests e Severe instability of the airways such as a destructive bronchial emphysema e Bronchial non specific marked hypersensitivity e Serious problems for the gas exchange total or partial respiratory insufficiency Relative contraindications For FVC tests e spontaneous post pneumothorax state e arterial venous aneurysm e strong arterial hypertension e pregnancy with complications at the 3 month For MVV test e hyperventilation syndrome Contraindications for Bronchial provocation tests The bronchial provocation tests must be executed according to the doctor s discretion There are not data that reveal specific contraindication for the bronchial provocation test through inhalation The modern standard processes have been revealing secure in several clinical studies However it is recommendable to respect the following contraindications Absolute contraindications e Serious bronchial obstruction FEV 1
124. port preview on the screen Printing the active window This printout function is only enabled when the active window title bar highlighted is one of the following objects e Any kind of Graph e Numeric data e List of visit To print the active window Ensure that the active window is one of the preceding objects 2 Select Print Active window from File menu Printing a series of reports Sometimes it 1s useful to printout automatically a series of reports all tests carried out with the employees all tests carried out in the today s session To print out proceed as follows 1 Select Visit List from the File menu 2 Set the criteria of the visits to be added in the list from to 3 Select Print Report from the File menu Electronic reports pdf If an Adobe PDF writer Printer Driver is installed and set as the default printer it is possible to store the printout report automatically in any location of the HD or eventually LAN paths according to a customizable filename format It is possible to define the created filename format selecting File Page Set up see Page set up Chapter 9 Spirometry 115 Export data With this function you can export the test data in 4 different formats txt ASCII xls Microsoft Excel wk1 Lotus 123 xpo Cosmed Export a test l 2 3 116 Quark b User Manual Select Export tests from the File menu Select the test to export from the
125. position is therefore to be determined from subject to subject 1 Enter in the ergometry program 2 Select a patient or add a new one File Patients 3 Select Start test from Test menu Chapter 7 Resting Metabolic Rate Test 85 86 Quark b User Manual Modify test information x 1D code Last name Bonn First name JAMES P Sex Birth Date 0670371957 3S Ethnic Corr 100 Female a Mode Height em 178 0 Temperature C js Height cm 178 0 6 po ARR an et Weight Ka 76 0 SEE HB max bpm 187 Press mmHg 760 C Gas ECG C Rest ECG FEY 1 I 0 00 Temp flowm C 34 c UN g day 0 0 Hum flowm 100 I Simulated test VD mij 0 incremental test cycloergometer Ergometer no one M Notes Protocol RMR El _Other data Distance 0 00 Unit of meas Workspace RMR zj Details Load 1 Load Unit of meas Watt Load 2 Real Load Unit of meas wat Cancel Cancel Load 3 Revolution Unit of meas RPM Fa Enter the patient s data and select the RMR mode 1st picture 5 Press Other Data and enter the dead space value 50ml Small mask 60ml Medium mask and 70ml Large mask It is possible to enter the Ureic Nitrogen value NU 2 picture 6 Confirm and start the test by pressing OK Selecting RMR the system set automatically the following options e Data acquisition with a 30 seconds average e RMR protocol which is 5 minutes
126. ption Calibration cylinder 5 CO2 16 O2 balance N2 Trolley for Quark PFT Trolley with arm for Quark PFT Pressure regulator for calibration cylinder Mask mouth nose breath ID28 adult XL Mask mouth nose breath ID28 paediatric L Mask mouth nose breath ID28 paediatric S Paediatric Headcap Oxymeter Heart rate monitor Cardiac output Spirometry Extension oxymeter cable Silica gel 500g Chapter 1 Getting started 25 PC configuration required 26 Quark b User Manual Pentium II 350 MHz Windows XP Vista 64 Mb RAM CD drive VGA SVGA monitor Serial Port RS 232 available 2 serial ports in case of Ergometer control An USB port can replace one RS232 serial port if using the USB RS232 adaptor Cosmed code A 388 410 001 Any Mouse and Printer compatible with the MS Windows operative system PC conform to European Directive 89 336 EMC Technical features Flowmeter Type Bidirectional digital turbine 28 mm Flow Range 0 03 20 L sec Accuracy t 296 Resistance 0 7 cmH O s L 12 L s Ventilation Range 0 300 litres x min Oxygen Sensor O Type Zirconia temperature controlled Response time 120 ms Range 1 100 O Accuracy 0 01 O2 Carbon Dioxide Sensor CO Type NDIR Response time lt 120 ms Range 0 15 Accuracy 0 03 Humidity absorber Capillary of Nafion Permapure Power Supply Voltage 100V 240V 10 50 60Hz Power consumption 100W Environmental Sen
127. r to read the desired value Chapter 10 System maintenance 123 Conformity declaration Manufacturer COSMED S r l Address Via dei Piani di Monte Savello 37 00040 Pavona di Albano Laziale RM ITALY phone 39 06 93 15492 fax 39 06 9314580 manufacturer of the following equipment Quark b declares under his sole responsibility that e the above listed equipment comply with the essential requirements of the Annex I of the Medical Device Directive 93 42 EEC e are classified in Class IIa e their design manufacturing and final checks are performed according the Cosmed s Quality System conform to ISO 9001 2000 and ISO13485 2003 Norms certified by CERMET certificates nr 387 A and 387 M e are CE marked according to the Medical Device Directive 93 42 EEC and certified by CERMET certificate nr MED 9811 The equipment conform with the following specifications Safety CEI 62 5 IEC 60601 1 EN 60601 1 EMC EN 60601 1 2 Chapter 11 Appendix 125 Service Warranty Warranty and limitation of liability COSMED provides a one 1 year limited warranty from the date of the original sale of COSMED products All COSMED products are guaranteed to be free from defect upon shipment COSMED s liability for products covered by this warranty is limited exclusively to replacement repair or issuance of a credit for the cost of a defective product at the sole discretion of COSMED COSMED shall not be liable under the f
128. requires the rotor to rotate freely without any friction that might be caused by dust that can be easily avoided with an ordinary cleaning procedure see Maintenance However in order to ensure accuracy it s recommended to run periodically the calibration procedure Calibration has to be carried out with a calibration syringe of 3 litres volume the calibration procedure is totally managed by software A measurement system should be calibrated daily in order to ensure maximum accuracy and reliable test results If a correct maintenance is provided it s possible to check the calibration of the turbine flowmeter even at relatively long intervals 1 e 1 month The calibration procedure assures valid and verifiable results within a 3 accuracy The calibration syringe The 3 litres calibrated syringe is included in all the Quark PFT line with the exclusion ofthe PFT 1 model 3 litres calibration syringe P N C00600 01 11 Turbine calibration for ergospirometry tests Before starting the calibration procedure be sure that the turbine type is properly selected in the calibration program select File Turbine results in the field Type mm must be entered 28 Turbine calibration results Actual Type mm 28 Gain Exp 1000 Beene 200 1100 Gain Ins 1000 Gain Ins 300 1100 Acceptable Range Cancel Factory Settings Hep Assembling the flowmeter 1 Connect the Opto reader to t
129. ressing the button by side Row data Name BA Unit of meas actor Precision Aux4B Aux4B You might configure the following options for each of the 8 channels Name identify the parameter Unit of meas unit of measurement Base line and Gain factors used to convert the acquired raw data mV into the final format according to Y mV BL Gain The value entered for gain must be multiplied by 1000 for Gain 1 enter 1000 Precision the number of decimals shown as 0 Pin out assignment pin AUX1 Signal AUX2 Signal AUXS Signal 1 AUXIA 0 5V AUX2A 0 5V AUX3A 0 5V 3 AUXIB 0 10V AUX2B 0 10V AUX3B 0 10V 4 GND GND GND 5 GND GND GND pin AUXA Signal 7 AUXAA 0 5V nc AUXAB 0 10V 4 GND 132 Quark b User Manual Heart Rate TTL input The Heart Rate TTL input allows to measure the hearth rate signal from any ECG with a pulse signal 0 5 Volts available or from the POLAR belt receiver probe Referring to the connector labelled as HEART RATE on the rear panel of the Quark PFT the pin out assignment is the following pin Signal 5 TTL input 4 GND Chapter 11 Appendix 133 Calculations references VO and VCO Energy Expenditure and Fuel Selection in Biological Systems The Theory and Practice of Calculations Based on Indirect Calorimetry and Tracer Methods M Elia G Livesey World Rev Nutr Diet Basel Karger 1992 vol 70 pp 68 131 Nutritional Assessment in Critic
130. s not available Help contains a description of each command and dialog box and explains many procedures for accomplishing common tasks To get the Help on line press the F1 key To know the software version and the serial number of the software select About Quark b from Help menu Chapter 3 Installation 41 Calibration Calibrating sensors The software allows to automatically calibrate zero gain and delay of gas sensors Even If the program doesn t force you to carry out the calibration we strongly recommend to execute it before each test Running the Calibration program Eh Start the program and choose Calibration from the Test Menu The software runs the Calibration software and the main menu changes accordingly Log file The program creates and updates as default the calibration log file containing the conditions and the results of all the calibrations performed by the user To access the file select File Report File from the calibration program Setting reference values Before starting calibrating make sure that the system has been configured correctly by setting the right values of gas concentration of room air i e 20 95 O and 0 03 CO of gas mixture contained in the cylinders and the volume of the calibration syringe i e 3 litres To set the reference values This operation must be performed only the first time The next times the system keeps stored the reference values entered in this step
131. set of predicteds click on the Delete button If a set 1s deleted also the associated formulae are deleted It is possible to generate a new set of predicteds with the same attributes and the same formulae of the selected one To do this click on the Copy button and specify a new Name To import a set of predicteds click on the Import button and select a file of Predicteds files type To export a set of predicteds click on the Export button In the list Set current predicteds choose the current predicteds for printing and viewing Set the current predicted Quark b allows to calculate the predicted values according to the following configurable sets Adult Paediatric ERS 93 Zapletal Knudson83 Knudson83 ITS white ITS white ITS black ITS black LAM LAM MC Barcellona MC Barcellona Nhanes III Nhanes III Select the desired choice in the group Predicted Formula definition Predicteds Et Predicteds set Formula definition 9 Predicteds set NN Description G Use the predicteds formulae oy the customized formulae Male Female Formula Standard Deviation yo MN B Adult peo se Parameter Save Delete Cancel Apply Help This form allows the user to manage the formulae associated to a set of predicteds Select the set of predicteds from the list Predicteds set To insert a new parameter click on the New button The parameter formulae can be Chapt
132. sex Cancel In the example it has been set to create a filename composed by lt date of the test gt followed by lt last name gt and lt first name gt 106 Quark b User Manual Spirometry tests vvv Note Read carefully the contraindications in Chapter 1 Once completed the phases of the introduction of the patient s data and the visit data it is possible to carry out the spirometric tests Quark b allows to perform the following tests Key Test FVC pre Forced Vital Capacity FVC post Forced Vital Capacity after bronchial stimulation SVC Slow Vital Capacity MVV Maximum Voluntary Ventilation Before performing any test make sure that 1 Quark b is properly connected to your PC and the selected serial port COMI COM2 corresponds to the one effectively use 2 The name shown on the status bar corresponds to the patient who is to carrying out the tests 3 The today s visit card exists Chapter 9 Spirometry 107 Forced Vital Capacity pre FVC is a reference test to verify obstructive airflow limitations and restrictive disorders lung volume limitations To achieve good test results it is fundamental a good manoeuvre quality control messages real time plots Recommendations The main parameters measured during FVC tests are FVC Forced Vital Capacity FEVI Forced Expiratory Volume in 1 second FEVI FVC FEV asa percentage of FVC PEF Peak Expiratory Flow FEF25 75 For
133. sories ccce eee eee e eee e eee eee eene e esses sees sees eese ense 25 PC configuration required ecce eee eee ee eee eee eee neon esee neue 26 Technical feat res ee eceee eee ee eode e step ee sa soe e ense Dae e e e vbe tese s pae ee oen sUo 27 Flowmeter erraina tecti ctt nette 27 Oxygen Sensor 02 27 Carbon Dioxide Sensor CO sss 27 Humidity absorber sse 27 Power Supply itd one oet Ree 2 27 2 Quark b User Manual Environmental Sensors e 27 Dimension and Weight 27 PURSE 27 Measurements 28 Pulmonary function tests and measured parameters 29 Breath by Breath exercise testing 29 Indirect Calorimetry ss 29 Lactate Threshold V Slope sse 29 OX KINGS nne tone oer rete RIT Peg 30 Spirometry Tests option sse 30 FVC Forced Vital Capacity 30 VC IVC Slow Vital Capacity and Ventilatory pattern 30 MVV Maximum Voluntary Ventilation 31 Bronchoprovocation Response 31 Installation 32 Unpacking the system ssssssssssessessescssecccseccsseccsseee 33 Setting Up the System eor ee oe eee e oet nu oo veu ooa eee san ved se vu oa aee ao inve eee a aun 34 Calibration Gas Cylinder essere 34 Gas pressure adjustment procedure 34 Connecting cables and tubing ecce e eee ee eee eee eene eere neenon 35
134. sors Temperature 0 50 C Barometer 400 800 mmHg Humidity 0 100 Dimension and Weight Dimensions 17x30x45 cm Weight 8 Kg Aux inputs Eight analog inputs 0 5 0 10 Volts for external measurement HR Pressure Digital TTL input for external ECG signal Auxiliary RS 232 port for ergometers control cicloergometers treadmill Chapter 1 Getting started 27 Indirect Calorimetry Breath by Breath exercise testing Symbol VO2 VCO2 Vt FetO2 FetCO2 R VE HR Qt AT VE SV RF FeO2 FeCO2 VE VO2 VE VCO2 VO2 HR VO2 Kg Ti Te Ti Ttot Vd Vt PaCO2 P a et CO2 Symbol EE EE BSA EE Kg FAT CHO PRO FAT CHO PRO npRQ Lactate Threshold V Slope Symbol VO LT R LT Time LT VCO VE UM ml min ml min 1 ml beat ml min Kg sec mmHg mmHg UM Kcal day Kcal day m Kcal day Kg Kcal day Kcal day Kcal day UM l m hh mm ss ml min l min Pulmonary function tests and measured parameters Parameter Oxygen Uptake Carbon Dioxide production Tidal Volume End Tidal O2 End Tidal CO2 Respiratory Quotient Ventilation Heart Rate Cardiac output Anaerobic Threshold Ventilation Stroke volume Respiratory Frequency Averaged expiratory concentration of O2 e CO ventilatory equivalent for O2 ventilatory equivalent for CO2 Oxygen pulse VO2 per Kg time breaths Vd Vt ratio arterial PCO2 estimated Delta PaCO2 PetCO2 Parameter Energy
135. ss 120 Disassembling the different parts of the mask 120 Cleaning the mask 120 Disinfecting the mask sse 120 Canopy bubblehood option cleaning 121 RMR reader option cleaning eee 121 Precautions during the cleaning of the turbine 121 Two way non rebreathing valve cleaning option 121 Mixing chamber cleaning and disinfection option 121 Permapure maintenance sese 121 InspectiOtls 342 enr t e Merlin nier 122 Replace the uses sine inner edens 122 Select the proper power supply voltage 123 Appendix 124 Conformity declaration ee eee eee eee ee eee ee eee eene eese eese nnne 125 Service Warranty 01 sees e coe eese eoe seas esa seda eese Sepa aoa sedo sise ses ed e 126 Warranty and limitation of liability sess 126 Return goods policy for warranty or non warranty repair 126 Repair Service Policy eed eim es 127 Privacy Information e eee e eee ee eee ee eene n eene sette soe e ees sees see eoo 128 Personal data treatment and purposes ssssssss 128 How your personal data are treated 128 The consent is optional but 128 Holder of the treatment 128 Customer rights 128 Waste of electrical and electronic equipment 129
136. t This device is not suitable for use in presence of flammable anaesthetics It is not an AP nor an APG device according to the EN 60 601 1 definitions Keep the device away from heat and flame source flammable or inflammable liquids or gases and explosive atmospheres In accordance with their intended use Quark b is not to be handled together with other medical devices unless it is clearly declared by the manufacturer itself It is recommended to use a computer with electromagnetic compatibility CE marking and with low radiation emission displays It is necessary to make the PC connected to the Quark b compliant with EN 60601 1 by means of an isolation transformer The Quark b needs special precautions regarding EMC and needs to be installed and put into service according to the EMC information provided in the section EMC Portable and mobile RF communications equipment can affect the Quark b Use only the cable and accessories supplied with the equipment The use of accessories and or cables other than those supplied may result in increased emissions or decreased immunity of the equipment The Quark b should not be used adjacent to or stacked with other equipment If adjacent or stacked use is necessary the Quark b should be observed to verify normal operation in the configuration in which it will be used Graphical symbols used in accordance to present specifications are described here below Equipment ty
137. t parameters to be printed 75 Customise the printout header sss 75 Electronic reports pdf 76 Print the current window 76 Print the customised report 76 Events management during exercise testing eere 77 Cardiac Output option T Setting up the Quark b for the cardiac output 77 Performing a Cardiac Output test 78 Flow Volume 100psS 78 Flow Volume loop during the test ssssse 78 6 Quark b User Manual QA COD VS TIME anis Re RM ee er 79 O2 CO2 vs Time during the test 79 O2 Saturation optional essen 79 O2 Saturation during the test 79 SPITOSTAM AE ds dental etre le en tan net en A en 79 Spirogram during the test 79 View the events after the test 80 CRUEL 80 Save Raw data oh necesites etes 80 Resting Metabolic Rate Test 82 Metabolism eile ioeeeeeo esee ee ao Sere eene nea eda a epa ea Re Pav Te tentes e Fes beo 83 Total Metabolic Rate 83 Resting Metabolic Rate RMR see 83 Importance to measure RMR seeeeeeeere 83 Measure of the rest metabolic rate with indirect calorimetry 83 How to perform a RMR test 83 Recommendations eee ee eee eee eee eee ee e eee eene noe teet eee hasse eee sese tees sess ee 84 Resting metabolic rate test using the face mask
138. t response reducing the diagnostic accuracy of the exam The patient must wear comfortable suit and gymnastic shoes and two hours before test stop any kind of drugs eat light and avoid coffee and smoke Chapter 6 Exercise Testing 57 58 Quark b User Manual It s very important acquire information on the patient s clinical past before performing the test Keep attention in particular way to the use of drugs tobacco to the physical fitness and symptoms produced with the exercise Patient assent The patient 1s informed that he will be submitted to a maximum effort which could be stopped at any moment and of the risks of the test execution Ending the test Test may end when the maximum value of the oxygen consumption has been reached and the patient s response established STRRT Note Selecting Simulated test the software allows to use the gas calibration in order to perform the test This is useful if the user would check vvv the accuracy of gas measurements 3 ABORT 9 STOP Before starting exercise test type a new patient information or choose one from the list of patient in the file As soon as a patient has been entered the software is ready to start a test The name of the active patient is shown on the status bar of the program window Start a test 1 Calibrate the analysers as described in the Calibration chapter 2 Choose Execute Test from the Test menu Height cm FEAT Mode
139. t the basal value without drug Main parameters are P10 Dose that causes a 10 fall of FEVI P15 Dose that causes a 15 fall of FEVI P20 Dose that causes a 20 fall of FEV1 The representative plot 1s the Dose response curve showing the percentage variation of FEV1 versus the Drug dose in logarithmic scale The program assumes as the baseline test the best FVC pre carried out during the today s visit You can change the reference pre test editing the Post test The name of the drug its quantity and its unit of measurement can be typed immediately before any FVC post manoeuvre manual protocol or can be stored in a database of bronchoprovocation File Bronchial Provocation protocols Database 112 Quark b User Manual Perform the test STRRT STOP During 1st step only select Protocol from the Test menu and choose the name of the bronchoprovocation protocol that you are going to use manual protocol if you want to type the information about the agent before any manoeuvre 1 Select FVC post from the Test menu 2 Select an existing protocol or click on manual protocol and wait the green leds turned on 3 Press F2 or the button by side to start the test Press F3 or the button by side to achieve the test ov dm In order to visualise the V t graph and the main parameters press the follow buttons view Flow Volume graph view data of the test view bronchial provocation response
140. te American J Respiratory Critical Care Medicine Vol 152 1107 1136 1995 ERS 793 Standardised Lung Function Testing Official Statement of the European Respiratory Society The European Respiratory Journal Volume 6 Supplement 16 March Lung function J E Cotes Blackwell scientific publications Guidelines for Clinical Exercises Testing Laboratories LL Pina G J Balady P Hanson A J Labovitz D W Madonna J Myers American Heart Association 1995 91 912 Sub maximal testing Cardiorespiratory Assessment of Apparently Healthy Populations Timothy R McConnell in ACSM s Resource Manual for Guidelines for Exercise Testing and Prescription 4 Edition pp 361 366 Franklin BA ed ACSM s Guidelines for Exercise Testing and Prescription 6 Edition Philadelphia Williams amp Wilkins 2000 22 29 Chapter 11 Appendix 139
141. te in order to monitor the patient response Enter the BPM 1 Choose BPM alarm from the Events menu 2 Setthe alarm by moving the scroll bar and press OK to confirm It also allows to enable or disable the acoustic alarm by the option Acoustic alarm Data management Viewing data vyv Note Double click in the window to open the edit test Creating graphs GRAPH As soon as the test has been completed all data stored can be retrieved for a complete management Data can be viewed in the following formats Table form numeric values of the various parameters columns corresponding to each step rows Graphic form graphical presentation on Y1 Y2 X charts Summary Predicted results of the test and statistical analysis of the blocks predicted values maximum value measured View data in table form 1 Select Data from the View menu 2 Select the test to visualise in the list box and press OK BOND J test n 2 Joj x t Rf VT VE voz vcoz VE VO2 VE VCO2 VO2 Kg R Feo2 FeCO2 HR VO2 HR Load FetO2 4 hh mm ss b min 1 l min ml min ml min ml min Kg bpm ml bpm Watt 00 00 00 12 2 1 151 14 1 556 505 25 27 7 32 0 90 15 86 4 35 61 9 1 0 14 79 00 00 06 10 2 1 626 16 6 595 574 27 28 7 84 0 96 16 40 4 20 65 9 1 0 15 61 00 00 10 12 7 0 610 7 7 250 236 31 32 3 30 0 94 16 94 3 70 67 3 7 0 15 88 00 00 15 12 2 0 865 10 6 344 341 30 31 4 52 0 99 16 91 3 91 66 5 2 0 15 83 00
142. tion from prior Exercise Evidence for O2 Transport Limitation of VO2 Kinetics A Review R L Hughson and M A Morrissey Int J Sports Med 4 1983 31 39 ISO 8996 Ergonomics Determination of metabolic heat production 1990 In the following picture it is shown how the O debit and deficit values are computed Y A B exp t to Tau 02 Kinetics YSA 4B expE t t1 Tau VO2 rest A B VO2 rest A VO2 work B VO2 work B 25 to start work t1 start work tl stop work t2 end test O2def VO2 workTau O2debt VO2 amp work tau 2 O2 deficit in VO l min VO2 work VO2 work O2 debt VO2 rest ODER i A i Y 50 to 100 150 200 250 300 time ec Cardiac output estimated non invasively from oxygen uptake during exercise William stringer James E Hansen and K Wasserman JAP 82 3 908 912 1997 Clinical Exercise Testing Third Edition 1988 Norman L Jones 134 Quark b User Manual ATS 94 recommendations Reference Standardization of Spirometry 1994 Update American J Respiratory Critical Care Medicine Vol 152 1107 1136 1995 ATS recommendations Volume range 8l BTPS Flow range 14 l sec Volume accuracy 3 or lt 50ml Flow accuracy 5 or lt 200ml sec Flowmeter resistance 1 5 cmH20 da 0 a 14 l sec Reproducibility the 2 largest of 3 acceptable FEV1 and FVC values should be within 5 or 150 ml The end of test no change
143. ts with VE gt 40 l min 3 Inlet for patient s exhaled air 4 Connector to be closed with the proper plug supplied with the equipment 5 Outlet for patient s exhaled air 6 Little plug for closing the connectors 1 or 2 7 Fixing holes Preparing the mixing chamber for a test 1 Connect the wrinkled tube to the inlet 3 of the mixing chamber 2 Connect the turbine to the outlet 5 of the mixing chamber 3 Disconnect the sampling line from the turbine and connect it to the connector 1 for resting tests or 2 for exercise tests of the mixing chamber 4 Close the connector 2 for resting tests or 1 for exercise tests of the mixing chamber with the little plug 6 5 Close the connector 74 with the proper plug supplied with the equipment Two way non rebreathing valve description The two way non rebreathing valve is very important in order to perform the test properly It is shown in the following picture The mixing chamber 99 l 2 3 Valve inlet Connector for the mask Valve outlet Note be very careful in order to differentiate inlet from outlet These two are not interchangeable to guarantee proper functionality Patient s preparation l 2 3 Screw the mask to the connector Z2 of the valve Connect the wrinkled tube to the outlet 3 of the valve Fix the mask as illustrated in the picture below Adjust the elastic bands on the head cap as necessary to eliminate possible leaks and create a ti
144. ttuale 000001 20 02 97 00 14 13 000002 13 03 97 00 15 00 BOND J 000003 11 04 97 00 10 43 TREADMIL T 000004 14 04 97 00 05 16 CARDIAC OUTPUT C 000005 16 04 97 00 07 14 F V LOOPS F Report 000006 26 01 00 00 14 45 GAS ECG G Tutti i test Wasserman C Const4plot C ST trends C ERS 98 OK Annulla VOZ ml min 3534 2862 2189 1516 844 171 00 00 01 45 03 30 05 15 07 00 08 45 10 30 12 15 14 00 15 45 Chapter 6 Exercise Testing 67 Data Editing vyv Nota In Data view double click in the window to enter in Data Editing 68 Quark b User Manual The software allows the user to edit the data acquired during the test in the following Ways e deleting one or more steps e editing row data e input new parameters e data filtering averaging or smoothing e advanced data elaboration After data elaboration it is always possible to restore the original data file by pressing the Restore button If you want to save permanently all the changes press Overwrite being aware this function replaces the original test definitely Editing values and input numerical values 1 Choose Edit test from the Test menu 2 Select the cell containing the value you want to replace with others values and press OK to confirm the editing The software will recompute all the parameters Both the tables and the graphs will be automatically updated Edit Test
145. ve abnormality it may be physiological Pred FEV1 gt 100 Obstructive abnormality mild Pred FEVI lt 100 and gt 70 Obstructive abnormality moderate Pred FEVI lt 70 and gt 60 Obstructive abnormality moderately severe Pred FEV1 lt 60 and gt 50 Obstructive abnormality severe Pred FEV1 lt 50 and gt 34 Obstructive abnormality very severe Pred FEV1 lt 34 Restrictive abnormality mild FVC lt LLN and Pred FVC gt 70 Restrictive abnormality moderate Pred FVC lt 70 and gt 60 Restrictive abnormality moderately severe Pred FVC lt 60 and gt 50 Restrictive abnormality severe Pred FVC lt 50 and gt 34 Restrictive abnormality very severe Pred FVC lt 34 Quality Control Messages Reference Spirometry in the Lung Health Study Methods and Quality Control ARRD 1991 143 1215 1223 Chapter 11 Appendix 137 Message Start faster Blast out harder Avoid coughing Blow out longer Blow out more air Blow out harder Take a deeper breath Blow out faster That was a good test FVC reproducible FEV1 reproducible PEF reproducible MVV time too short 138 Quark b User Manual Criterion VEXT gt 5 of the FVC and gt 150ml PEFT 7120 msec 50 drop in the flow in first second FET100 6 sec flow gt 0 21 s within 20 ml of FVC dPEF lt 10 dFVC 200ml and 5 best FVC dFEV1 lt 200ml and 5 FEV1 No errors diff 2 max FVC within 0 21 diff 2 max FEVI within 0 2 1 diff 2 max P
146. ve clinical supervision and subject individuals to levels of physical stress that may be unnecessary depending on the objectives of the test Consequently maximal testing is reserved for clinical assessments athletic evaluation and research A sub maximal exercise test costs less and carries a lower risk for the individual Although less sensitive and specific for detecting disease or estimating maximal oxygen consumption correctly performed sub maximal tests can provide a valid estimate of cardiorespiratory fitness Pre test health screening is essential for risk stratification and for determining the type of test that should be performed and the need for an exercise test prior to exercise training A thorough pretest health screening includes the following e Complete medical history e Medical contraindications to exercise e Symptoms suggesting cardiac or pulmonary disease e Angina or other forms of discomfort at rest or during exercise e Unusual shortness of breath at rest or during exercise e Dizziness or light headedness e Orthopaedic complications that may prevent adequate effort or compromise the validity of test results e Other unusual signs or symptoms that may preclude testing e Risk factors for coronary heart disease e History of major cardiorespiratory events e Current medications e Activity patterns e Nutritional habits e Reading and signing an informed consent form Chapter 8 Sub maximal Exercise Testing 93
147. w menu Delete a test 1 Select Patients from the File menu or press the button by side 2 Select the test that you want to eliminate from the list of the tests referred to the Current Patient and press Delete 114 Quark b User Manual Printing results You can print out in three different ways e printing the Report e printing the Active Window e printing a series of reports Printing Reports k To print a report of the current visit select Print report from File menu The software will choose automatically the best performed test Lj The standard Report is composed by 1 2 or 3 pages depending if you wish to printout the FVC data and the graphs together on the first page or if you wish to printout the bronchoprovocation response e Selecting the option One page no ATS the report will contain on one page the F V and V t graphs of the best test overlapped on the FVC Post the patient data the notes the diagnosis and the test results e Otherwise the report will contain two pages the first with the patient data the graphs and the diagnosis and the second one with the measured parameters according to the ATS recommendations e The 3 page will contain the bronchoprovocation response Select the desired options FVC graph Prints the F V and V t curves for the best FVC test One page no ATS Prints data and graphs on the first page Response Prints the bronchoprovocator response Preview Views a re
148. ware and press OK It is possible to edit the Cardiac Output event in the following way 5 Select Edit from the Event menu to change the parameters measured during the steady state before the rebreathing the CO concentration at the equilibrium and the calculation method It s a particular feature with which the user can check and save some parameters CO output O concentration and volumes in Ascii file format in a archive apart at a sampling rate of 25 Hz Save Raw data 1 During the test choose Event from Events menu 2 Select Raw Data from the list 3 On the save data box give a name to the file and select the destination folder 4 To stop saving Raw data press the stop icon or press F3 on the keyboard Chapter 6 Exercise Testing 81 Metabolism Metabolism can be understood as the conversion by the human body between food and accumulated fat into energy The energy is used by the body to maintain constant temperature to move and to make all the organ function Measure of metabolism is calories cal Total Metabolic Rate The total metabolic rate are the total calories that the human body needs in order to actuate the daily functional activities Resting Metabolic Rate RMR Resting Metabolic Rate represents the calories that the vital organs need to properly operate at rest heart brain lungs liver kidneys etc RMR represents between 60 and 75 of the human s total metabolism Importan
149. x BMI and interpretation Graph of the energetic expenditure for all the data acquisition interval highlighting the selected average interval In order to verify the goodness of the test check that the FeO and FeCO values are within the acceptability ranges 20 2 20 8 and 0 5 0 8 respectively and the heart rate is the rest heart rate of the patient How to modify the average interval Print If the average interval automatically identified by the software is not satisfying for example because the patient was speaking in the first minutes it is possible to modify the interval of the average Right click and select Edit RMR It is possible to move the start and the end lines To move the start line left click on the exact time in which you want to start the calculations for the end line right click The print of the current window generates a report similar to the one of the RMR test using the face mask Chapter 7 Resting Metabolic Rate Test 91 Sub maximal Exercise Testing Introduction Pre test screening Several physiological responses to exercise are used to evaluate cardiorespiratory fitness including oxygen consumption heart rate and blood pressure Measuring these variables during exercise particularly maximum exercise increase the chance of detecting any coronary artery disease or pulmonary disease Unfortunately maximum exercise tests are impractical because they are expensive require extensi
150. y and the individual s primary care physician notified and all specified follow up procedures performed In the event of mechanical or electrical failure that may compromise the accuracy of the test results or monitoring capabilities the test should be terminated until the problem is corrected General Indications for Stopping an Exercise Test in Apparently Healthy Adults Onset of angina or angina like symptoms Significant drop 20 mmHg in systolic blood pressure or a failure of the systolic blood pressure to rise with an increase in exercise intensity Excessive rise in blood pressure systolic pressure gt 260 mmHg or diastolic pressure gt 115 mmHg Signs of poor perfusion tight headedness confusion ataxia pallor cyanosis nausea or cold and clammy skin Failure of heart rate to increase with increased exercise intensity Noticeable change in heart rhythm Subject requests to stop Physical or verbal manifestations of severe fatigue Failure of the testing equipment Assuming that testing is non diagnostic and is being performed without direct physician involvement or electrocardiographic monitoring Chapter 8 Sub maximal Exercise Testing 95 Considerations for accuracy 96 Quark b User Manual The ability to obtain valid and reproducible results is essential to ensure that any differences between pre treatment and post treatment test results are due to exercise training rather than variations in testing procedures Som
151. y in Chinese subjects in Hong Kong Lam Kwok K wong Pang Shing et Al Annals of Human Biology 1982 vol 9 No 5 459 472 Multic ntrico de Barcelona Spirometric reference values from a Mediterranean population J Roca J Sanchis A Agusti Vidal F Segarra D Navajas R Rodriguez Roisin P Casan S Sans Bull Eur Physiopathol Respir 1986 22 217 224 Nhanes III Spirometric reference values from a sample of the general US population John L Hankinson John R Odencrantz and Kathleen B Fedan Am J Respir Critr Care Med 1999 159 1798 187 Pneumobil Brazil Valores extraidos do Programa Pneumobil Brasil para a Tese de Doutoramento do Dr Carlos Alberto de Castro Pereira Boehringer Gutierrez Chile Gutierrez et Al Reference values for Chile population Knudson Morris and Bass The maximal Expiratory Flow Volume curve Knudson et al ARRD Vol 123 p 659 664 1981 Spirometric Standard for healthy non smoking adults ARRD Vol 10 3 p 57 67 1971 Pereira Brazil Pereira CAC Barreto SP Sim es JG Pereira FWL Gerstler JG Nakatani J Valores de Refer ncia para Espirometria em uma amostra da popula o brasileira adulta Jornal de Pneumologia 1992 18 10 22 Malloz MC Valores de refer ncia para espirometria em criangas e adolescentes calculados a partir de uma amostra da cidade de S o Paulo Valores finais publicados em Pereira CAC Lemle A Algranti E Jansen JM Valen a LM Nery LE Mallozi M Gerbas

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