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1. MELOS UNUM itn UMEN S Gn Ns NEM HU RM IIS NE 47 EI Body B x calibration V 49 E 22 01541125 eR m T er 49 E COC EFIE EEVVERENESSVEKVHERENTERUE FEM CHVKEEM KE amines arr rien 49 LR gi ITE A E T 50 Calibrate the Quark i2m _ 51 O Reviewing Cal Results 70 53 B Previewing the calibration report 1 0 6 6 53 Previewing the Body Box calibration report 53 E Printing the calibration SXPE SAESP SEPA GERE Ur EIN EGRE RE MESE VPE EE 54 E D MES TIN 54 thess ema d 55 E M eU MM MEN ete M ME a MH ME 55 Quark series Cont
2. esas stes assess sanas sess ss 233 LE hu lide RTT m 233 ESSI ter ieri EMME 233 Graph customization 1 0 0 t sett sett sett rete sete sE EESE PESEE ESEE 233 Moving within d data table sadce e E AEE R Aaa 234 Viewing information of the current test cccccecccccssecccesseccceececceececeueececeueceeeeececeuseceseuecesseeceesuneeeeenecetseneeets 234 Selecting parameters to view in real 234 Selecting a diferent WOIKSDICG neu pne n E Samosa Dn pU eur SI 234 O Events management during resting metabolic rate testing 236 OUO nantes nein cts ted eben 236 Os COs dgraphrevenbduring th LOSE o A AA 236 MES ger UM 236 Spirogram event during the nena nsns sean esee esses essere nnns 236 Viewing relis nennen TATARER 238 DITS VIG WINE aiarra EEEE 238 NT VES
3. purge c M eA c M 1 2 3 4 5 B 8 9 10 11 12 13 14 15 18 17 18 18 201 81 Far Help press F1 30 05 2007 James BOND If no SVC test has been detected at the end of the procedure the software will prompt you to select a SVC manoeuvre from previously performed tests If the user aborts the operation it will be necessary to associate a SVC to the test at a later time without apnoea intrabreath method 1 Select Test Start Single breath CO diffusing capacity or press the icon and select Single breath CO diffusing Capacity x Patient Simulated test Canoe 2 Press Patient to confirm or modify data for dead space haemoglobin and carboxyhaemoglobin you may select the ATS recommended values or enter the actual patient s value for the first 2 parameters Press OK to confirm 138 Lung diffusing capacity DLCO CO Diffusing Capacity DLCO Test Hemoglobin Hb ATS C Manual 14 5 E Carboxyhemoglobin COHb 0 Deselect the checkbox Breath hold Select the checkbox Simulated test if you wish to perform the test without having the patient
4. 14 1 3 4 EE PPS rrr Bn nn E p r i Lem e 2 y lt re eem m dac alc 17 4 Mee oen ge Ses on ae ee in e m ipt io ia n em SSeS om SS seh n sa n a nce 4 MM QN ee _ 4 NNNM NIMM SEM aai d duca eo ns a an m gt P rns x ps mts cease rm 7 oe 4 Q te 4 Q i Q 1 4 4 0 A AAL AAAA AAA 30 S E S 9 0 ___ gl 100 1 120 __ 10 __ _ 40 1505 Wen u 2 mu ET eM MM M eM MN M ED 4 4 4 e lt lt 290 See me eases ee ee ee t c N N N N N e 4 eo e rn MENS EMEND S Es EMI IN TRE S B Von
5. 1 138 _ CIC Alm mr M 140 RU TIPP PEERS 142 BEN Membrane difusion cid oto 143 EN Per Orne Ue fee eis ieee emoreau 143 enna cane ice spa nnn 144 Q Box Respiratory mechanics AE cm 146 E Panem preparati Rm wane ean aR eee 146 Usine he ON E E omm 146 HF 146 Other 5 146 74 7 38 5 147 E tie aii ERN 147 E VIENWIBETSSUB S EHE LIUM ete eM MEUM LUI MEM 148 PO LIBSSBISIDEU OP IU E nen een es 149 E ens 149 EN VIEWIDE r EE E UR ERU ERU 150 R
6. E EA 238 Viewing data in graph FOLM cccccesecccceseccceeseccceeccceenececeusececeececsunececeuneeseeeeceeseeceseuseeesenecetseecessuaceesenecetsuneeets 239 VISUS RISE ENG DIM SD DPA M NM NUI Nf 240 E Modifying the average Interval 5440 PAUL ES ER EPA SE PR RUE AK OR CIR SERI ps E OE 241 VIS WINE IRI TTE 241 LAB S er EIER 242 E Viewing Pest IhEOEPBHOLIDIT EXON E 242 E Viewne the tesEsumimdlV N 244 B Switching between data and graph viewing 1 1 1 1 244 EBENE uisus mmt 245 12 em EE U 245 With alinear regressio 245 Fitting a graph with a monoexponential regression 1 enne nnne nnne nenas 245 the mean Tm 245 BEES S100 omm PEE 247 E 247 W c EE E RC TR A RR 247 Deleting one More SEEDS dain oni an 248 SB dee 248
7. 83 M FN RE MEME 84 asa accep rcs ces sete UU tT 84 4H gum 85 S TUTTI mmm mS 85 Printout reports 9 86 B ECG printout 87 SW Spiro Archive management and printouts EWEB 0 105010 90 2 T 90 AISLE Call Cl D 90 91 icis rn E Ete RT Mm 91 Patient RE TET 91 E care nieve danny EC EUR caren ea ERR MENU ROVER ROVER ENEN UTE 92 Editing a patient de T mr Ter 92 Me a 92 E TA ces ic RIA RT RARE S 93 Nm M 93 E Eding RITE o R 93 E de Tm 94 E Exporting a test card oisi
8. SERERE A S TE IT EI DIU recreo ee Ae Seon conven TT E E deans lee maja mw wn cx d Thermal equilibrium in progress test will start in 50 seconds Door Closed Body Box pressure cmH20 Frequency 1 min For Help press F1 12 06 2011 James BOND 3 In the first phase the operator is waiting the thermal equilibrium between the inside and the outside of the Body Box In the meanwhile the patient will begin to relax inside the box During the first 60 seconds all the buttons are disabled and the vent valve between the inside and the outside of the Body Box is open to allow reaching the equilibrium In this phase the Body Box pressure column oscillates around the zero Under the volume time graph the 60 second countdown is shown and only the button is enabled in order let the graph start from O the 60 second countown does not start again from O Note The PNT can always be re zeroed by pressing the button Ensure that the patient is disconnected fr
9. 1 e mw oh seam 20 cee 221s e N A 38 4 2 i E D 30 1 z 5 E A D IRE 45 1 5 c ee nm PE 5 p Tov 236 j 9 5 5 m A gt 60 OPEN For Help press F1 17 06 2011 James BOND 2 The patient must breathe at a respiratory frequency of about 60 breaths minute for the same reasons described above 3 To capture a TGV press In the upper part of the screen a bar will be shown with the measured TGV Note The can only be activated if the patient performs at least 3 similar breaths with volume at least 200 ml 4 Capture at least three TGV measuremetns with values within 5 the difference between the higher and the lower value divided for their mean value must be lt 0 05 to guarantee repeatability of the manouver Slow Vital Capacity test 1 At the end of the TGV perform a Slow Vital Capacity If necessary the patient can remove the mouthpiece and breathe between the TGV and the SVC Patients with severe dyspnea may have difficulty performing the preferred VC method i e ERV immediately after TGV followed by a slow IVC To overcome this the patient
10. E AE EEE E AAA A AA A A 164 _ e AE EAE EEA E EN E AE EN E AEE EAE EE ENIO ET E E EE AE E EE E A EA E ES 164 mee memet 166 Forced oscillations 12m Gera 170 dau vU MEM MEME E 171 UI tT 173 Oximetry SPIRO PFT gt CPET SE BEC CE Cu 176 B Patient preparation 176 Patient preparation 176 BEES NENEA 177 A 55 mom 177 Ju ARD E E E N E E 178 PFT CPET Q Box 179 Airways resistance measurement SPIRO GS 180 Ml mmm 180 O The Airways Resistance measurement test sas tesa asse ease se sas seas 181 TNE Reim 181 _ VIENWIDES Fe ES ENEE NENN 184 PFT K4 Exercise testing Recommendations for exercise Ces B aeneaikusak du ER URN RARE nne
11. E Tau Constraint B 85818 Constraint Tau io Constraint Max attempts o Cancel 2 4 Enter if necessary the initial values for A B and TAU parameters these are the values from which the iterative algorithm begins The more attempts made to obtain the best fit curve the more accurate the curve will be 5 Select the Constraint checkbox next to the parameter if that value must be the exact parameter that is entered 6 Select the Add checkbox if the fitting must be added to others already placed on the graph Otherwise the existing fittings will be deleted 7 Press OK to confirm The fitting is graphed and its equation is displayed near the upper limit of the X interval Calculating the mean value 1 Select the fitting type Mean value 2 Select the first point X1 by placing the mouse on the desired location in the graph and press the Left key or use the and keys near the X1 field Resting Metabolic Rate Test Data management 245 Select the last point X2 by placing the mouse on the desired location in the graph and press the Right key or use the and keys near the X2 field 4 Select the Add checkbox if the fitting must be added to others already placed on the graph Otherwise the existing fittings will be deleted Press OK to confirm The fitting will be graphed and its equation will be shown near the upper limit of the X interval 246 Rest
12. er Dae a 1 rd ruis e ciel i 010 8 4 21 l 2 1 4 T m ANC P E S e M DUET ET HENCE Pond 0 1 2 3 4 5 6 7 8 8 10 11 12 13 14 15 16 17 18 201 s Washout Sample Breath hold os eas ATS 95 Criteria 5 35 sec 13 96 sec Ti 0 5 Cancel 1179 ml 3533 ml 0 7 Ti 0 5 Sample Pressing Select SVC allows you to associate another SVC to the test as shown above Test current patient 5 1 08 06 7007 S C 08 06 2007 S C 6 46 FRY Cancel 2 44 Rf 15 00 Preview 03 06 2007 SYC Pressing System allows you to confirm or modify the system dead space and the oxygen cylinder concentration Press OK to confirm A System dead space VD I Cylinder concentration 2 21 H anoei When pressing Patient you can confirm or modify the anatomic dead space the haemoglobin and the carboxyhaemoglobin either the ATS recommended values or the actual patient s value may be entered in for the first 2 parameters Press OK to confirm Anatomic Dead Space ATS C Manual 0 ES Cancel Hemoglobin Hb ATS o Manual 146 g dl Carboxyhemoglobin 0 H
13. Pee 110 Sp SPIRO PFT K4 ERE E E A E AA E E E A A E E A 112 E O RIT 112 EON 112 NE TTE 112 O16 ale ao 2 a 16 8 9 T S E 112 forced Vital Capacity PrE RT 113 PaE OS E Temm 113 iil e dem G 114 BECA Rein D H 115 _ 1 a A mme 115 L Maximum Voluntary VentilatiOr GR aaa 116 E Performing 3 MYV Tm 116 Bronchodilator and Bronchial Provocation Testing ccccsssscossssccsssssccccsssccccscsccccecsesececscseccsscesecsseesecssesseceseess 117 E TNE 117 NW 117 E OTT TET 117 BEER Uem 119 M 119 PFT Q Box General cung RET et 122 _ ETT TETTE PH coc 122 iUum 124 Lung volumes PFT General
14. esent essere nni 193 Selecting different workspace s 193 EN ONE EVENTS dunne Tesb oiii da eni FERME EERK REV KE VPREKEEE YE RR ERATES OU ERHRM nena 194 Entering a loading phase or intent usu pte Ns 194 Entering realtime ABG arterial blood gases 194 Changing the load during the test nnne nnne nnne sar essa 194 ENESTE 8 steerer caer Habent AI ate err lpn tere QM MM 0 Rap TUM uin E EUM SIN UU 195 EVISU AIS bcd URGES FUP USO M Uc iu cane uae M cU Ub NUM Eu I une Nard E E 195 Modifying the 195 Pertormibe events dunne TEST arrene 195 DIVINE CPE ONAL DER UNDE 196 EN ECG related functions during EUR 196 sog cp PE 196 AEAEE E mU mmm 196 Printinge astored coc 196 IS Te 00 Y E H H 196 P Vu Ry CEA tC OT UN VON NT Een 197 SHOWING THe ORS and VICW PC 197 Viewing the QRS parameters
15. 35 acta 1 1 1 Branit hield daneg anid Mende 1 1 1 0707777 177777777 01 0707775 01 070777 01 070777 01 0707775 1 277557777777 1 1 1 1 1 1 1 Washout 0 30 0 20 f mE IMMER CUNT 0 05 E E lE E n I d n T rrr7777777 ni ni ni ni 7777777 e 0 0 1 2 3 4 5 B 8 9 10 11 12 13 14 15 18 17 18 18 20 Volume Time DL CO Into vtl Vit 800 rest ole ones and Meade 7 AEN Washout T 00 IER 4 4 4 1 41 1 iu M E E ayn li cur peer ieee
16. 64 case EA AE peewee ines m 64 Preferences a PFX PFT 64 Preferences A on NM 64 Spirometry PEX Sp SPIRO PFT CPET RMR a aO 65 GDT 5 SPIRO PFT CPET RMR aO Cox Se 66 Multi breath N Wash out 222 2 66 Single breath CO diffusing capacity 67 Respiratory drive E K 68 Forced oscillations E MIR m 69 iioi e ESSET 69 E re eu E eee 69 E E A E E 70 air Nc 70 E 71 Rm TR 71 71 21 72 ccm 72 Bro
17. Concentration 0 0000 mg ml Cumulative Dose 0 0000 mcg Fall FE 1 0 94 6 continue with the next step press Continue to end the test press Stop Results are displayed as shown in the Spirometry chapter 124 The dosimeter Performing the test Lung volumes _ General warnings FRC and CV tests must be performed using the ID 28 turbine or the PNT X9 with the sampling line connected The Quark unit must be connected to the PC with the appropriate communication port selected The oxygen and calibration cylinders must be fully opened and contain a pressure between 5 and 6 bars The name shown on the status bar must correspond to the patient carrying out the test A visit card for the testing date must be created The soft mouthpiece flowmeter and antibacterial filter must be assembled correctly prior to testing dg For hygienic reasons the use of an antibacterial filter is strongly recommended In case of using the PNT X9 the use of an antibacterial filter is mandatory Note After powering the device on wait at least the recommended warm up time before beginning calibration or testing procedures Notice Cellular phones should be turned off to eliminate potential electrical interferences E Patient preparation Calibrate the turbine or the PNT X9 as indicated in the chapter Calibration ATS recommends a daily calibration Perform a FRC calibration see Calibration Connect the
18. File View Test Options Window FAIT vt 4 TON Een T M 3 x D UEM qeu pee p poco i 3 a 17777757 9 S US dm mI ala mm E mmm Laa eee ERN D AVADA ARAARARAARARRARRAARARAR AA A Bae f AJAA IN FAVAJ A v AME oo epe n Ew Hue erue 5 9 EE S feos Ee r AM zzii Hzc TM T UNE EN m 1 n 1 Ti 05 LESE in te 777 50 7 72 LI BEES ME 1 1 1 Accepted Discarded Parameter UM Pred TEST 2 Pred EWC 5 18 4 83 23 1 46 0 81 56 IR 3 26 Vt 0 74 4 01 Toy 3 49 2 72 78 6 73 RiP leth 2 03 1 90 30 26 a5 TGVITLC 52 40 77 2 24 1 85 83 GA lsiemHZO 0 45 0 54 121 sRAW 12 00 SGA 1licmH20 s 0 08 238 RF Raw 1 min 36 mlicmmH2O 830 5 5 0 50 Far Help press F1 17 06 2011 James BOND It is also possible to select an SVC to be linked to the test among all the SVC performed
19. Carica Select Protocol to set a predefined protocol You may choose to select the desired protocol from the list Select Manual to edit the protocol manually You may set the following options Ergometer specifies the ergometer used From to specifies the interval in which the changes should be applied by adjusting the horizontal lines The vertical bars on the lower graph will move accordingly Load 1 Load 2 Load 3 sets the loads in the selected time interval Phase modify modifies the phase You will then need to select the specific phase to be modified You may customize the graph in the lower part of the window by selecting the variables to be graphed the list on the left will be displayed in red and the list on the right will be displayed in blue Show data displays tabular data instead of the graph Press Execute to run the editing Save to save permanently the editing or Cancel to abort 216 Exercise testing Data editing Resting Metabolic Rate Test K4 Metabolism Metabolism involves the process of converting food and accumulated fat into energy within the human body Energy is used by the body to maintain a constant temperature for movement and activity and to allow the organs to function Metabolism is measured in calories cal E Total Metabolic Rate The Total Metabolic Rate is the number calories that the human body needs in order to perform daily functional activitie
20. Summary Formula Esso selecting Options Customize parameters the icon you may add edit delete export or import parameters To create a new parameter press New You must enter the parameter name Name the unit of measurement Unit of meas the number of digits that will be displayed before and after the decimal point Integers and Decimals and if the parameter will be included in the summary Summary Press Formula to open the Formula editor and enter the formula you wish to calculate the parameter Press OK to confirm or Cancel to abort the operation To select a parameter press List and confirm by pressing OK To find a parameter by name enter the name in the Name box and press Find After selecting a parameter you have the option to e Delete it by pressing Delete e Copy it by pressing Copy e Import it from a parameter file by pressing Import and selecting the file xpm from which the parameter should be imported Export it in a parameter file by pressing Export and typing the filename in which the parameter should be exported B Predicted customization B Mame ane Delete Mew List Find Import Unit of meaz Calculation Male paediatric Integers Male adult Decimals Males limit age E Female adult Females limit age Female paediatric Related ta no pa
21. T mme 126 Ludos UTR 126 FRCtest N m EM 127 EEN E T E OE EOE 127 E EE EEEE 129 Closing test CV Jiasi a 130 Parone E E N 130 SERITUR E A 131 RU i A e E A E P EEE E D E A E E E O E E 132 PFT Q Box Lung diffusing capacity DLCO wanine S aE EEEE EE KANAE KENE 134 _ 134 O Diffusing Capacity DECO RERUM MULK RE RA VERE RARE RR UE US RR M Ab YR REA MU RO 135 DLCO with breath hold standard 1 1 135 with breath hold test 1 1 1 135 Tips for obtaining acceptable DLCO testing 137 DLCO with apnea standard 1 ortho seno aseo aseo esee se 137 without apnoea intrabreath method
22. nu UE 197 tre OR 198 te BPM alarm threshold 198 E Command RR P 198 O Events management during exercise 199 E Flow Volume IOOBS roncar EEE EEEE 199 Flow Volume loop event during 199 199 O CO graph event during the GU S SUCI SUME IR wo NU UU a CEN IDEM E es 199 EM HEU Ede OD XEM eat ade enna 200 Spirogram event during the 1 20000 nenne sene ssa 200 201 RITUUM 201 10 Why 201 ON NT 202 MICE el TO TIO mmm 203 WIC WIRE SE EE 203 VIENNE ABG TE 204 E E deni prp E 204 E Viewing test informat holi 205 Ri dd lie TL M 207 E The test summary rrini a
23. TURCO Seed kae VERRE A QUI EX UEM 17 O Minimum Computer PC esa se ssa 20 EI SoBwareaistallatlObiussssskaxEeNSREFNENKFARCMEINBED UE PENES SENI VAQEEEREEE NMEHINKRENEPARANSEIIFEERMNENNERUSURINARSSRURMRI MEER 21 21 SOR A E E E AE AAA E EAA 21 E E EE EA EET AT TE E EATE E TOTAS E AEAT E TE E A TEAS 21 a PAF CLAN VS E M mM 21 b i Workstation installati i 22 cl Howto Map Network Drive mec P 22 B Installation of the USB driver kka ZIP C QUELLE O 22 Opening and closing InB SOPBWAEB uu UV ERU PERI ENT VE entre E QUE QUE CRM EEUU MS 24 BARI SECTOR A T m 24 Cosme die SOWA M AMUM Mta UM UPPER DINE MU E PR UN NN EMI NUMINA DE 24 Product registration Wikia 5 25 Activate additional modules new software
24. gs Cr HODIE 104 E Editing patient OU LEUTE diaii 105 E Fe aE crakear CU mE 105 FEXDOFUDE aga eas cae een ain sp cms ws evn en MM MM MM M FREIE 105 slg HRS 106 BEP educere 108 Deleting the 108 R drcanizine T 108 Backing gp 108 0 5 ne eda RUNI CEP 108 eesti mse 110 110 B Report printing SEED Ca QE 110 ECG summary printing 110 AME d doge TETTE TITIO HR mont rn RCE NI eR PORT on ier pers ane 110 E
25. ito LA CASA Esecuzione test Fat si Test Visualizza Finestra R X Freq an s 1 0 ie ae SSS EA quem TASSE ET pre 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 12 000 10 000 8 000 PFT Suite La calibrazione eseguita di buona qualit vuoi accettare questa calibrazione 6 000 4 000 2 000 4 8 10 12 14 16 18 20 22 24 2B 28 30 32 34 Coh Freq xl Start Fedo Stop Abort 4 8 000 aa Se REEE 1 1 1 1 1 1 4 000 2 000 2 000 4 000 6 000 5 000 36 38 40 42 44 46 48 Freq Hz 4 8 1 12 14 16 18 20 22 24 2B 28 30 32 34 Perla guida in linea premi F1 8 Remove the calibration piece from the head 52 Calilbration Calibrate the Quark i2m 3 46 48 Frea Hz B 40 42 44 10940372007 Wito LA CASA NUM Reviewing Cal E Previewing the calibration report Select Preview from the File menu x nalyzers DLCO 28 09 2007 12 13 56 Firmware Micropro PFN 1 0 Ambient Temperature C 24 Barometric Pressure mmHg Relative Humidity 26 46 8 CO 8 PA miig Measured Predicted Acceptable Bra Methane Reference GaS 0 000 0 000 0 010 0 010
26. 0 00 0 00 User A 0 00 min 0 0 User 0 00 0 00 0 00 User C 0 00 Hest Peak PaO mmHg 0 2 mmHg 0 4 1 Notes Distance 0 00 Unit of meas m Load 1 Speed Unit of meas Kmh 10 Load 2 Elevation Unit of meas Cancel Load 3 N A Unit of meaz 7 Modify allows you to edit the test information Calibration Data E X Calibration Warm up hh mm ss 00 00 Gas 08 05 2007 Delay 08 05 2007 Digital trimmer 1 Turbine Last calibration 00 00 0000 Exp Gain 0 Insp Gain 0 Environment Env Temp 220 Internal Temp 220 Humidity 4 552 Press mmHg 02 4 02 4 02 Analyzer Base Line 28 Gam 1007 Delay CO Analyzer Base Line 3 Gain 994 Delay 570 Calibration allows you to view the calibration data for the current test Resting Metabolic Rate Test Viewing results 243 x Test type BxB Ergometer COSMED Treadmill Type Treadmill Reason for Test Protocol Naughton Symptoms Response Reasons for Stopping Test TT Physician Technician good Interpretation Medications Cancel Comments allows you to view the results and add additional comments Viewing the test summary The summary displays the minimum maximum mean and trend for all of the displayed parameters in e
27. 26 _ OED SERRE RR E TE EM E TIE AE E 26 PNT Flowsafe calibration PFX SD SPIRO 28 PNT X9 calibration PFX 5 ASPIRO a CPET Q Box RR 28 PNT Rocc Calibration 9 huius nnnm nnnm nennen nnns 28 Analyzer calibration VELLE WEG pO BOX 28 B Body Box calibration 12 222 4 29 MES Le EN ETSI t 29 Running the Calibration program Running the Body Box calibration program CHASAS CAL EP NH 29 w Setting reference values B Box reference values 2 22 2 2 2 2 30 Sending the PNT linearization tables 4 0 6 31 LI Calibrating flows eR MIT TIT 33 B Particular requirements for K4 b a INERENTI AAT NAT 34 B Flowmeter calib
28. Cancel 3 The window allows you to select the parameters to be graphed up to 2 parameters may be graphed on the Y axis Select the parameters in the two lists or by using the fast graphs buttons below them You can customize these buttons by selecting Options Parameters to view Fast graphs 4 Press OK to view the desired graph Resting Metabolic Rate Test Viewing results 239 Rf VU2 t DI PIETRO test n 1 B ib min VO ml min PP PP PP OFM D in c oO oo oO oO oO oO oF M F amp F om 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 View the RMR summary Open a test and select RMR from View menu wr Quark RMR DI PIETRO test n 1 RMR File Test Eventi Visualizza Opzioni Finestra 8 HT v HR E Parametro Basale Teor Teor Var Legenda BMI Intervallo mm ss 10 00 Sottopeso 18 5 RMR Kcal day 1838 1718 106 896 18 2 Normale 18 5 24 8 0 83 0 85 98 7 6 1 Sovrappeso 25 0 29 9 902 ml min 265 241 109 6 16 1 Obesit classe 30 0 34 9 2 ml min 222 205 108 396 198 Obesita classe 35 0 39 9 VE l min 7 2 5 0 120 896 Obesita classe Ill gt 40 Rf b min 13 5 12 0 113 196 HR bpm FAT 96 54 1 CHO 96 45 3 PRO 96 0 0 0 83 NU g day 0 0
29. Connect 1028 turbine to the unit Pheumotach connector through the pressure line and connect the turbine to the breathing valve On the pressure line the switch must be placed as in the following picture I Using the PNT Calibrate if needed the PNT as indicated in the chapter Calibration Connect the PNT to the unit through its pneumatic line To perform a 1 test the sampling line must be also connected to the unit Other operations Ask the patient to apply the nose clips The use of antibacterial filters is strongly recommended 146 Respiratory mechanics General warnings MIP MEP test The MIP MEP test measures the patient s maximal inspiratory expiratory pressure You should instruct the patient to begin by breathing normally perform a maximal expiration inspiration and then inspire expire maximally against a closed valve The parameters measured during MIP MEP testing include Symbol UM Parameter MIP cm Maximum inspiratory pressure MEP cm Maximum expiratory pressure Howto perform the test Select Test Start MIP MEP or press the icon and select MIP MEP 2 Connect the patient to the breathing valve and instruct him her to breathe normally 3 Askthe patient to complete a maximal expiration for a MIP or a maximal inspiration for a MEP gt 4 Press F2 or the icon at the end of the expiration inspiration Instruct him her to continue to attemp
30. Performing tests with Body Box Viewing and editing test results 167 Forced oscillations ec General warnings Once the patient and visit data has been successfully entered it is possible to carry out the test Before performing any test ensure that 1 Quark i2m is properly connected to your PC and the selected serial port COM1 COM2 corresponds to the one effectively use Options Settings Fot 2 The name shown on the status bar corresponds to the patient who is performing the test 3 The today s visit card exists Note PC software performs its calculations with Cosmed filter values In order to have a correct measurement use only Cosmed antibacterial filters Note Use antibacterial filters in order to control and prevent cross contamination and infections Note Cellular phones should be turned off prior to testing to eliminate potential interferences 170 Forced oscillations General warnings Perform a test Parameters measured 1 FOT tests include the following Symbol ResFreq Fdep 4 24 Fdep 4 48 MeanR 4 24 MeanR 4 48 MeanX 4 24 4 48 R 4 R 6 R 8 R 10 R 20 X 4 X 6 X 8 X 10 R ResFreq hpa l sec Hz hpa l sec Hz hpa l sec hpa l sec hpa l sec hpa l sec hpa l sec hpa l sec hpa l sec hpa l sec hpa l sec hpa l sec hpa l sec hpa l sec hpa l sec hpa l sec Parameter Resonant Frequency Frequency dependence 4 24 Hz Frequency de
31. Resting Metabolic Rate test using a Canopy sssssssssssssssscscscseosececsecsecscceosececssoecsececsecsosececsececsesscsececsecscsecsesee 219 B Resting Metabolic Rate test on mechanically ventilated patients RMR TOUT NU RT 219 sien manne eee ee 221 _ E 221 lui dl penta senses 221 Ts 221 Performing test using the canopy 44 esa sss nasse sas 223 e a a bon MIR RU IERI EI ER 223 Preparing the canopy tie 223 11 Replacement or A Edad Leod 223 COMING CHING CANO T 223 B Preparing the canopy Tcp p FP 224 224 tque 225 E Ending the Test 226 E Ending the test ang saving data ninemsn 226 Performing a test with mechanically ventilated patie
32. End test criterium FetH 2 2 H Extrapolate FRE Yt stability threshold 100 ml C 200 ml C 400 ml Test quality control Lower Upper Depth of breathing ml 200 2000 Frequency of breathing 17min 30 Parameters bar Cancel The Multi breath Wash out tab allows you to customize certain options for FRC testing Option Description End of test criteria Defines the FetN value under which the wash out test will be automatically concluded Extrapolate FRC Enables the extrapolation of FetN to the end of test criteria Vt stability threshold Defines the recognition criterion of regular tidal volume respiration Depth of breathing Defines the quality control range of the depth of respiration in ml 66 User interface and settings PFT Suite settings Frequency of breathing Defines the quality control range of the frequency of respiration in breaths min System LOO System dead space VD s ES Cylinder concentration 2 0 By pressing System you may enter in the following parameters Option Description System dead space VDs Dead space volume of the antibacterial filter if used Cylinder concentration N concentration of the cylinder being used By pressing the SVC button after a test you may select a Slow Vital Capacity manoeuvre previously performed by that patient to allow for the calculation of their TLC To
33. Predicted values Test summary Lactate threshold Test Results ECG Summary Parameters RHR Mame Wasserman Graphs in one page m 1 lt i Le ER E i E VO2 HR YCO graph YCO Le no graph no graph PetCo al ES no graph no graph no graph Cancel The software allows the user to printout data and graphics according to four customizable reports The customized printout header will be printed on each page i By selecting Options Report you may specify the details of each of the four reports In the Report n section select the progressive number of the report You must enter a name of the report and select deselect if you would like all of the graphs to be printed on one page Graphs in one page In the Printed pages section you may select what type of data you would like to be printed by checking the desired checkboxes The parameters you wish to print can be selected by pressing the button Parameters In the Graphs section you can select up to 12 graphs to be printed along with the parameters to be displayed on each graph x t VE Load1 Grid m Autoscale Hin 0 0000 10 0000 Step 0 0000 Options Autoscale Hin 0 0000 400 Step 50 0000 Autoscale
34. 0 00 Ic n 0 00 Post exercise 0 00 fluss 34 User 3 0 00 FE 1 Ij 10 00 Marker l min 0 0 Distance 0 lin meaz IC 1 10 00 2 Pressing Other data allows you to enter additional testing measurements obtained from the patient the flowmeter humidity RH fluss and the temperature T fluss The humidity and temperature should be maintained respectively at 100 and 34 3 Confirm and start the test pressing OK After confirmation of warnings the SW displays another message with the suggested ventilation calculated starting from the patient s anthropometric data Then if the air calibration is enabled the SW will start this calibration At the end of it the test will start This event will repeat automatically every 5 minutes In the first part of the test the flow rate of the pump should be adjusted with the Flow adjustment handle on the front of the Canopy unit in order to achieve FeCO between 0 796 and 1 396 values be read on the right side of the monitor Resting Metabolic Rate Test Performing a test using the canopy option 225 VE Flowa stment amp VE Flow auy stment _ CPET The knob for flow adjustment is very sensitive For this reason the adjustment must be performed by rotating the knob very carefully After modifying the flow please wait
35. 2 Press OK to confirm The software will recalculate all parameters with the edited information Both the table data and the graphs will be updated Data filtering x Details C Averaging 00 00 4 C Smoothing Points 1 By pressing Filtering the following options are available Discard invalid steps deletes all invalid steps By pressing the button Details you may set the criteria for step deletion For all the parameters displayed Respiratory Frequency Tidal Volume 9 and FeCO 96 you have the option to set the acceptability range and determine whether the parameter meets the criteria for step deletion Exercise testing Data editing 213 Delete Step Criteria Xj Parameter min max M i b min v VT I 6204 2 4 ioo 20 00 02 x 1 00 Restore Cancel Averaging averages values on an interval which be specified with the horizontal bar Smoothing performs a mobile average on the specified number of points as entered in the field Points Clicking on the bar between the box and right arrow will move the averaged interval up in 0 15 increments 2 Press OK to confirm Deleting one or more steps This function may be useful if one or more steps were not correctly stored i e data was recorded before starting the test signal gaps occurred patient removed the mask Place the cursor on the step to be deleted and pre
36. Data x Header Data Margins Footer Printed file name Column 1 Column 2 Column 3 Line 1 Date of Birth Age Line 2 First 0 Weight Ko Line 3 Ethnic Con 0 Height cm 0 Line 4 Description BM 0 Line 5 Predicted 0 Company Smoke Print user free fields tae Patient and visit information will be printed below the header This data is reported within 3 columns and 5 rows The user may configure modify or delete the fields if desired 74 User interface and settings PFT Suite settings The checkbox Print user free fields will allow the printout of user defined fields Margins Page setup X Header Data Margins Footer Printed file name _ Margins Column order steps pe Vertical priority d Bottom 0 5 cm H Horizontal priority EE 3 Left 0 5 cm ES Right 0 5 cm cancel Margins will configure the print margins from the borders of the paper and Column order steps will allow you to choose if the steps will be displayed in vertical or horizontal columns Footer x Header Data Margins Footer Printed file name Left Center Right Iv Diagnosis Page v Signature Notes v Date Line width 5 9 Version cancel Footer will allow you to configure the information to be displayed at the bottom of the page By che
37. E x1 00 00 02 ES DD Add x2 00 10 21 Cancel open the Fittings window open a single Y vs X graph and select Test Fittings Note The results graphs and equations are not stored in the archive To record this information you must print the active window after creating the fittings Fitting a graph with a linear regression 1 Select the fitting type Linear 2 Select the first point X1 by placing the mouse on the desired location on the graph and press the Left key or use the and keys near the X1 field 3 Select the last point X2 by placing the mouse on the desired location on the graph and press the Right key or use the and keys near the X2 field 4 Select the Add checkbox if the fitting must be added to others already placed on the graph Otherwise the existing fittings will be deleted 5 Press OK to confirm The fitting is graphed and its equation is shown near the upper limit of the X interval Fitting a graph with a monoexponential regression 1 Select the fitting type Monoexponential 2 Select the first point X1 by placing the mouse on the desired location on the graph and press the Left key or use the and keys near the X1 field 3 Select the last point X2 by placing the mouse on the desired location in the graph and press the Right key or use the and keys near the X2 field Fittings Insert initial factors for the formula
38. EUR NAR EOD ER NECI MR eT REOS 94 E m m 94 95 LB und t caterer IET 95 E Jnporing E oe Pru ce eae neon ee I ANE NAM RU 96 Receiving data from the unit 97 Archive Maintenant TR E OD Lote 98 DCTS ROI SENTO TT E 98 Reorganizing the archive 98 oo 98 Emm 98 sacs cares 100 E Active window Naar nc canna ca GEEK ERE SEpr abies n CHOR EN RCM PIS 100 100 E M MM E MEM M M E DN 100 E Become repris BUT een aa Ee Sad MR 101 Micra i RA ES IE EI E EE 104 E PINE
39. Pressing Default will restore the default settings Fowler allows you to view CO and CH as a function of the exhaled volume Dead space is calculated according the Fowler method Lung diffusing capacity DLCO CO Diffusing Capacity DLCO Test 141 Pressing Equations enables the viewing of the alveolar CO concentration which is calculated by the 3 equation method When placing the mouse on the vertical dotted lines you may change the end of wash out and sampling phases This can be achieved by dragging the lines with the right mouse button or by moving the horizontal bars in the lower part of the window Note Editing a test may be useful to correct tests if particular curve morphology does not allow an accurate evaluation To change the algorithm for apnoea time calculations select the desired algorithm in the list above Breath hold To set the phases of the test according to ATS criteria check the checkbox ATS 95 criteria Press OK to confirm or Cancel to abort the changes Viewing results To view the tests results of a DLCO test 1 Select Patients from the File menu or press the icon 2 Select the patient corresponding to the test you wish to view 3 Select the test from the list box and press OK To switch between graph and or data use the following buttons on the toolbar 53 shows the DLCO graph n shows the Volume Time graph of the SVC procedure shows numeric data shows the Volume Time g
40. R X Freq 1 000 plo i oe cT Ec comm Pee eee pL qc cu TES Pre ees E frc E ERE a lee Wt EET 000 12 000 4 000 10 000 2 000 8 000 6 000 2 000 mmm x Ci sonaz3 su 23 Frequenze con Coerenza soddisfacente i i i 4 000 vuoi salvare il test eseguito 4 000 2 000 6 000 8 000 4 8 1 12 14 15 18 20 22 24 26 28 30 32 34 3B 38 40 42 44 46 48 Freq Hz Coh Freg 4 B B 1 12 14 16 18 20 22 24 2B 28 30 32 34 3B 38 40 42 44 46 48 FreqrHz Fer la guida in linea premi F1 08 03 2007 ito LA CASA NUM message will communicate how many frequencies have coherence gt 0 95 Press Yes to accept test No to discard and repeat it 172 Forced oscillations Perform a test L Viewing results Visualization functions will apply for the test performed by the current patient whose name is indicated on the left side of the status bar To view tests results 1 Select Patients from the File menu or press the icon 2 Select the patient corresponding to the test you would like to view 3 Select in the list box of the tests the one you want to view It is possible to view the mean of more tests Confirm with OK To switch between graph and or data visualization use the following buttons on the toolbar showstthe impedance graph shows the
41. Software Suite Ww Spirometry Pulmonary Function Testing Cardio Pulmonary Exercise Testing U Nutritional assessment Manuale Utente User Manual Manuel d utilisation Benutzerhandbuch Manual del Usuario Pulmonary Function Equipment 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 Suite Software User manual V Edition 09 2013 Copyright 2012 COSMED COSMED Srl Italy http www cosmed com Part N C03939 02 91 Table of contents of contents eee E TIS ee EE O Ov viewofthemantal 16 WOU 17 E TUBOEISDBIE 17 _ GIGDEE KOVBODBSL Gon ORE ONIE REAPER ER EREMO AMNEM MEME MEME ENIM MM EIS 17
42. TR TTE 213 Deleting one or more eene nennen nnno nens ses se osos 214 E Advanced 111 RR Uem 214 _ Re torme deuil 215 b un ALES RTT 215 LEE uale 215 Graphical BOIS S UI estas E CP UMS 216 Threshold noise suppression cssccccsseccecesececcesececeesececeececcuececeusececeueceeseneceseuseceseuecesseneceseuesesenecetsenecetseesetees 216 E Editing the tesi etr c 216 K4 Resting Metabolic Rate Test 218 e TER tT etm 218 B Resting Metabolic Rate 1 1 218 E importance of measuring RMR aA E a aai 218 B Measuring Rest Metabolic Rate with Indirect 1 1 2 1 218 Por E S 218 G Recommendations sonses EAEE EENE E a 219
43. There are two types of editing graphical noise suppression using the mouse directly on the graph and threshold noise suppression using threshold filtering on the measurements Graphical noise suppression 1 Select the parameter to be edited in the Parameter field The graph of the selected parameter will then be shown 2 Click on the point to be edited and drag the mouse to the desired place 3 To cancel the edit left click before releasing the right button 4 Repeat the above procedure for all parameters and press OK to confirm Threshold noise suppression 1 Select the parameter to be edited in the Parameter field The graph of the selected parameter will be shown 2 Enter a noise threshold as a percentage of the parameter value by moving the horizontal Noise bar in the SmartSmooth section Every point outside of the selected range will be considered an artefact 3 Press Execute to run the editing Undo to undo the editing Find to find all the points to be corrected or Fix to correct only the selected point 4 Press OK to confirm Editing the test protocol By selecting Test Phases and protocol you may edit the test protocol x C Protocol 15 Watt Ramp iz Manual Save Ergometer Cosmed Bike Cancel From 00 00 02 4 _ 2 To 00 10 21 4 Load 1 Power 0 C 2 Warm up ead 2 inktosBp 0 Exercise C 4 Recovery Load 3 ink to DBp 0 vO Bioline
44. To calculate the Oxygen Kinetics open a VO vs Time graph and select Test O2 Kinetics Note The results will not be stored in the archives To record this information you must print the active window after creating the fittings Kinetics Init Fact O2def Init Fact O2debt Selection 1 0127 2 1127 n 00 04 23 Cancel Bi 593 B2 1720 t2 00 03 13 Taul 400 Taz 400 rc Max attempts 100 1 Select the beginning of the exercise phase t1 by placing the mouse the desired location on the graph and press the Left key or use the and keys near the t1 field 2 Select the beginning of the recovery phase t2 by placing the mouse on the desired location on the graph and press the Right key or use the and keys near the t2 field 3 Enter if necessary the initial values for the A B and TAU parameters these are the values from which the iterative algorithm begins The more attempts made to obtain the best fit curve the more accurate the curve will be 4 Select the C checkbox next to the parameter if that value must be the exact parameter entered and press OK to confirm Default enters the default values for detecting the Oxygen Kinetics EX v02 t LA CASA V test n 1 iBl x 1702 ml min 1881 V02 583 1136 1 exp t 263 56 4 VO2 1720 1989 1 exp t 553y 81 2 R 0 20 00
45. UN PRIN 3 Y E 2 gt gt gt gt E Bf neuem mecum eme B o asm mem eodem mm ee ee s axe diam me re P En crcedeseumme ook Sapien ose an sche na C 7 E EE E E Press button to capture loop Mouth Pressure Body Box Pressure Tgv 0 029 PMouth cmH20 PMouth cmH20 aS oe aah te See stars gt Sn l on se UC Ga nnd fas cal E nS 40 sso i e 45 3 ale lat laa ata aati E 38 4 55 2252252525 2522 52 00 55 5 425552242225 Le 45 1 0 050 0 100 PBox cmH20 0 50 0 25 0 25 0 50 PBox cmH20 0 0 4 lE 45
46. cick HEURE Ere CERO EHE CHE PINE MIND PEE amen htt nr PRX MU UNO ert phir 249 KE RENTUR OM CEP ERO OE FEE VERMES 249 249 Graphical NOISE 250 TU MEE 250 K4 Sub maximal Exercise Testing EEEE EE NENE 252 xia Neil 252 O Sub maximal exercise testing cccssccsccsssscsssssscscssssccccecsecccesscsececseseccsseececsesececsssesecsssececsssececsesececsssesecscsssecesesss 253 Sub maximal exercise testing considerations 1 1 se os eo nue 253 E lt lt 253 cscs E 254 Indications for stopping an exercise test iecoris noxa ere lesa e YyER Eee vo VUE QU saa er HERE Pa Vw Poco eua s EE TENE E PdFNEF PUE oa 254 Considerations for accuracy Goodieseresdtevqut2didoububs EYamEUdt aU FUA Env 255 O Performing the test ROT 256 OT N
47. Cellular phones should be turned off prior to testing to eliminate potential interferences Preparation for a test Calibrate the PNT and the Body Box as indicated in the chapter Calibration Connect the PNT and the breathing valve inside the Q Box unit as described in the chapter Calibration Patient preparation The equipment is adjusted so that the patient can sit comfortably in the chamber and reach the mouthpiece without having to flex or extend the neck The patient must be seated comfortably thre is no need to remove dentures The procedure is explained in detail including that the door will be closed the patient s cheeks are to be supported by both hands and a nose clip is to be used Let the patient enter into the Body Box paying attention to avoid head bumps if necessary he she can use the proper handle Explain the procedure in detail including that the door will be closed the patient s cheeks are to be supported by both hands and a nose clip is to be used The patient is instructed to insert the mouthpiece in their mouth and breathe quietly until a stable end expiratory level is achieved usually 3 10 tidal breaths 154 Performing tests with Body Box General warnings Note Control of shutter closure includes a program to reopen it after 3 seconds TGV only to minimise patient discomfort and avoid the subject experiencing fear when s he is trying to breathe but the shutter is closed Patients should
48. FRC 08 06 2007 BOND James 000001 11 06 2007 BOND James 000001 CV 11 06 2007 BOND James 000001 DLCO 11 06 2007 BOND James 000001 The window will show all of the archived tests The list may be sorted by the patient s ID last name or date by selecting the relative option on the right side of the window Select the test to be exported and press OK Archive management and printouts Patient s database 95 You should then select the folder and the format for the test to be exported in Export tests performed by James BOND by Description NUN Cancel Preferences Export all tests Export selected tests You may also type a description in the Description box and select if all tests or only the selected test will be exported Press OK to confirm E Importing a patient list You have the option to import a patient s list in text format Select File Import patients and select the file you wish to import The file must be a text file formatted as Template txt 96 Archive management and printouts Patient s database Receiving data from the unit CED In order to download the tests performed and stored on the unit please do the following 1 Connect the unit to the PC through serial or USB connection depending on the settings 2 Select Receive test from the Test menu Test Download x Device Database Database Bon
49. If an anti bacterial filter is used for testing you should also use one when performing turbine calibrations Turbine calibration Flows and volumes are measured by the bidirectional digital turbine which offers a very low resistance to flow Air passing through the helical conveyors causes the spiral rotation of the turbine rotor The rotating blade interrupts the infrared light beamed by the three diodes of the optoelectronic reader The turbine flowmeter does not require a daily calibration since it is not affected by pressure humidity and or temperature However regular calibrations should still be performed as well as the recommended maintenance procedures see System maintenance chapter PNT Flowsafe calibration PFX Sp SPIRO PFT Q Box The PNT Flowsafe is a disposable flow transducer pneumotach which calculates the flow by measuring the pressure differential between the two sides of a screen Cosmed recommends that you perform a daily calibration and a calibration every time a new box of pneumotachs is opened PNT X9 calibration PFX Sp SPIRO PFT CPET The PNT X9 is a flow transducer pneumotach which calculates the flow by measuring the pressure differential between the two sides of a screen ATS recommends a daily calibration of the pneumotach Note The PNT X9 must be calibrated with the COSMED antibacterial filter PNT Rocc calibration The PNT is flow transducer pneumo
50. Load Vath etabolic Response VO2 ml min 3291 VO2IKg 41 13 METS 11 7 R 0 94 entilatory Response VE l min 172 8 96 30 00 VT D Rf b min 50 0 D VYDAT E E Rest Warm upLT RC Peak Pred ePred HR bpm 188 66 HRR 96 100 100 100 15 666 VO2IHR 17 5 16 1 Gt min SV iml beat P Syst mmHg P Diast mmHai 4 b gt view a report with the test results select View Test results By double clicking the window you are able to view the test information Exercise testing Viewing results 207 Viewing the test summary The summary displays the minimum maximum mean and trend for all of the displayed parameters in each phase bai LA CASA Y test n 1 Summary Rf VT VE Voz VE VO2 VE VCOZ VO2 R Feoz FeCOZ HR VO2 HR FetO2 FetCoz b min 1 l min ml min ml min ml min amp amp bpm ml bpm amp amp Phase n 1 Start 00 00 00 End 00 04 21 Loadi 0 Load2 0 Lo
51. Patient info Import in Code 4 Current patient card First name 57H Last name GIUSEPPE Birth date 10 12 1979 cancel Visit of 0 Date 01 06 2007 Weight Kg 70 0 Test Height 180 0 Diagnosis Diagnosis Quality That was good test errors E Exporting a test card You have the option of exporting a patient s Test card when the relative Patient card and Visit card are open 1 Select the patient 2 Choose the test to be exported and press the icon 8s All data from the test will be exported in an XPO file Cosmed proprietary Note Test can be exported imported in xpo format only between the same software version Diagnosis database The program allows you to manage a diagnosis database which consists of a list of diagnosis ID codes along with their descriptions When reporting the diagnosis associated to a current visit you may either type the desired text in the field Diagnosis of the Visit Card or retrieve the desired diagnosis from the database To insert modify or delete a diagnosis from the database select File Diagnosis Database 94 Archive management and printouts Patient s database x List 135 Sarcoidosis 162 9 Lung cancer 2770 Cystic Fibrosis 305 1 History of tobacco a 335 20 ALS 414 4 ATHEROSCLEORTIC HEAR 415 19 Pulmonary embolism Allows you to enter a new diagnosis Type the diagno
52. time a test has been opened To print report select File Report XXX XXX represents the name of the report to be printed You may also press the icon and select the name of the report you wish to print Set the printer and its properties and press OK E ECG summary printing 4 ECG summary is the report of the ECG performed during the exercise test Select File Print ECG summary E Test list printing A list of all tests performed can also be printed Select File Print test list E Electronic reports pdf If an Adobe PDF writer is installed you may store the printout report automatically in any location of the HD or LAN path according to a customizable filename format The created filename format may be defined in Page set up 110 Archive management and printouts Data printouts Spirometry mQ PFX Sp SPIRO PFT CPET Q Box L General warnings Su Note Please note the contraindications listed in the first chapter of the User manual of the device prior to testing If the flowmeter is attached to the breathing valve during the tests please be sure that the corresponding checkbox in the Spirometry options is enabled The sampling line should be disconnected from the flowmeter for spirometry testing The device must be properly connected to the PC with the appropriate communication port selected The name shown on the status bar must corre
53. to the point of maximum exertion This allows the estimation of 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 subject s predicted maximal heart rate HR 220 age A variety of protocols for different exercise modalities treadmill stationary cycle step increments can be used assuming that can be estimated with accuracy at each selected workload The objectives of cardiorespiratory fitness assessments 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 fitness levels e Document improvements in cardiorespiratory fitness as a result of exercise training and or other interventions e Motivate individuals to initiate exercise programs or comply with established programs e Provide information concerning the health status of individuals The following conditions are necessary to ensure the accuracy of results when using sub maximal exercise testing to estimate gt e Selected workloads are reproducible A steady state heart rate is obtained during each stage of the test Workload durations of 3 minutes or more are typica
54. 00 00 19 14 9 0 696 10 4 325 AY 29 34 4 06 0 83 16 59 SPI 00 00 23 15 2 0 697 10 6 326 275 29 34 4 08 0 54 16 63 3 71 00 00 27 0 701 10 6 324 276 29 34 4 05 0 55 16 66 3 76 00 00 31 15 4 0 713 11 0 338 256 29 34 4 22 0 54 16 65 3 77 00 00 36 15 4 0 719 11 4 347 290 29 34 4 34 0 83 16 60 3 777 00 00 40 15 3 o 717 11 0 345 285 28 34 5 31 0 52 16 60 3 75 00 00 44 alee 0 711 10 6 339 ey 3 6 Sad 0 80 15 54 3 00 00 46 14 6 0 697 10 2 331 261 27 35 4 13 0 78 15 43 3 72 00 00 52 0 673 9 6 311 Pup AY 3 88 0 76 15 48 Sb o Gal 00 00 56 14 2 0 640 9 1 254 226 27 36 3 68 0 76 16 46 3 67 00 00 59 14 a 0 619 288 218 27 36 3 60 IPS 1 le 3 67 00 01 02 15 0 Ube dd 309 230 26 35 3 87 0 74 16 21 0 00 01 04 15 8 0 645 10 2 349 260 26 35 4 36 0 743 16 24 OP 00 01 07 17 1 0 5688 11 8 409 309 26 34 5 12 0 75 16 19 3 82 00 01 09 18 6 0 751 LS 4 8 4907 361 25 33 6 21 Bla wm 1 ais ale 3 90 00 01 12 20 4 0 9813 16 6 595 464 25 32 7 43 0 78 16 12 3 96 00 01 14 21 8 0 646 16 5 659 25 32 5 24 012 iis a SF 72 5 41 View graphic Archive tests list ID Date Duration 20 02 1997 00 14 13 B ND J f Current patient 000002 13 03 1997 00 15 00 BOND J 000003 11 04 1997 00 10 43 TREADHIL T All tests 000004 14 04 1997 00 05 16 CARDIAC OUTPUT 000005 15 04 1997 00 07 14 LOOPS 0000016 26 01 2000 00 14 45
55. 1 Connect the Canopy unit to the mains by means of the medical grade AC DC adapter provided 2 Attach the vail to the bubblehood through the velcro strips 3 Insert the adapter into the bubblehood from the outside and connect it by screwing the ring from the inside as shown in the following picture gt 2 2 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 ID18 turbine to the output of the Canopy unit Resting Metabolic Rate Test Performing a test using the canopy option 223 E Preparing the canopy 1 Fixthe vail to the bubblehood through the velcro strips 2 Insert the adapter into the bubblehood from the outside and connect it by screwing the ring from the inside as shown in the following picture 3 Connect the bubblehood to the corrugated tube inserting an anti bacterial filter 4 Connect the wrinkled tube to the canopy hood connector on the rear panel of the Quark 5 Connect the ID18 turbine to the RMR flowmeter connection on the rear panel of the Quark B Preparing the patient 1 Switch the Canopy unit on The red led on the front panel of the unit should flash for few seconds followed by an alarm beep If the led does not flash and or the alarm does not beep the test cannot be performed because either the backup battery is exhausted or there is no backup battery 2 When the green l
56. 11 Cancel Stage 14 Stage Stage 20 Stage 23 Stage 26 Stage 29 Stage 32 Select the desired event and confirm with OK Once the event has been opened you have the option to perform the following functions Exercise testing Viewing results 203 Events Edit edits the event tag e Events Delete deletes the event Events Print events prints the event Events Superimpose ECG superimposes ECG to the event Events Setup leads customizes the ECG leads view You may customize the F V loop event by selecting Events Edit In this window you may select the desired reference curve from all FVC tests performed by the current patient with the Spirometry program Viewing ABG results It is possible to view the ABG results by selecting Test ABG results 1 t Phase 8 VD VT Pacoe Pade PH Bade HCO3 Lat Hh hh mm as Epa mmol mmol L 00 00 24 Rest 0 0 0 00 4 7 10 8 7 35 21 0 0 2 14 0 0 0 00 00 52 Warm up 0 1 0 00 4 8 10 8 7 36 0 4 14 0 0 0 00 01 25 Exercise 0 1 0 00 4 8 11 0 7 37 98 22 0 0 5 14 0 0 0 00 01 44 Exercise 0 2 0 00 Sa Sl 43 2 1 Po SO Se oc 14 0 0 0 00 02 02 Exercise 0 3 0 00 5 0 11 2 7 42 a8 22 5 D 14 0 0 0 Customizing graphs To customize a gr
57. 2 56 5 Select System Activation codes Activation Code X Activation 6 To activate a new software version select Software in the field Activation and enter the two parts of the Software Activation Code in the Left and Right fields Press Activate 7 To activate new modules select Modules in the Activation field and enter the two parts of the Module Activation Codes in the Left and Right fields Press Activate 8 Atthe end of the operation a message will confirm its success Confirm and exit by pressing Close 9 Turn off the device When turned on the unit will be enabled for the new modules Current configuration In order to verify the current configuration and the activated modules select System System information A window will show the required information 26 Installation Activate additional modules new software Calilbration Introduction Regular calibrations are necessary to assure your system is acquiring reliable measurements Each device requires different calibrations depending on the features of each product ui Flow volume calibration mQ Sp SPIRO PFT CPET RMR K4 Q Box Flow volume calibrations are performed using a 3 liter calibration syringe If the syringe is not included in the packaging it can be ordered directly from Cosmed P N C00600 01 11 Each flowmeter requires a separate calibration turbine PNT Pnt Rocc Note
58. 3 When 5 or 6 complete breaths have been acquired press Event End or F3 or the icon E to stop the data acquisition E Spirogram The spirogram event allows you to display and store the Volume Time plot Spirogram event during the test 1 Begin storing data in an exercise test F2 or 2 During desired phase rest or exercise select Spirogram from Events Event Vil t hh mm ss 00 00 00 10 00 20 00 30 00 40 00 50 t hh mm ss 00 09 23 9 tas 3 Press Event End or F3 or the icon to stop data acquisition and store the curve 200 Exercise testing Events management during exercise testing L Viewing results When the test is complete all data that has been stored can be retrieved for complete analysis Note Many of the following operations are also accessible by right clicking on the active window Data viewing Data can be viewed in the following formats Format Description Table form Displays the numeric values of testing parameters in columns corresponding to each of the steps in rows Graphic form Displays a graphical presentation on Y1 Y2 X charts Report Displays the results of the test and statistical analysis of the blocks You may also view the events that were stored during the test Viewing data in table form 1 Select Data from the View menu or press the icon ID Date Duration Name List 20 02 1997 00 14 13 BON
59. 34 BTP5 exp 1 020 First name Vito Hum flowm 100 Press mmHg 744 Patient data 0 00 Date of test 08 05 2007 Age 32 1 0 00 Time of test 10 30 Height cm 180 0 IC n 0 00 Test n 1 Weight Kg 80 0 MYY 0 0 M of steps 22 BSA 1 9 post ex 0 00 Duration hh mm ss 00 10 21 HHmax bpm 188 FEV1 post ex 0 00 LT time hh mm ss UN g day 0 0 IC post ex 0 00 time hh mm ss Keal day 0 post ex l min 0 0 VD ml 70 2 ml min 0 User 0 00 User 0 00 User 0 00 Notes E Comments Modify LT Calibration 2 Select View Information or press the icon 8 The software allows the measurement of the Energy Expenditure and Metabolic Substrate To measure the and the CHO parameters accordingly you may enter the UN Ureic Nitrogen in the UN field If a value is entered all nutritional values will be recalculated using the specified UN Modify test information 1 X ID code Male Last name TEST Female First name MALE Birth Date 01 70171994 Ethnic Cor x 100 Height cm Temperature C 25 Weight Ku 5 0 Temp flowm 34 max bpm 189 Humidity 2 50 UN g day 00 flowm 27 100 Kcal day 0 Press mmHg 747 0 ERIS VD ml Post exercis
60. 5096 Resting Metabolic Rate Test Performing a test with mechanically ventilated patients 231 5 nability to separate inspired and expired gases due to bias flow from flow triggering systems IMV systems or specific ventilator characteristics Presence of anesthetic gases or gases other than CO e N in the ventilation system Presence of water vapor Inappropriate calibration E Connection of the Quark RMR to certain ventilators with adverse effect on triggering mechanism increased expiratory resistance pressure measurement or maintenance of the ventilator 10 Internal leaks 11 Inadequate length of measurement 232 Resting Metabolic Rate Test Performing a test with mechanically ventilated patients L Performing a Resting Metabolic Rate test Here follow further details about the execution of a RMR test Realtime visualization During the test you may view windows which display the measured data graphs and or information VO2lIKg about the test The selected workspace will determine which windows are automatically displayed 3248 During the test the main parameters VO Kg VE R and VO2 are displayed on the right side of the 3 60 screen 32 1 9 For each value the actual value is shown in a big font and the minimum and maximum values reached during the test are shown in a smaller font The coloured bar displays the range of the actual value VE Parameters colours and thresholds may be cu
61. 52 Ireatholk Cancel Help VA 8 06 Preview Select the test to be modified and press OK to confirm Preview will display preview of the selected test below the window A window for the DLCO editing will be opened Edit the desired parameters and confirm with OK Note Editing a test may be useful to correct tests if particular curve morphology does not allow for an accurate evaluation Press OK to confirm or Cancel to abort the changes 144 Lung diffusing capacity DLCO Membrane diffusion test Respiratory mechanics General warnings 1 MIP MEP and 1 tests must be performed with the ID 28 turbine and the pressure line connected or with the PNT Flowsafe or X9 The Quark must be properly connected to the PC with the appropriate communication port selected The name displayed on the status bar must correspond to the patient carrying out the test A visit card for the testing date must be created The mouthpiece should be connected to the flowmeter and the antibacterial filter properly Ge For hygienic reasons the use of an antibacterial filter is strongly recommended In case of using the PNT X9 the use of an antibacterial filter is mandatory Note Cellular phones should be turned off to eliminate potential electrical interferences E Patient preparation Using the turbine Calibrate the turbine as indicated in the chapter Calibration ATS recommends a daily calibration
62. 6 000 a me E Mr a EE 55 Har MER MER a MOS 22 lo E c ME ee E MEL E G00 debe eee dee dede 4 000 4 4 4 000 ee ce 5 000 4 B 8 1 12 14 1 18 20 22 24 2B 28 30 32 34 3B 40 42 44 46 48 Freq Hz Flusso Pressione 3 00 2 00 1 00 0 1 00 2 3 00 4 00 Fer la quida in linea premi F1 08 03 2007 vito LA CASA NUM 4 Pressthe calibration button i 5 f necessary set the signal level and press Send We suggest not to modify the default value The optimal signal level is the one which generates a pressure within 1 and 1 hPa Farced Oscillations Options Signal Level 40 Send Remove Offset Calibration Start Set Uncalibrated Calilbration Calibrate the Quark i2m 51 6 Press Start in order to start the calibration Calibration will be performed automatically 7 At the end of the calibration procedure the coherence graph will be diaplayed together with a message about the goodness of the calibration We suggest to repeat it if it is not good H Suite 8 1a b1
63. BMI Kg m 2 20 3 Normale Protocollo RMR EEkc 3500 0 3000 0 2500 0 2000 0 1500 0 1000 0 500 0 tihh mm ss 00 00 00 45 01 30 02 15 03 00 03 45 04 30 05 15 06 00 06 45 07 30 08 15 09 00 09 45 10 30 11 15 12 00 12 45 13 30 14 15 15 00 15 45 16 30 mSS The window summarises all the main results e average time interval default 10 minutes e Average values of R RMR VE HR FAT and predicted values if available and 96 of variation during the test e Mass Index BMI and interpretation e Graph of the Energy Expenditure for all data acquisition intervals with the selected average interval highlighted Only for face mask tests in order to verify the quality of the test assure that the minute ventilation and respiratory frequency values are respectively near 12 breaths minute and 6 litres minute and that the heart rate measurement is close to the patient s resting heart rate 240 Resting Metabolic Rate Test Viewing results During the Canopy tests the respiratory frequency 12 breaths minute and the ventilation are the values of the pump while the FeCO and the are the concentrations in the hood not at the patient s mouth Note The percentage of Proteins used PRO 6 and the npRQ are calculated assuming 12 grams of Ureic Nitrogen 24 hours You can modify this value by selecting View Information Modify E Modifying the average
64. Display all steps Smoothing 5 points C Mixing Chamber mm ss Discard invalid steps Details Memorize filtered test Automatic calibration Highlight parameters Parameter n 1 Parameter V 27Kg 5 Yellow value 75 0 Red value 100 0 on predicted Store ECG when load changes HH reading from Quark T12X C12X When selecting Options Real time Settings you may customize the following If all steps will be displayed if the software will perform a smoothing on certain steps as entered in the box near Smoothing or if a mixing chamber is going to be used If a mixing chamber is used the steps will be displayed every mm ss as entered in the box near Mixing chamber You may only select one of the options listed above e If invalid steps will be deleted By pressing the button Details you are able to set the criteria for step deletion For all the parameters displayed respiratory frequency Tidal Volume FeO and FeCO 96 you may set the acceptability range and if this parameter meets the criteria for step deletion User interface and settings CPET settings 79 Delete Step Criteria X Parameter min max M i b min M VT 0 6204 M 02 4 20 00 02 x 1 00 Restore Cancel 2 5 If filtered steps will be stored the filtered test results are automatically displayed when the test is opened If an air cal
65. EEEE E EEE 256 PFT CPET K4 chamber EEEE SEEE EEEE EEE EE EEE 258 a tem 258 B Preparing the mixing chamber for 258 Two way rebreathing valve description sesssssosssessssecsesessececsessosecsosesecssososecsssecscsessssecscsessssessesessoseoseses 258 Connecting the two way non rebreathing valve to the 1 1 1 4 1 21 2 259 Connecting the above assembly to the head support 1 4 259 iui iul ne Y gt E RE 259 aMiu slidtAtb A5 lm 260 13 Getting started Overview of the manual This manual is organized in the following chapters Getting started Overview of the manual Installation Lists the steps required to properly install the software and additional modules Calibration Outlines the calibration procedures Explains the functions of the control panel User interface and settings Describes the user interface and how to customize software settings language settings page header parameters Archive management and printouts Explains how to properly manage and maintain software archives backup reorganize Describes the procedures for printing test results and reports Spirometry Includes instructions for executing spirometry testing FVC SVC MVV and data viewin
66. HE ques Quark RMR Antisaliva filter 1 2 3 Sampling line 4 Sampling line extension 5 Adapter for ICU calibration Select Calibration Gas ICU and follow the prompts Press OK and wait until the procedure automatically ends Do not breath near the calibration valve 15 20 25 30 35 45 Sampling calibration gas 02 CO calibration results ICU Oxygen analyzer 12 Response Adjustment Actual Acceptable Range Gain 998 800 1200 ero 46 Zero 200 200 Delay 310 Delay ms 00 1300 Zero Hw 205 zem 50 500 Response Time ms 50 Response Time 0 1000 Response Factor 5000 Enable 02 Adjustment Carbon Dioxide analyzer Actual Acceptable Range 800 1200 Gain 904 366 mv 10 600 Cancel Delay ms 730 Delay 5D 1200 3 ero 23 ero 0 511 Response Time ms 60 Response Time ms 0 200 Help Analyzer pressure mmHg Actual 600 Acceptable Range 500 50 Sampling flow ml min Actual 400 Acceptable Range 300 500 When the calibration is complete the software will display the new calibration factors Values within the acceptability range will be appear black and those outside of this range will be red If one or more values are outside of the acceptable range the calibration must be repeated If calibration values r
67. Hin 0 0000 150 0001 Step 30 0000 Cancel By pressing More listed beside the details of each graph you may customize the following variables within each graph Markers Squared Ignore 0 Points only Mark points recovery If a grid will be drawn 5 If a scale will be automatically drawn if this option is deselected you can set the range of the axes and the grid step You may also enable or disable the following options Ignore 0 will remove all the points which the measured value is zero Points only will show a dispersion graph without a line connecting the points Mark points will mark each measured point with a symbol Markers will highlight each point in which a marker was entered with a symbol e Squared will make the graph squared instead adapting it to the space e No recovery will exclude the recovery phase from the graph 86 User interface and settings CPET settings Press OK to confirm Cancel to cancel changes or Restore to restore the default configuration E ECG printout xl _ Cancel Cancel Margins tet E Big 40 Top Bo Bottom Bo PFT CPET K4 By selecting Options ECG printout you may set the following printout options for the ECG e Paper margins left right top and bottom If a grid will be printed and the length of the grid grid may be useful if no graph paper is used User interf
68. RMR After entering in the calibration program select Calibration Control panel Body Box If necessary change language selecting Options Change language EJ Log file mQ PFX Sp SPIRO PFT CPET RMR K4 The program creates and automatically updates a calibration log file which contains the details of all calibrations performed by the user To access the Log file select File Report File from the calibration program Calilbration Introduction 29 x CAL LOG TXT Browse Cancel Save report file Append Setting reference values mQ PFX Sp SPIRO PFT CPET RMR K4 Q Box Before beginning the calibration you should assure that the system has been configured with the correct gas concentration values 1 Room air i e 20 93 and 0 0396 CO 2 239 The mixture contained in the gas calibration cylinder s 3 The volume of the calibration syringe i e 3 litres It is only necessary to configure these values the first time the device is used or if the reference values were to change e g when cylinders are replaced The system will store the most recently entered reference values for future calibrations 1 Select Reference Values from the File menu ELSE Type the correct values for the and CO room air concentration i e 2093 for 20 93 Then type the correct values for the gas concentrations of the calibration cylinders Ref
69. Shows the pressure and flow graphs Starts a FOT calibration Shows the measured data Shows the bronchoprovocator response Shows data step by step Creates a new window Places the windows in cascade Tiles the windows horizontally Tiles the windows vertically 5 o 5 h e O 79 m o zj Opens the patient s database Prints the current window Prints the reports Starts the calibration program Starts the test Shows the data from a test Show the graph from a test Calculates the Anaerobic Threshold Shows the predicted values and the predicteds of measured parameters 60 User interface and settings User interface Opens an event of the selected test Shows information from the selected test qe m Edit the current test Exports a test Send a test to Excel 222122 I Selects the parameters to be displayed Select create and or edits the exercise protocol used to drive an ergometer during testing Customizes parameters 3 md Tiles the windows horizontally Tiles the windows vertically Closes all open windows Toolbar icons in the CPET software real time P MEN STHRT Starts data acquisition during the test smP Ends the test 8 Performs an event during testing R Selects the parameters to be viewed during testing BRAFH Shows a graph of the current test Selects a test prot
70. Use to temporarily modify the colour of the selected item without saving changes The previous colours will be restored when the software is restarted Press Restore to restore the default colours Software configuration Cache teorics database Cache graphs windows O2 WHO predicteds Restore Easy Read _Bestore Safe graphs printing 2 Alternate Color Printer detect Fast graphs GPS coords 1271352 REE Black predicteds Ignore ergometer delay EKG compatibility Disable Tango Sbp Dbp measuring device Consider different IDs as different Subjects Cancel By selecting Options Settings you may configure the software options E The three Cache checkboxes Cache parameters database Cache teorics database and Cache graphs windows allow you to save memory but will cause the software to run slowly these should only be deselected when using an older PC with very little cache memory We suggest that you keep these checkboxes selected Checking VO2 WHO predicteds will allow the usage of VO WHO predicted equations instead of Wasserman equations Checking Easy Read will display the test steps in colours If deselected the steps will be shown with a white background 5 Selecting Safe graphs printing allows you to correct printout errors caused by the drivers of certain printers If the graph is noticeably incorrect you should select this checkbox 78 User interface and s
71. actually inhale the CO and CH mixture This is useful when familiarizing the patient with the procedure prior to performing the actual test Press Start to begin the test Wait until the automatic air calibration is completed When the system is ready a message will be displayed on the lower part of the screen Ask the patient to perform a Slow Vital Capacity manoeuvre if desired This is necessary to allow for the calculation of all lung volumes You may also choose to select a SVC test previously performed by the patient when the DLCO test is complete 8 Ask the patient to begin by breathing normally and press F2 or the icon during a maximal exhalation to begin the test 9 Instruct the patient to inspire the DLCO gas mixture to a TLC level At the end of inspiration ask the patient to exhale slowly to RV while maintaining a constant flow rate between 250 and 750 ml s To abort the test press AIt F3 or o 6 2j To restart the test press K On the right side of the graph a coloured column is displayed which represents the instantaneous flow This column is green if the flow is within the acceptable range and red if it is considered unacceptable On the lower graph a dotted horizontal line represents 90 of the patient s best VC If there are no FVC or SVC manoeuvres stored in the patient s archive then the line indicates 90 of the predicted value SS PFT Suite 9 0a b1 Test TEST Real Time Test DLCO 8 x i Tes
72. always be informed to remove the mouthpiece from their mouth in the event the shutter does not open or if the subject senses substantial difficulty breathing Instruct the patient to apply the nose clips Close the door The plethysmograph door is closed and time is allowed for the thermal transients to stabilise and the patient to relax normally 2 minutes Performing tests with Body Box General warnings 155 Test execution This test measures the TGV thoracic gas volume and the Raw airway resistance In particular the plethismograph relates pressure variations inside the Body Box with volume variations of the air within the lungs by means of the Boyle s law It states that under isothermal conditions the product of volume and pressure of a gas is constant During a panting maneuver respiratory frequency about 60 breaths perminute the apnea valve is closed and patient is asked to perform short and rapid breaths While the patient try to breathe he she expands the gas within the lungs and causes the pulmonary volume to increase Consequently the body box pressure increases since its volume decreases When the patient exhales the opposite occurs In healthy individuals there is a little difference between the FRC measured with nitrogen wash out technique or other dilution techniques and the TGV measured by means of a Body Box This is not true for patients with particular pulmonary pathologies for these patient
73. and the predicted values To abort the test press AIt F3 or To restart the test press E 5 To visualize the F V graph the V T graph or the main parameters press one of the following buttons n shows the Volume Time graph shows numeric data 6 Repeat the test until the desired number of manoeuvres has been obtained correctly 7 Press to visualize the test list and results from the current session Choose Ehe test to keep xj EVIL Ivi ERV Vt Heas Meas 4Pred Meas Pred Meas Pred Testn 8 041 00 6 17 103 1 10 207 00 0 26 10 2 Tests are sorted from best to worst Save all Discard all Cancel Help 8 Select the test that you wish to save tests are sorted from best to the worst according ATS criteria and press Spirometry Slow Vital Capacity 115 1 Maximum Voluntary Ventilation Measurements of Maximum Voluntary Ventilation are commonly performed when exercise testing is also being conducted MVV measurements indicate an index of the subject s maximum ventilatory capacity The procedure consists of breathing in and out as deep and fast as possible for 12 seconds The expired volume during the 12 second period is then extrapolated to 1 minute Parameters measured during MVV testing include the following Symbol UM Parameter MVV l min Maximum Voluntary Ventilation MVt Tidal Volume during MVV MRf 1 min Maximum Respiratory frequency MVVt sec MVV duratio
74. at least 5 minutes between trials Note After turning the device on wait at least the recommended warm up time before beginning calibration or testing procedures Notice Cellular phones should be turned off to eliminate potential electrical interferences E Patient preparation Calibrate the turbine or the PNT X9 as indicated in the chapter Calibration ATS recommends a daily calibration Perform a DLCO calibration see Calibration Connect the sampling line to the flowmeter and connect the turbine to the breathing valve Instruct the patient to apply the nose clips The use of antibacterial filters is strongly recommended 134 Lung diffusing capacity DLCO General warnings CO Diffusing Capacity DLCO Test Diffusion can be defined as the flow of particles from an area of higher concentration to an area of lower concentration Measuring diffusion in pulmonary function laboratories can provide information about the transfer of gas between the alveoli and the pulmonary capillary blood Oxygen and Carbon Dioxide must move accross both the alveolar capillary membrane and the blood plasma barrier during the diffusion process The rate of diffusion across these barriers is limited by several factors the surface area available for diffusion to take place the distance the gas molecules must travel the solubility coefficient of the gases in the liquid and the partial pressure gradient between air and blood and the densi
75. be displayed amp Calibration BodyBox Leakage Check 15 06 2011 15 49 8 x File Tests and Calibrations System Options Window Help 8 dH 6 Leakage Check PressureccmHzQ 0 550 0 500 0 450 0 400 0 350 0 300 0 250 0 200 0 150 0 100 0 050 0 000 0 5 10 15 20 25 tis Measured Min Max Results Executed on 15 06 2011 15 49 Leakage time ms 135800 6000 14000 PASSED Target PBox femH20 0 293 O270 0330 PASSED Ready m Polytropic coefficient Warning Calibrate the body box when it is empty without the patient and closed Wait at least 2 minutes after closing the door before starting the check Select Tests and calibrations Body Box Polytropic coefficient The procedure is fully automatic At the end the results will be displayed Calilbration Body Box calibration 49 5 Calibration BodyBox Polytropic Factor 17 06 2011 09 47 a x File Tests and Calibrations System Options Window Help E 1 6 PressureccmHzQ 0 100 Polytropic Factor Calibration 0 080 0 060 0 040 0 020 0 000 0 020 0 040 0 060 0 080 0 100 5 10 15 20 25 30 38 40 45 50 55 tis Measured Min Max Results Executed on 17 06 2011 09 47 Ambient Pressure mmHg 749 Ambient Temperature C 2b Relative Humidity 45 Polytropic coeff ml cmH20 908 400 1100 PASSED Ready i ex E Error messages COSMED Calibration 7 Calibr
76. by this patient selecting Select SVC Test paziente corrente SYC E 08 06 7007 SWC 08 06 2007 SYC E 6 46 Annulla E 244 5 00 Anteprima 03 06 2007 SYC Trend To display a trend of more than test performed by the same patient select View Trend 166 Performing tests with Body Box Viewing and editing test results Trend James BOND x Selezionare i test da includere nel grafico del trend Premere SHIFT sulla tastiera fare clic con il mouse sulla lista per selezionare un range di test Premere CTHL sulla tastiera fare clic con il mouse sulla lista per selezionare un test per volta 26 01 2007 0870672007 12 42 0870672007 12 42 0870672007 12 42 0870672007 SYC 12 56 0870672007 SYC 12 56 0870672007 SYC 12 56 0870672007 MYY 12 59 0870672007 MYY 12 59 0870672007 F C Post 14 12 Salbutamol 0870672007 F C Post 14 13 Salbutamol 20 000 Grafico 1 v Grafico 2 Parametro 1 xl Parametro 1 Parametro 2 Parametro 2 Teorico Teorico C Seleziona Seleziona B Annulla Select the tests which you would like to view and the graphing options which you would like to display The Parameter 2 allows the visualization of two different parameters on the same graph the Graph 2 allows the visualization of two different graphs in the same window Press OK to confirm
77. corresponding to the test you wish to view 3 Select the test to view from the list box and press OK To switch between graph and or data use the following buttons on the toolbar FRC shows the FRC graph lee shows the Volume Time graph shows numeric data T Ed shows breath by breath data If you wish to visualize more than one window select New Window from the Window menu To display a list of tests of the current patient select Test current patient from the View menu or press the icon amp l Lung volumes FRC test N2 washout 129 Closing Volume test CV The Closing Volume testing procedure consists of instructing the patient to perform a single inspiration of 10096 oxygen followed by a complete however not forced expiration to RV The complete exhalation allows for the measurements of the instantaneous N concentration and the total expired flow The expired nitrogen is plotted on a N Volume graph which displays four phases Phase Description Phase Gas expired during Phase represents the oxygen contained in the patient s upper airways which does not participate in gas exchange Phase II Phase II displays a rise in the N and represents ventilation from the patient s upper and lower airways where the initial N has been diluted with inspired oxygen The anatomical dead space may also be calculated via the Fowler method Phase Ill Alveolar Plateau is visible during Phase which
78. for at least 8 minutes following the test or until he she returns to pre exercise conditions E Preparing the patient To receive the most accurate test results it is necessary to communicate with the patient before during and after the procedure The patient should be well informed of the testing details and receive appropriate instructions prior to the test Before testing The physician conducting the procedure must be provided with a written request including a diagnosis confirmed or suspected the indication for the test and the subject s current medications To standardize the test results and to reduce the patient s anxiety you should provide him her with either written or oral information prior to the test When scheduling the exam patients should be instructed to avoid smoking caffeine and eating for three hours prior to the test He she should also be informed to wear comfortable clothing and shoes during the procedure Medications which could impair the effort response and reduce the diagnostic accuracy of the exam may need to be stopped prior to testing i e Beta Blockers or Calcium Antagonists A detailed medical history should be acquired from the patient before performing the test Medications tobacco use current activity levels nutritional habits and the presence of any abnormal symptoms should be noted Patient assent The patient should be informed that he she will be subjected to a maximal or submaximal effort alo
79. interval If the average interval that is automatically identified by the software is not satisfying i e patient was speaking during the first minute you may manually modify this range Select Test Edit RMR or right click and select Edit RMR to move the start and end lines of the interval Quark RMR DI PIETRO A test 1 E i 81 x File Test Eventi Visualizza Finestra Selezione punti 8 x xi 00 05 30 8 00 15 30 27 0 0 tthh mm ss 00 00 00 45 01 30 02 15 03 00 03 45 04 30 UT 06 00 06 45 07 30 08 15 09 00 09 45 10 30 11 15 12 00 12 45 13 30 14 15 15 00 15 45 16 30 To move the start line for calculations place the mouse on the desired location in the graph and press the Left key or use the and keys near the X1 field To move the end line for calculations place the mouse on the desired location in the graph and press the Right key or use the and keys near the X2 field Press OK to confirm Viewing an event Select Events View or press the icon Select the desired event and confirm with OK Once the event has been opened you have the option to perform the following functions Events Edit edits the event tag e Events Delete deletes the event e Events Print events prints the event Resting Metabolic Rate Test Viewing results 241 Customizing graphs To customize a graph select View Customize g
80. new values Cancel to abort the operation or Factory Settings to set the default values 4 Since ventilation is very low during Rocc manoeuvres normally 10 litres min the turbine calibration should be performed with very slow manoeuvres each manoeuvre lasting between 10 15 seconds Calilbration Calibrating flows and volumes 35 Analyzers calibration DCDCDC E Connections In order to calibrate the analyzers you should disconnect the sampling line from the reader and connect it to the front panel of the Quark The cylinders used for the calibration must be properly connected to the rear panel of the Quark and the output pressure should be between 5 and 6 bars Before starting the calibration you should make sure that the reference values are correct see the Setting Reference Values section Note Cellular phones should be turned off to eliminate potential electrical interferences Analyzers Calibration P X Gas is absent check the calibration tank Note If the window shown above appears during the calibration you should make sure the cylinder s residual pressure is above 10 bar and that the cocks are open 36 Calilbration Analyzers calibration 5 bar press 6 bar press 10 bar E ERGO RMR calibration PFT CPET RMR Warning After turning the Quark on you should allow the system to warm up prior to beginning any calibration The ERGO RMR calibration should be performed daily and repea
81. performed Note When the test has been completed the Raw will be recalculated based on the actual TGV if performed It is normal that the real time Raw measurements are different from the one shown when the test is completed unless the calculated TGV is equal to the predicted one 4 Capture at least three sRaw within 596 the difference between the higher and the lower value divided for their mean value must be 0 05 to guarantee repeatability of the maneuver Note When at the bottom of the screen the indication invalid loop appears the calculated regression has an invalid value i e negative values and the value will not be shown and stored TGV test 1 Press the icon In the lower part of the screen the software will show the current Mouth pressure Box pressure loop and the current TGV graph with real time values Performing tests with Body Box Test execution 159 Suite 10 0 b21 James BOND Real Time Test Raw 8 x 2 Test View Window Help 8 x 123 123 a 7 1 ps Kol 4 gt SR Tay Redo Abort Capt Valve Zero Filter Align VT Tgv ND Lr X BM 4 4 4
82. sampling line to the flowmeter and connect the turbine to the breathing valve Instruct the patient to apply the nose clips The use of antibacterial filters is strongly recommended 126 Lung volumes General warnings _ FRC test N washout Lung volume measurements typically include the Total Lung Capacity TLC Residual Volume RV Functional Residual Capacity FRC and Vital Capacity VC These measurements are essential to assess lung function and assist in the diagnosis of obstructive and restrictive lung disorders FRC can be determined by using one of the following techniques 1 Multiple breath open circuit Nitrogen washout 2 Body Plethysmography 3 Multiple breath closed circuit Helium dilution The Quark utilizes the nitrogen wash out technique to measure lung volumes This method involves removing or washing out the N gas present within the lung by allowing the patient to breathe 100 O for several minutes The washout is complete after 7 minutes of rebreathing has occurred or when the final concentration of expired N is below 1 5 2 5 for three consecutive breaths The exhaled nitrogen represents the patient s initial lung volume which allows the measurement of FRC to be calculated The following parameters are measured during the test Symbol UM Parameter E Performing the test 1 Select Test Start Multi breath N2 Wash out or press the icon and select Multi breath N2 Wash out Then wait until
83. size by relaxing the smooth muscle E Test execution 1 Select Test Start Body Box Post or press the icon B selecting Body Box Post I x Farmaco Salbutamol Unita di misura mcg Stepn 1 di step 8 a Quantita 0 0000 Quantita cumul 0 0000 2 Confirm the suggested step and medication used by pressing OK 3 Start and perform the test as indicated in the previous section i 162 Performing tests with Body Box Body Box Post test execution Limitations of the measurement method Below are some limitations of this procedure according to the international scientific community Overestimation of TGV in subjects with severe obstruction or induced bronchospasm unless slow panting speed ie approximately 1 cycle s is maintained Erroneous measurement of TGV Raw or sGaw due to improper panting technique Excessive pressure fluctuations or signal drift during panting may invalidate TGV Raw or sGaw Non panting measurements have been suggested for use in children or others who have difficulty mastering the panting maneuver Non panting maneuvers in plethysmographs with built in thermal leaks may invalidate TGV or Raw measurements Computer determined slopes of either TGV or Raw tangents may be inaccurate All slopes should be visually inspected and adjusted according to an established laboratory procedure Excessive abdominal gas or panting techniques that employ accessory muscles may i
84. the patient carrying out the test 5 visit card for the testing date must be created 6 The mouthpiece flowmeter and antibacterial filter must be properly connected Note Cellular phones should be turned off to eliminate potential electrical interferences E Testing preparation Prior to testing the Rocc should be calibrated as described in the chapter Calibration Ask the patient to apply the nose clips The use of antibacterial filters is strongly recommended 180 Airways resistance measurement General warnings The Airways Resistance measurement test Traditional methods of measuring airways resistance are based on body plethysmography which requires a great degree of patient cooperation along with extensive testing equipment and skilled clinical technicians Many patients are unable to perform plethysmography testing due to the testing conditions involved Patient populations which may benefit from measuring airway resistance using alternative methods include critically ill patients acute Asthmatics geriatrics unconscious patients neonates and pre school children Instruments based on the interrupter technique provide reliable resistance measurements and are very well tolerated by all patient populations The interrupter technique implements a transient airflow interruption and measures the pressure at the mouth immediately after the interruption occurs Since the pressure at the mouth is proportional to the p
85. to the patient s finger E Patient preparation Enter in the b control panel and select Settings External device and press Enter Enable the Oximeter option by moving the sign on Oximeter and press Enter to confirm settings Place the probe on the patient and properly fix the cable to the harness with Velcro stripes to minimize motion artifact 176 Oximetry General warnings The oximetry test The oximetry test measures the percentage of hemoglobin saturated with oxygen in the blood The test can be performed at rest or during after a light exercise phase cycling jogging The parameters measured include the following Symbol UM Parameter SpO 90 Hemoglobin saturation HR bpm Heart rate E Performing the test NV 1 Select Test Start Oximetry or press the icon and select Oximetry 2 The HR and SpO values along with a plethysmographic graph will be displayed initially The graph allows you to monitor the quality of the signal 4 3 When a real time tracing of acceptable quality is maintained press F2 or the icon to begin acquiring data 4 The HR and 5 values will be stored every five seconds 5 Press F3 or the icon to end the test The software will then display the graphs measured parameters and e predicted values To abort the test press Alt F3 or 24 To restart test press 8 Suite 9 0a b1 James BOND Oximetry 6 30 05 2007 14
86. variable range If this option is deselected it you may set the range of the axes and the grid step Points only draws the graph without a line connecting the points Mark points draws the points with a symbol Squared creates a square graph instead of adapting it to the window Ignore zero ignores any points with a zero value Viewing results To view the results of an oximetry test 1 Select Patients from the File menu or press the icon 2 Select the patient corresponding to the test you wish to view 3 Select the desired test from the list box and press OK To switch between graph and or data use the following buttons on the toolbar se shows the SpO graph mu E shows breath by breath data If you would like to view more than one window at one time select New Window from the Window menu To display a list of tests of the current patient select Test current patient from the View menu or press the icon amp l 178 Oximetry The oximetry test Airways resistance measurement SPIRO CPET 99 75 General warnings 1 This test must be performed with the Rocc module connected to SpO Rocc port on the rear panel of Quark 2 The Rocc should be assembled as shown in the following picture 3 1 Occlusion valve 2 Reader 3 PNT 3 The Quark should be properly connected to the PC with the appropriate communication port selected 4 The name shown on the status bar must correspond to
87. when conducting RMR measurements e subject may not eat for at least 12 hours or smoke for at least 2 hours before the test e Testing conditions must remain quiet throughout the procedure and a normal temperature must be maintained The subject should refrain from moving during the test e Medications recently taken should be noted particularly stimulants or depressants e first 5 minutes of data acquisition should be discarded when performing the test e steady state should be achieved during the test which is defined as a 5 minute period when the average minute VO and VCO changes by less than 10 and the average RQ changes by less than 5 e 15 20 minute test should be conducted to assure stable interpretable measurements e Renal failure patients requiring haemodialysis should not be tested during dialysis therapy 218 Resting Metabolic Rate Test Metabolism Recommendations Before starting a RMR test you should calibrate the ID18 turbine and the analyzers by performing the Ergo calibration The calibration procedure can be reviewed in the Calibration chapter Note After turning the device on wait at least the recommended warm up time before beginning calibration or testing procedures E Resting Metabolic Rate test using a Canopy 1 Do not measure a comatose or incapacitated patient with the canopy in a place without a source of back up power to assure continuous operation of the flow genera
88. 0 PO 1 Pressure cmH20 0 1 0 1 0 1 0 0860 Flow PNT mils 65 67 57 0 0840 RAW Analyzer 0 5 065 065 0 0820 2 Analyzer 16 78 16 66 16 88 0 0800 Relative Umidity 42 42 42 0 0780 MIP MEP Pressure cmH20 3 3 3 0 0760 Analyzers Flow ml min 186 177 186 0 0740 Mouth Pressure cmH20 0 11 0 10 0 12 1 Rocce Pressure kPa 0 0720 Dosimeter Pressure psi 0 0700 5 2 Oximeter E 0 0680 Heart Rate SpO2 bpm O 0 0660 Heart Rate TTL ANT bpm ii 640 Flow mils volume ml 0 0620 0 0600 0 0580 0 0560 0 0540 0 0520 0 0500 0 0480 0 0460 0 0440 0 0420 0 0400 0 0380 0 0360 0 0340 0 0320 Invert Base Line 0 0300 0 0280 Refresh msec 100 0 0260 0 0240 Raw Data Reset Statistics Pause Graph Graph Setup 0 0220 0 0200 0 10 20 30 40 50 t s Ready Measurements of the listed parameters be displayed by checking the checkbox Enable Measurements also be graphed if the Graph checkbox has been checked The buttons on the top right part of the window directly operate the Quark and make troubleshooting easier b Control panel Control Panel be activated by entering into the calibration software and then selecting the menu item Calibration Control panel Calilbration Checking the system
89. 0 72 5 95 73 100 00 0 00 60 61 du 00 23 15 04 1 71 2 03 0 59 49 31 2 08 199 20 44 81 5 88 0 64 100 00 0 01 867 74 3 00 27 14 49 1 66 2 8 0 82 18 44 2 87 504 14 45 51 6 05 0 58 100 00 0 00 51 39 4 00 31 14 74 1 77 2 30 0 90 41 51 3 66 590 28 52 41 6 06 0 65 100 00 0 01 65 77 4 00 35 15 79 1 88 1 92 0 47 35 68 3 34 365 13 55 69 5 63 71 99 95 0 02 78 03 00 39 14 81 1 80 2 285 0 54 14 13 1 44 416 17 59 96 5 89 0 58 99 94 0 02 76 52 ds 4 Multi breath N2 Wash out Ln N2 35 Ln 5 NN LEE NN 1 t WO time mm ss 2 c 13 8 1 aE petentes E 1 1 1 1 1 1 1 1 1 24 ee ee T 1 1 1 1 1 1 1 1 1 n i i i i i i i B 1 a T 2 5 1 0 e E 0 10 20 30 40 50 TO al 100 Far Help press F1 08 05 2007 James BOND NUM GE 6 If a SVC effort has not been detected upon completion of the washout procedure the software will prompt you to select an effort from previous SVC manoeuvres performed by that patient Select the desired effort and press OK to confirm A Preview is displayed below the window of the selected test Test current patient 5 X 08 06 7007 S C 08 06 2007 SYC 6 46 FRY Cancel 2 44 Rf 15 00 Preview 03 06 2007 SYC 7 In order to v
90. 00 0 Select View Information or press the icon to view information about the current test Selecting parameters to view in real time Parameters En view Select parameters to view vuoa v HR You may select the parameters to be viewed in real time by selecting View Parameters to view or pressing the icon Selecting a different workspace Workspace X Select workspace to set CREE Cancel To change the workspace select View Set Workspace and choose the desired workspace from the list Press OK to confirm Select View Save Workspace to save the current workspace 234 Resting Metabolic Rate Test Performing a Resting Metabolic Rate test X Workspace Select workspace to save Select the name of the workspace and press OK to confirm Resting Metabolic Rate Test Performing a Resting Metabolic Rate test 235 Events management during resting metabolic rate testing During the test you may choose to perform one of the following events e 02 2 graph e 5 x Event to execute Loo 02 CO Graph 5 pirogram Cancel To perform any of these events during the test select Events Event or press the icon select the event and press to confirm O CO graph The event allows you to check the real time readings of the O and CO signals during the test O CO graph event d
91. 00 0 0000 0000 o 0000 0 Cumulative Dose mca 0 0000 0 0000 ooo ooo Default Recalculate Cancel The window is divided into 4 parts plus the Select Protocol selection list which allows the selection of a specific bronchoprovocation protocol and the checkbox Logarithmic graph which allows the graphing of the bronchoprovocator response in a logarithmic scale Dosimeter parameters Start delay defines the delay in the bronchoprovocator delivery Since the bronchoprovocator delivered depends on the air pressure before the delivery the device checks if the value of this pressure correspond to the values entered in the field Nebulizer driving pressure with the error defined in the field Accepted pressure error Flowmeter specifies the flowmeter in use Turbine PNT Flowsafe or PNT X9 If the user uses the COSMED dosimeter please check the checkbox COSMED Dosimeter in order to let the Quark driving the dosimeter and its deliveries User interface and settings PFT Suite settings 73 Save Display Print The Fall FEV196 parameter can be saved displayed printed as function of the selected parameter Broncho Dilator Please specify the agent its quantity and its measurement unit Broncho Challenge Please specify the agent and the measurement unit Then the lower part of this section is divided in steps Each step can refer to the sa
92. 06 E x a File View Test Options Window val 8 Into SpO2 96 HRC 100 0 nina 00 05 00140 0012 00 15 0x17 00 20 0022 00 25 00 27 00 30 00 32 00 35 00 37 00 40 0042 00 45 00 47 0050 55 55 5 l min na 00 9 75 00 05 9 TT 00 10 97 74 00 15 97 00 20 97 78 00 25 97 78 00 30 97 78 00 35 97 76 00 40 97 75 00 45 9 TT 00 50 97 77 Far Help press F1 30 05 2007 James BOND 6 In order to visualize the graph and the main parameters press one of the following buttons shows the SpO graph shows breath by breath data After completing the test the following options are accessible by right clicking on the active window Oximetry The oximetry test 177 e Pressing Customize Graph will customize the current graph e Pressing Graph Builder will allow you to build another graph using the measured parameters Up to 2 parameters can be displayed on the Y axis Yi and Y2 axis parameters axis parameter Spo Time HH EE 5 02 HH Customize Graphs Axis Time mm ss v Autozcale Cancel Min 00 00 00 50 Step 00 03 Yi Axis 12 2 Y2 Axis Options Grid Points only Autoscale Autoscale Mark points Squared Ignore zero Grid allows you to draw the grid Autoscale scales the graph according to the
93. 1 06 2007 11 06 2007 DLCO Ireatholt Cancel 11 86 Help VA 7 34 Preview 2 Select two or more DLCO tests performed during the same visit and confirm by pressing OK Preview will display preview of the selected test below the window 3 The resistance to diffusion vs concentration along with the calculated values will then be displayed Lung diffusing capacity DLCO Membrane diffusion test 143 BM PFT suite 9 0a b1 James BOND DM 2 3 1 a xl File View Test Options Window al Membrane diffusion Into TELCO 9H Y 0 00542 0 0144 0 045 0 040 0 035 D030 2 2 2 2 2 2 2 2 2 2 22222222222222222222222222222222222222222 0 0 0 025 00204 1 09 0 015 1 0m 0 010 0 005 1 0 5 05 1 0 1 5 2 0 2 5 3 0 3 5 4 0 4 5 5 0 Peo Parameter UM Pred TEST 2 Pred TEST 3 Fit 21 00 60 00 DLCO mlirminimrmHg 39 84 47 91 120 3 33 94 53 6 mliminimrmbHuiL 4 58 5 87 1235 4 7 64 159 6 0 103 0 119 0 2246 0 233 Breathold sec 10 96 MA 8 06 8 05 Dm mlirminimrmHg 69 45 185 Far Help press F1 22 04 2002 James BOND E Editing a test At the end of a test or when viewing a test you may edit the test by right clicking on the active window and selecting Edit or by double clicking on the graph Select test to edit 13 21 0 DLCO 04 60 0 41
94. 1 3 76 00 10 00 11 9 0 4367 195 15 25 6 Book 2 02 0 585 16 72 Bo Pe 00 10 30 12 9 0 440 5 7 20 170 27 5 33 5 3 00 0 82 16 59 3 72 0 00 11 00 abs E 0 646 5 3 295 266 28 3 31 4 4 28 D 90 16 64 a Se aE AE The data will be shown every 30 seconds for face mask tests or every 5 seconds for Canopy tests Viewing data in graph form List ID Date Duration 20 02 1997 00 14 13 BOND J Current patient 000002 13 03 1997 00 15 00 BOND J 0000013 11 04 1997 00 10 43 TREADMHIL T All tests 000004 14 04 1997 00 05 16 CARDIAC OUTPUT 000005 15 04 1997 00 07 14 LOOPS 0000016 25 01 2000 00 14 45 GAS ECG 000007 09 09 2002 01 12 27 GPS T 0000018 12 06 2007 00 12 34 BOND J 000004 12 06 2007 00 12 34 BOND J 000010 12 06 2007 00 12 34 BOND J Find 000011 12 06 2007 00 12 34 BOND J aaa 00001 2 12 06 2007 00 12 34 BOND J 12 06 2007 00 12 34 BOND J 2 You may view a list of tests performed by the current patient or a list of all of the tests in the archive Select the test to be displayed and press OK to confirm Find finds a test based on the search key entered Notes shows the notes of the selected test Show shows a preview of the test below the window Hide hides the preview Yi and Y2 axis parameters axis parameter vo vcn2 r t load hr t 2 feco 7
95. 228 6 VOZ ml min 334 1914 56 3367 3002 112 VO2 Kg ml min 4 99 28 57 56 50 25 44 80 112 l min 12 4 53 2 39 136 4 166 6 62 Rf b min 16 6 33 5 6 49 9 50 0 99 VOZ 0 746 1 590 58 2 734 2 85 95 HR bpm 3 5 11 8 64 18 3 15 8 115 5 94 162 88 184 190 96 BR amp 14 3 100 15 20 REE kcal day 18 07 30 00 60 VO2Q8LT ml min 2217 5 1660 7 133 HR Recow bpr 334 1914 56 3367 1291 148 1 15 Sane 12 125 FEV111 0 00 4 96 MVV l min 0 00 4 16 IC 1 0 0 e 145 METS 0 00 Vt FVC 1 4 8 1 56 14 3 12 8 112 VO2 WR slope mlO2 watt 0 55 Select View Predicteds or press the icon Double click on the window to open the predicteds customization window 208 Exercise testing Viewing results Viewing the Anaerobic Threshold Lactate Threshold The device can automatically or manually calculate the Anaerobic Threshold via the Modified V slope method TREADMIL T test n 3 LT E nm VCO ml min FetC Zz amp 3979 19 36 19 36 3482 15 94 15 94 2984 14 52 14 52 2487 12 10 12 10 1989 9 68 3 68 1492 7226 7226 994 4 84 4 84 497 2 42 2 42 Vos ml min 0 00 Vo ml min 9
96. 300 files 249 files 29 Mb 27Mb A bar will display the progress of the restore Archive management and printouts Archive maintenance 99 Data printouts The PFT Suite software can print reports in the following three options e active window e report e series of reports E Active window printing This printout function is only enabled when the active window the window with the title bar highlighted is a test result or a list of visits To print the active window select File Print Active window or press the icon A select the desired printer properties and press OK E Report printing To print a report of the current visit select File Print report or press the icon x ST Multi breath 2 w ash out o EXC aah single breath 02 EX Response v Single breath CO diffusing capacity mis Single breath no breath hold Help CO diffusing capacity Steady State Respiratory drive Iv Oxpmetry Lung Volume Summary Lung Diffusing Capacity Summary Forced Oscillations POST tests Test Drug Dose FE 1 17 Salbutamol 0 00 4 31 18 Salbutamol 20 00 3 97 C ATS page no ATS Preview Select the test s you wish to be printed in the report from the upper part of the dialog box Only the best manoeuvre from each test which is automatically selected by the software will be printed The following opt
97. 44 Patient data Gen WM 0 00 Date of test 08 05 2007 Age 32 1 0 00 Time of test 10 30 Height cm 180 0 IC n 0 00 Test n 1 Weight Kg 80 0 MYY 0 0 M of steps 22 BSA m 1 9 post ex I 0 00 Duration hh mm ss 00 10 21 bpm 188 FEV1 post ex II 0 00 LT time hh mm ss UN g day 0 0 IC post ex I 0 00 HC time hh mm ss Kceal day 0 post ex l min 0 0 VD mi 70 ml min 0 User 0 00 User 0 00 User C 0 00 Notes Comments Modify Calibration Select View Information or press the icon Eu The software allows the measurement of the Energy Expenditure and Metabolic Substrate To measure the FAT and the CHO parameters accordingly you may enter the UN Ureic Nitrogen in the UN field If a value is entered all nutritional values will be recalculated using the specified UN 242 Resting Metabolic Rate Test Viewing results Modify test information X ID code 224 Sex Male Last name TEST Female First name MALE Birth Date 01 70171994 Ethnic 100 Height cm 180 0 Temperature Weight 85 0 Temp B4 max bpm 183 Humidity po UN g day 0 0 Hum flowm 20 1400 AMR Kcal day 000 Press 747 VD 0 Pre exercise Post exercise 0 0 00
98. 7 7 i 7 a i 7 7 7 7 i L 7 7 i 7 7 gt AB e e wo e ho o 18 19 201 s Ine and Meade v ATS 95 Criteria 10 80 sec 11 04 sec 0 7 Ti 0 55 ample Cancel Washout Sample Breath hold 4 4 2146 ml 1070 ml 140 Lung diffusing capacity DLCO CO Diffusing Capacity DLCO Test liil Edit James BOND DLCO 17 11 06 2007 12 28 l 8 x System Patient Default Fowler 3 Equations Single breath CO diffusing capacity CO CH4 cor ia CRGA MEME Tap Xuan SICH i piss Washout i l MUNERA A E E E BN i los ce Xu ume minty Pd UR D plete Thais MN IM E Le TOMUS P NT T MA PM EN UN T NEM m 045 p 4 50 hore iia y dim de cic 1 Sur dae NEL IS EET
99. 7 E Lactate Threshold 5 MEC MEM PUMP 188 188 tbe ee EINER FENCE PAM 189 EN Preparing the device and the 45 es TESINE ENEE N 189 _ IDE oap Ep RH HEIDE SER FERE RIVER ENDE AAE AE E 189 E NOTA MI DERE CHEC DERE RER 191 Ending the test and saving data neus 191 E Rea nme visuallzal lol 191 MR 191 Other data displayed during the test sooo sen 192 NNN et alse 1 E A 192 Graph customization 192 Moving adata table TET Tot 193 Viewing information of the current aera Fo F eS EEN US TENER FEE CHI UE T EYE REF IAE XR 193 Selecting parameters to view in real
100. 700 Canbration raso in ee cee eset 0 306 Brags 0 299 0 311 Phase egy 640 1000 400 1200 EC cer ERE TER T car Ya vU Ar 264 1000 800 1200 600 Base LINE mr EDEN Ie 2 100 57300 240 250 ugs Respobse Tune Imago E 270 180 0 400 500 Carbon Monoxide PORTO RCE 0 000 0 000 0 010 0 010 400 CallbrationiGas 56 0 306 0 307 s Phase bo Sec 222222222 ETT 1000 400 1200 d A 1030 1000 800 1200 300 Base libe Vete EET 147 100 5 300 246 250 THING SOC 240 180 0 400 200 Analyzers Pressure mmHOQ 578 600 500 700 Bon Fre More LOW AAA 609 600 500 700 100 Turbine 28 mmi ae C Turbine 18 mm LUE C Ergo C Flowsafe z Pnt X9 p C Turbine C Pnt Rocc iim C Pnt Rocc PUE C Erao Analyzers Analyzers C Fre e Dico C Graph You may choose the desired report visualization numerical values or graphs by selecting the relative option in the lower part of the dialog box Values in blue indicate that the values are equal to their predicted value Values in red represent a result that occurred outside of the acceptable range Press the Print button to print a report Previewing the Body Box calibration repor
101. 9 19 47 19 47 351 17 70 17 70 3256 15 93 15 93 2894 14 16 14 16 2532 12 33 12 39 2170 10 62 10 62 1808 8 85 8 85 1447 7 08 7 08 1085 5 31 5 31 Tes 3 54 3 54 361 1 77 1 77 0 ml min 0 00 VO ml min D 795 1591 2387 3183 3979 D 795 1591 2387 3183 3979 VE VCDZ 7 Parameter Values Max 75 75 Es hh mm ss c 00 00 00 1 1 Load att E in Load2 Watt 0 54 54 Load3 w at 48 48 YO 0 gt 347 di VE mi wee Q0 e A aee HR e T di R 00 0 00 13 13 s LT i 1 UK Cancel Auto detect LT allows you to view the Lactate Threshold window to display and calculate the Anaerobic Threshold see later Data management 1326 1989 2652 3316 3979 View test results li LA CASA V test n 1 Dl est Information Test Duration 00 1 0 21 Exercise duration0O0 04 47 Ergometer Protocol Test type Reason for Test Physician Technician Reasons for Stopping Test Subject s Response 2 PreEx Pred Post Ex Ex FYC D 5 19 FEV1 D 4 32 150 IC D Warm upLT Recov 2min t hh mm ss 00 09 10 00 01 08 Load1 att 241
102. 94 1989 2984 3979 8 1326 2652 3979 VE V Z VE VC Z 75 75 66 66 55 56 Parameter Values LT VO2max Values 47 47 _ _ _ Bs tihh mm ss 00 04 11 00 06 56 60 3 eM 10 144714 s ae Caricoz Watt 0 080 2 18 18 0 D 00 5 vOz mlimin 1914 3367 56 8 9 VOZ ml min 28 57 50 25 56 8 394 1989 2224 3979 1877 3948 424 VEC mir 53 2 135 4 39 0 m AN Select View Lactate Threshold or press the icon Double click on the window to open the Lactate Threshold calculation window see later Data management Switching between data and graph viewing Select either View Current test graph or View Current test data Exercise testing Viewing results 209 Data management E Fittings The software allows you to fit data according to linear mono exponential and or mean value functions The Fittings option is available only if the active window is a single Y vs X graph i e VO vs Time or VO vs Load Fittings Selection Tyne E x1 00 00 02 Lt Add x2 00 10 21 Cancel 2 open the Fittings window open single Y vs X graph and select Test Fittings Note The results graphs and equations are not stored in the archive To record this
103. Bronchoprovocation Protocol X Protocol to use Protocol m Cancel Help Choose the bronchoprovocation protocol Select Free protocol if you choose to specify the information about the agent before performing the manoeuvre Bronchoprovocator Salbutamol Unit of measurement mcg n 1 of steps 8 no Quantity 0 0000 Quantity 0 0000 2 Confirm this step by pressing OK or select a different step by using one of the following icons EET Help gt 3 When the green led appears on the right side of the screen press F2 or the icon to begin the test 4 When the test is complete press F3 or the icon 9 or wait for the automatic end of the test when 5 seconds passes without detecting any flow The software will display the F V and V T graphs the main parameters and the predicted o values To abort the test press or ES To restart the test press 21 5 To visualise the F V graph the V T graph or the main parameters press one of the following buttons shows the Flow Volume graph vt shows the Volume Time graph shows numeric data shows the broncoprovocator response graph 6 Repeat the test until the desired number of efforts has been performed correctly 7 Press to visualize the test list carried out during current session Select the test you would like to save sorted from best to the worst according to ATS cri
104. D J Current patient 000002 13 03 1997 00 15 00 BOND J 2 0000013 11 04 1997 00 10 43 TREADMILT All tests 000004 14 04 1997 00 05 16 CARDIAC OUTPUT 000005 16 04 1997 00 07 14 LOOPS 000006 26 01 2000 00 14 45 GAS G 000007 09 09 2002 01 12 27 GPS T 000008 12 06 2007 00 12 34 BOND J 000009 12 06 2007 00 12 34 BOND J 000010 12 06 2007 00 12 34 BOND J m 000011 12 06 2007 00 12 34 BOND J Find 000012 12 06 2007 00 12 34 BOND J 000013 12 06 2007 00 12 34 BOND J Notes Cancel ex Show 2 A list of all tests performed by the current patient may be viewed as well as a list of all tests stored in the archive Select the test to be displayed and press OK to confirm Find finds a test based on the search key entered Notes shows the notes of the selected test Show shows a preview of the test below the window Hide hides the preview Exercise testing Viewing results 201 Ini xi t Rf VT VE Wig VCOA VE VOZ VE VCOZ vos R Feoz 4 hh mm ss b min 1 l min ml min ml min ml min Ktug bpm 00 00 00 13 9 0 699 2 7 321 259 27 34 4 01 0 50 16 41 3 84 00 00 04 14 2 TOS 10 0 Sete 266 27 34 4 11 0 80 16 43 3 84 00 00 07 14 5 0 701 10 2 332 259 27 34 4 15 0 50 16 45 3 02 00 00 12 14 5 0 695 10 1 323 266 34 4 04 0 62 16 52 3 81 00 00 16 14 6 0 696 10 2 323 267 28 34 4 03 0 52 16 54 3 60
105. Deletes a current test from the archive Edits the current test E Entering a new patient Patient Card x Cancel Help Personal Data ID Birth Date a First Ethnic corr Last Mame Address Information Address User Text City State Code User Text User Text To enter a new patient press the icon A window will open which will allow you to enter the patient s data Enter data ID First name Last name Birth date and press OK to confirm In the User fields listed in the nformation section you may enter the name of three user defined fields Patient names If a patient has the same name first and last of a patient that already exists the software will ask if you wish to use the same patient card or create a new one Select the desired option and press OK to confirm JAMES BOND Date 0 Code 0170171970 000003 Cancel E Add new patient card Archive management and printouts Patient s database 91 Finding a patient x Search by mmu Search for Type the first letters of the string you re looking for BOND James 000001 0170171371 BOND James 0100003 0170171370 BOND James 000001 0470371357 LA CASA Vito 000001 25 03 1975 NOSARZEWSEA Agnese 000002 21 06 1579 TEST Test 000010 0170171370 ts To find a patient in the archive press the icon You may search by using a last na
106. Dre Geet de ayer evened ee er HN sicui aaa IE Eu EUM UT aera ys Flow scale Algorithm Mouth pressure scale Algorithm Haw 0 5 Standard Pressure scale 2 21 Body box pressure scale pre E Ree af R2 regression 089 Reset Regression slope 3 05 3 Regression slope I 0 08 E i oes eese s oe Tav 2 92 EA Regression offset sGaw 1 cmH 207s 0 33 oneal Regression offset Discard this loop pm _ 2 Discard this loop Slow Vital Capacity ee ee 55 BDt s Cancel The graph visualization options can be modified Flow scale and Pressure scale the Edit sRaw graph Mouth pressure scale and Body box pressure scale in the Edit TGV graph as well as the slope and the offset of the regression line Regression slope and regression offset the algorithm used for calculating the regression the occlusion volume and if the loop must be discarded The discarded loops will be shown on the final graph with an empty dot and they are not used in calculating the results Press OK to confirm Reset to cancel the changes Export to export loop data in text format press Cancel to cancel Performing tests with Body Box Viewing and editing test results 165 PFT Suite 10 0 b21 James BOND Raw 2 17 06 2011 12 46 m x
107. E Particular requirements for b Before starting the calibration procedure be sure that the turbine type is properly selected Please select on the portable unit 1 Settings 8 Turbine 18 28 and set Turbine 18 or Turbine 28 If the calibration is performed through the PC in the calibration program select File Turbine results in the field Type mm must be entered 18 or 28 Turbine calibration results 1 x Actual Acceptable Range Type mm 28 Gain Exp 1000 Gain Exp 300 1100 1000 Gain Ins 9001100 Cancel Factory Settings Help E Flowmeter calibration turbine 1028 PNT flowsafe or PNT X9 After opening the calibration program 1 Select in the Calibration menu the flowmeter to be calibrated and check the prompts Calibration X 5yringe volume 3000 ml Results Move the calibration syringe 34 Calilbration Calibrating flows and volumes 2 Begin with the syringe piston pushed all the way in When the Calibration dialog box appears move the piston in and out for 10 inspiratory and expiratory strokes The values will be automatically displayed Turbine calibration results X Hew Acceptable Previnus 28 338 Type mm an Gain Exp 374 Gain In 1003 Type mm 900 1200 Gain Exp Gain Exp Gain In 1005 900 1200 Cancel Factory Settings Help 3 The software will then display the
108. ET m E 154 O Test execution eee P M 156 Jiu sap cR ROTER E APA A A AA A A E A E E A A E A A AE A E AE E 156 ODE IO eae AE 157 SI A ee 158 ice mc Mu P 159 SION VIE tetur dear d uS deu MM E 160 Problems and error messages related with the test execution 1 4 161 Body Box Post test execution ssccccssscccsssscccsssceccecsesccessesececscseccsseececsssesecsesecacsesececsseccessesesessesesecsseesecsssess 162 1 EENN ERROR EET 162 Limitations of the measurement method 00 e rete ees saa tete esses osse eese eese 163 LI Viewing SNE editing test RR BR Ou MU UN 164 E VIEWED o EHE ER MM MEER AMI MM A EE 164 Predicted values interpretation DUREE REPOS NKS ERE DRE S UE EVENE USES PET UC DOU MR EK UNE KNIE 164
109. Execute Event Event execute F V Loop 12 C02 Graph 5 pirogram Bias Flow Check Cancel To check the bias flow select Events Event or press the icon 8 select the event and press OK to confirm A graph with Flow and VCO vs time is shown A green horizontal line shows the bias flow To adjust the bias flow e Press the icon LJ and enter the new bias flow value OR e Press the icon ed and the bias flow will be automatically detected E Ending the test without saving data 1 Select Test Abort or press Alt F3 2 Select Yes to abort the test or No to continue E Ending the test and saving data 1 Select Test End or press the icon or press Alt F3 2 Select Yes to end the test or No to continue E Limitations of procedure The bibliographic reference reports the main sources of error during a RMR test on mechanically ventilated patients 1 Leaks of gas from the patient ventilator system preventing collection of expired gases including e Leaks the ventilator circuit e Leaks around tracheal tube cuffs or uncuffed tubes e Leaks through chest tubes or bronchopleural fistula 2 Peritoneal and hemodialysis due to removal across the membrane of CO2 that is not measured by the indirect calorimeter 3 Instability of delivered oxygen concentration FiO within a breath or breath to breath due to changes in source gas pressure and ventilator blender mixing characteristics 4 gt
110. GAS ECG 000007 09 09 2002 01 12 27 GPS T 000008 12 06 2007 00 12 34 BOND J pom 000004 12 06 2007 00 12 34 BOND J 000010 12 06 2007 00 12 34 BOND J Find 000011 12 06 2007 00 12 34 BOND J rear E List 00001 2 12 06 2007 00 12 34 BUND 4 12 06 2007 00 12 34 BOND J 2 You may view a list of tests performed by the current patient or a list of all of the tests in the archive Select the test to be displayed and press OK to confirm Find finds a test based on the search key entered Notes shows the notes of the selected test Show shows a preview of the test below the window Hide hides the preview Yi and Y2 axis parameters axis parameter vcn2 r t loadl hr t feo feco 7 Cancel i 3 The window allows you to select the parameters to be graphed up to 2 parameters may be graphed on the Y axis Select the parameters in the two lists or by using the fast graphs buttons below them You can customize these buttons by selecting Options Parameters to view Fast graphs 4 Press OK to view the desired graph 202 Exercise testing Viewing results BOND J test n 8 i amp l xi Voe iml min VCO ml fmin tthh mm ss of ah 30 02 15 03 00 03 45 04 30 05 15 06 00 06 45 07 30 08 15 09 00 09 45 10 30 11 15 12 00 12 45 Viewing a report 1 Select Repor
111. Graph builder Up to 2 parameters can be displayed on the Y axis LULU Yi and Y2 axis parameters axis parameter Pressing Configure allows you to customize the graph Customize Graphs Axis Time mm ss x v Autoscale Cancel Min 00 05 Help Max 02 41 Step 00 08 Y 1 Axis EV I btps M Grid v Autoscale Hin 0 41 1 10 Step 0 03 2 PO 1 cmH20 Points only Autoscale Mark points Squared Hin 0 00 Ignore zero Max 3 90 Step 0 20 Grid draws the grid Autoscale scales the graph according to the variable range If this option is deselected you may set the range of the axes and the grid step Points only draws the graph without a line connecting the points Mark points draws the points with a symbol Squared creates a square graph instead of adapting it to the window Ignore zero ignores any points with a zero value E Viewing results To view tests results of a PO 1 test 1 Select Patients from the File menu or press the icon 2 Select the patient corresponding to the test you wish to view 3 Select the desired test from the list box and press OK To switch between graph and or data use the following buttons on the toolbar E shows the PO 1 graph shows the Volume Time graph of the SVC mu EJ shows breath by breath data 150 Respiratory mechanics PO 1 Respiratory drive If you wish to view more than one
112. M SEV dauid eU Sd an dnb uU AER nd 208 E Viewing the predicted VOUS Loop Eon DUERME bOREHE DH RHAP DUREE EREERD CORR CR ERROR UN 208 B Viewing the Anaerobic Threshold Lactate 1 1 1 21 1 209 B Switching between data and graph 1 1 2 4 209 ua uz tomm 210 Rm 210 Fitting a graph with input bna cus QM avr Ia b eria dre 210 Fitting a graph with a monoexponential regression 0 nennen enne nennen nnne nan 210 T 210 Ei Hab ii cT 211 Anaerobic Lactate Threshold calculation ccsscssccsscsscsssccscccsccsccecccsscsccecccscceccescessceccescssceccescssceccescescseccecs 212 cere 213 E Fudilinga SEED ValuB ernn ERU HO ERAN URN EE E ERE A TR ERRARE ERE AEN UN E CEA E 213
113. O O concentration of the cylinder being used ATS standard 21 ERS standard 17 User interface and settings PFT Suite settings 67 By pressing Patient you may enter in the following parameters Option Description Anatomic dead space VDa You may choose to use the ATS calculation criterion VDa 2 2 weight or to enter in a value Haemoglobin Hb You may choose to use the ATS calculation criteria Hb 14 6 for adult males and 13 4 for adult females and children or to enter in a value Carboxyhaemoglobin COHb value of carboxyhaemoglobin Respiratory drive Test options The Respiratory drive tab allows you to customize certain options for PO 1 testing Parameter Description Vt stability threshold Defines the recognition criterion of regular tidal volume respiration 68 User interface and settings PFT Suite settings Forced oscillations QU x Single breath CO diffusing capacity Respiratory drive Preferences 5 pirometry Multi breath w ash nut Forced Oscillations Body GODT Quarki m configuration Com Port Use Filter Signal Level 40 Coherence filter p Enable Value 0 95 Display single Test Enable smooth line on flow curve tae You can set Thecommunication port COM1 2 e Ifyou use an antibacterial filter In this case the software will automatically subtract the filter impedance Note PC software pe
114. O2det ml 1058 RENE a f wr O2debt ml 2695 Tau 56 4 sec 81 2 sec 00 00 00 45 01 30 02 15 03 00 03 45 04 30 05 15 06 00 06 45 07 30 08 15 09 00 09 45 10 30 11 15 12 00 12 45 Exercise testing Data management 211 Anaerobic Lactate Threshold calculation Lactate Threshold VCO ml min Fet zit 3979 19 47 47 38617 17 70 TO 3256 15 93 33 2894 14 16 16 eb3z 429 2170 10 N 1808 8 85 85 1447 7 08 08 1085 5 31 31 3 54 54 351 1 77 ote Vo ml min 0 00 VO ml min 795 1591 2587 3183 3979 VE V zi VE VC z Parameter Values M gt Max t hh 00 00 00 mm ss 1 1 00 1 1 Loadi Watt eee TO 8 El Load Wat 54 54 Load3 wat 0 48 48 02 ml min e i V02 Kg ml min Kg 0 00 2 ml min VE l min HR wrens 2 VO ml min 663 1326 1989 2652 3316 3979 Cancel Auto detect Select Test Calculate LT You have the option to manually modify the Anaerobic Threshold and RC values by moving the horizontal bars in the lower part of the window The graphs will update with each modification of LT and RC values and the new values will appear in the parameter list Press Auto detect
115. Onset of angina or angina like symptoms Significant drop in Systolic Blood Pressure 20 mmHg or failure of the SBP to rise with an increase in exercise intensity Excessive rise in blood pressure SBP 260 mmHg or DBP gt 115 mmHg Signs of poor perfusion dizziness 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 the test Physical or verbal manifestations of severe fatigue Failure of the testing equipment 254 Sub maximal Exercise Testing Sub maximal exercise testing Considerations for accuracy The ability to obtain valid reproducible measurements is essential when making comparisons between pre treatment and post treatment test results Inconsistencies in the testing conditions could create variable results e Sub maximal heart rate can be influenced by the time of day eating smoking and familiarization with the test procedure e Prediction equations for estimating VO max may overestimate trained individuals and underestimate untrained individuals capabilities e The efficiency of motion during walking running and cycling varies e Cardiac Output and have a test retest variability of 3 496 Psychological factors such as pre test anxiety may influence the heart rate specifically at low workloads In such cases the resting heart rate and or blood pressure ma
116. Performing the test Before conducting a test you should read the Exercise test chapter to review the details of the testing procedure data viewing and analysis The sub maximal exercise testing procedure is as follows 1 Create or refer to an appropriate testing protocol for the subject being tested guidelines for many protocols are reported in ACSM s Guidelines for Exercise Testing and Prescription 6 Edition Philadelphia Williams amp MWilkins 2000 22 29 2 Perform the procedure as if you were conducting a maximal exercise test only terminate the test when the subject s heart rate reaches 8596 of their HRmax The test should also be terminated if an event listed in the section Test termination should occur 3 Display the VO Kg vs HR plot 4 Select Test VO2 Submax or right click on the graph and select VO Submax PFT Ergo 81 VO2 Kg HR BOND J test n 1 BOE TA Eile Test Events View Options Window 2 la x isi Be Dae PEE NORMS VO2 Kg ml min Kg YO2Kg extimated 50 28 red 39 00 Pred 128 9 50 00 40 00 30 00 20 00 10 00 bpm PFT Ergo B1 Version 9 0a Press F1 for Help The estimated value of VO Kg the predicted value and the percentage of predicted are displayed in the upper right section of the window If the predicted HR max that is automatically calculated 220 age is not suitable for the patient being tested you may edit this value from the View I
117. Pred will print the FVC Post as a of the predicted value 70 User interface and settings PFT Suite settings Sort x View Print Sort Customize Parameters sort uf You may select the order that the parameters will be viewed by dragging the parameters to the desired order Customize View Print Sort Customize Description NORMS Parameter UH New Save Integers Decimals 2 Delete Formula tab Customize allows you to add edit or delete new parameters as defined by the user To create a new parameter press New You must then enter the parameter description Description the parameter name Parameter the unit of measurement UM the number of digits to be displayed as integers and decimals ntegers and Decimals and the formula that will be used to calculate the parameter Formula Press Save to save the new parameter To abort without saving click Cancel To edit a parameter select it from the list and enter the new values To delete a parameter select it from the list and press Delete The icon opens the Formula Editor In order to restore to the default parameters press the icon E Predicteds management The program contains a default set of predicted equations but you have the option to customize your own predicted sets Select Predicteds manager from the Options menu The window will be divided into two ta
118. Press OK to confirm To enter a marker select Events Marker or press the icon L Note Holding the Shift key down while entering a marker allows you to include a tag for the marker also Entering realtime ABG arterial blood gases data During the test it is possible to enter ABG data Press the button in correspondence of the blood sample puts a marker during the test At the end of the test it is possible to enter data by right clicking and selecting Edit ABG xi Paco Pal PH Sal HCO3 Hb 00 00 24 00 00 52 00 01 25 00 01 44 00 02 02 Test n 20 Duration 00 02 08 Changing the load during the test The software will drive the ergometer according to the selected protocol When driving an ergometer you still have the ability to change the load after the test has begun Select Events Ergometric protocol or press the icon E 194 Exercise testing Performing the test Suspend A window will display the remaining load changes Select the desired load and press to confirm Select Suspend if the protocol must be temporarily suspended It is possible to resume the protocol by deselecting the checkbox Entering parameters During the test you may choose to enter additional user defined parameters x Systolic press mmHg Diastolic press mmHg 0 Cancel User 1 0 00 User 2 0 00 User 0 00 When selecting Events Insert parameters or the i
119. Real time Settings under Highlight parameters Viewing graphs in real time Select View Graph or right click on the data window and select Graph or press the axis parameter vcn2 vert rit loadl hr 7 t feos feco 7 1 Cancel VO2lKg 32 18 3 60 32 18 VE 72 5 9 726 1 09 0 74 1 07 2574 288 2574 window allows you to select the parameters to graphed up to 2 parameters be graphed on the Y axis Select the parameters from the two lists or by choosing one of the fast graph buttons below them You may customize the buttons with Options Parameters or View Fast Graphs Graph customization When viewing a graph in real time you may customize it by selecting View Customize graphs or by right clicking on the graph window and selecting Customize graphs Customize Graphs X pom MV Autoscale From 00 00 00 00 01 21 Options Ignore 0 Grid Points only Markers M Autoscale Autoscale Squared Min 288 050 Hin 21 8 866 723 088 596 393 Step 0 0000 Step 0 0000 recovery Mark points For each variable you may set the following options e Ifa grid will be drawn e Ifthe scale is automatic or not if this option is deselected you may set the range of the axes and the grid step The following options may also be ena
120. Selection of the RMR windows workspace The software will automatically stop the test and save the data at the end of the 16 minute if the RMR original protocol was not modified For further details about the test execution see later Performing a Resting Metabolic Rate test For further details about protocols customization see the chapter User interface and setting 222 Resting Metabolic Rate Test Performing a test L Performing a test using the canopy option The ventilated bubblehood system allows a stream of air to pass across the face of the subject and mix with the air being collected by the transparent hood over the subject s head The flow rate measurement system will calculate the oxygen consumption production and the Energy Expenditure Note Cellular phones should be turned off to eliminate potential electrical interferences B Calibrations Before the test an ERGO RMR calibration is necessary see Calibration chapter and a Turbine calibration is recommended see Recommendations in this chapter E Preparing the canopy PFT K4 Replacement of the power plug If the power plug does not fit into the socket properly you will need to replace it with the additional plug in the packaging To replace the plug 1 Extract the plug from the battery charger 2 Insert the appropriate plug in the charger Pe P Pene ro TT ITE PEPE ra LT f i Connecting the Canopy
121. Solare San E A E A EEEE E EN E AE 78 dai rx id in PM NINE KUNAU MM RU EN NUN EN 79 Hi sarees eats cae ed et acne ecard ea earned een ee c MH P 79 rr E 79 Arrhythmia PFT 80 Options 2 2 80 Creating anew OO Em 81 Test protocols eu on ce mc seo morcm em 82 Creating a NEw protOCOl 82 ME e ute Tine 82 E Un ormess e A AE D ORE 82 B Summary settings Willi CPET ceca E eect cee nese 83 E Steady State ______ 83 Anaerobic Threshold UEM
122. Test Number Date 08 06 2007 Test Type POST Rel PRE 0 Auto Diagnosis Spirometria normale Post Humidity 2 37 Drug Press mmHg 741 Quantity 0 0000 Temp 2 linit of meas Information User Text User Numeric User Numeric Environmental Data To edit a test card in archive press the icon Eil A window will be opened in which you may edit the data You have the option to associate a patient s FVC Post test to their relative FVC Pre test by pressing the button Rel PRE You must then select the FVC Pre test you wish to be associated Archive management and printouts Patient s database 93 E Importing a test card You have the option of importing an additional Test card when you have the relative Patient card and Visit card opened 1 Select the patient 2 Choose the test press the icon 8s All data will be imported from an XPO file Cosmed proprietary Note Test can be exported imported in xpo format only between the same software version If the software detects a difference between the current patient name and the name of the test to be imported it will ask if you would like the test to be imported into the current patient s card or if you would like to create a new patient card Select the desired option and press OK to confirm Import test 9WAPP CV XP l X File created on ba 11 06 2007 9 57 25
123. able data and the graphs will be updated Data filtering x Details C Averaging 00 00 4 C Smoothing Points 1 By pressing Filtering the following options are available Discard invalid steps deletes all invalid steps By pressing the button Details you may set the criteria for step deletion For all the parameters displayed Respiratory Frequency Tidal Volume 0 and FeCO you have the option to set the acceptability range and determine whether the parameter meets the criteria for step deletion Resting Metabolic Rate Test Data editing 247 Delete Step Criteria Xj Parameter min max M i b min v VT I 6204 2 4 ioo 20 00 02 x 1 00 Restore Cancel Averaging averages values an interval which can be specified with the horizontal bar Smoothing performs a mobile average on the specified number of points as entered in the field Points 2 Press OK to confirm Deleting or more steps This function may be useful if one or more steps were not correctly stored i e data was recorded before starting the test signal gaps occurred patient removed the mask Place the cursor on the step to be deleted and press Delete step to delete all data from the row E Advanced editing Hode Delete steps Time Range 00 10 21 gt steps C Smoothing Edit para
124. able the calibration must be repeated If you continue to receive unacceptable calibration factors you should contact Cosmed s technical assistance If the calibration cannot be performed because the soda lime absorber is exhausted a message requiring its replacement will be prompted to the user Contact the COSMED technical support DLCO calibration Warning After turning the Quark on you should allow the system to warm up prior to beginning any calibration The DLCO calibration should be performed daily and repeated prior to each DLCO test Select Calibration Gas DLCO and follow the prompts Press OK and wait until the procedure automatically ends Calilbration Analyzers calibration 39 not breath near the calibration valve 20 25 30 35 40 Sampling calibration gas CH4 CO calibration results Methane analyzer Actual Acceptable Range 3 ain 971 Gain 900 1200 ero mV 151 Zero mv 5 300 Delay 700 Delay 400 1200 ero Hw 243 0 511 Hesponse Time ms 15 Hesponse Time ms 0 400 Carbon Monoxide analyzer Actual Acceptable Range Gain 384 800 1200 feo mv 205 Zero mV 5 300 Delay 590 Delay ms 400 1200 b feo 33 feo 0 511 Response Time ms 205 Response Time ms 0 400 Analyzer pressure mmHg Actual 550 Acceptable Range 500 00 Sampling flow ml min Actua
125. ace and settings CPET settings 87 Archive management and printouts Patient s database The patient s database consists of a Patient Card a Visit Card and a Test Card which are displayed on one screen when the Archive Navigator is opened To open the database select File Patients or press the icon amp l x Patient Card Tests to Display 4 gt gt t Sa Sort by 1D 18 09 1998 James Last BOND Ip o00001 Male Birth 04 03 1957 Visit Card 18 09 1998 FYC Post PEF 3 Date 22 04 2002 18 09 1998 FVC Post Eg Height 195 weightiKg 9 Aue 25 ES 1 E 5moke Drug Mo Yes C Years 0 Cig Day 0 Diag Technician Quality Control Description Blow out longer FETIOO lt sec chec not reproducible Diagnosis 5 pirometry 18 09 1998 FVC Post 18 09 1998 FYC Post 572 18 09 1998 FYC Post FEV1 not reproducible PEF reproducible The 2 largest PEF withi Patient Card The patient card stores all the information of the patient which remains the same for each visit first amp last name DOB There is only one patient card for each patient which is created prior to the first test that the patient performs The following is a description of the buttons within the patient card Moves to the first patient in the archive Moves to the previous patient in the archive Moves
126. ach phase PIETRO A test n 1 Sommario o E Rf VT VE voz voco VE VOZ VE VCOZ Vo Eg R Fede Voz b min 1 l min ml min ml min ml min Eg bpm ml Fase n 1 Inizio 00 00 00 Fine 00 05 00 bcaricols D caricost D Caricos B Min 11 4 0 493 5 8 201 172 25 9 30 1 2 91 0 62 15 24 3 63 Max 13 5 0 652 5 5 341 294 30 1 34 3 4 94 0 92 16 92 4 14 Media 12 4 0 564 7 0 255 219 27 9 32 2 3 66 0 66 16 60 3 88 Trend 12 4 0 581 T Z 260 27 6 31 6 3 7 16 59 3 92 Fase n 2 Basale lnigior 00 05 30 Fine 00 15 30 Caricol D Caricoz D Caricos D Min 11 4 0 3858 5 187 155 24 6 29 3 2 71 0 75 16 16 3 59 Max 18 3 0 671 3 9 360 337 24 8 34 7 5 22 0 94 16 82 4 25 Media 13 5 0 533 Ted 265 27 4 3 83 0 83 16 55 3 62 Trend 14 7 0 568 8 3 305 242 27 4 34 5 4 42 0 79 16 60 3 62 When selecting View Summary double clicking on the window the summary options will be displayed Switching between data and graph viewing Select either View Current test graph or View Current test data 244 Resting Metabolic Rate Test Viewing results Data management E Fittings The software allows you to fit data according to linear mono exponential and or mean value functions The Fittings option is available only if the active window is a single Y vs X graph i e VO vs Time or VO vs Load Bl Fittings Selection Tyne
127. acking up the archive To back up the archive select File Archive Backup Backup v 5 5 xj Statistics Backup to 299 files 30 Mb Browse Description Cancel Enter the archive description and the folder you wish to back up the archive to Press OK to confirm Backup v 5 5 xj Backup in progress Disk n 1 c swapp i phto0en test 00000004 Total Hemaining 299 files 258 files 30 Mb 28Mb A bar will show the progress of the back up Restoring the archive To restore the archive select File Archive Restore Restore v 5 5 X Restore from C Nswapp k Browse rr Cancel Select the folder to restore the archive from 98 Archive management and printouts Archive maintenance Restore v 5 5 x Select backup set Original position Information Backup executed on Friday 28 September 2007 at 14 58 300 files 29 Mb 1 disks used oo The dialog box will show the files when have been backed up Select the desired folder and press OK or press Browse and select the desired folder Select the checkbox Original position if you would like the archive to be placed in the folder it was located before the back up was performed Restore 5 5 Restore in progress Disk n 1 1 00000009 Total Hemaining
128. ad3 0 Min 15 4 0 563 10 5 304 281 24 28 3 80 0 79 15 94 3 27 46 5 4 14 89 4 45 Max 23 4 1 087 22 1 683 651 38 38 8 54 1 07 17 62 4 46 64 11 0 16 88 5 81 Average 20 0 0 774 15 4 448 417 31 33 5 61 0 93 16 92 3 83 56 7 9 16 10 5 02 21 7 0 769 16 7 488 451 31 33 6 10 0 92 16 94 3 81 62 7 8 16 20 4 86 Phase n 2 Exercise Start 00 04 23 End 00 09 10 Loadi 100 Load2 0 Load3 0 Min 20 8 0 765 19 7 593 550 16 24 7 41 0 64 13 93 3 93 35 8 4 12 64 4 86 Max 28 5 1 623 45 0 1880 1658 31 33 23 51 0 94 16 93 5 20 28 46 4 16 18 6 30 Average 24 1 1 461 35 0 1488 1272 22 26 18 60 0 84 15 50 4 76 71 23 1 14 50 5 89 Trend 23 3 1 759 41 0 1644 1514 24 26 20 55 0 92 15 81 4 83 26 17 1 14 79 6 01 Phase n 3 Recovery Start 00 09 13 End 00 10 21 Loadi 0 Load2 0 Load3 0 Min 18 3 1 110 22 1 602 720 23 24 7 52 0 91 15 54 4 30 43 11 5 14 60 5 48 Max 24 1 1 784 42 7 1720 1579 37 29 21 49 1 26 17 35 5 23 96 24 4 16 61 6 36 Average 20 8 1 477 30 9 1075 1107 28 26 13 44 1 06 16 40 4 72 66 16 4 15 54 5 89 Trend 19 9 1 134 22 6 610 737 34 28 7 63 1 20 17 14 4 41 52 11 7 16 43 5 58 When selecting View Summary and double clicking on the window the summary options will be displayed Viewing the predicted values The software calculates Predicted Values for certain testing parameters which can be viewed in a separate window LA CASA V test n 1 Predicteds x Parameter Rest Max RBVO2max Pred Pred Loadi Watt 10 71 14 ae
129. ality control messages are available to ensure acceptable maneuvers are performed for interpretation Parameters measured during FVC tests include the following Symbol UM Parameter FEV1 FVC FEV1 as a percentage of FVC FEV6 FVC FEV6 as a percentage of FVC Best FEV1 Best Forced Expiratory Volume in 1 sec Best PEF l sec Best Peak Expiratory Flow Vmax2596 l sec Flow when 75 of the FVC remains to be exhaled Vmax5096 l sec Flow when 50 of the FVC remains to be exhaled Vmax75 l sec Flow when 25 of the FVC remains to be exhaled FEF25 7596 l sec flow between 25 75 FVC FET100 Sec Forced expiratory time FEV2 Forced Expiratory Volume 2 sec FEV3 Forced Expiratory Volume 3 sec FEV2 FVC FEV2 as a percentage of FVC FEV3 FVC FEV3 as a percentage of FVC FEV1 VC Tiffenau index FEF50 7596 flow between 50 75 FVC FEF75 8596 flow between 75 8596FVC FEFO 2 1 2 l sec Mid exp flow between 0 21 1 21 FiVC L Inspiratory Forced Vital Capacity FiF25 7596 gt Forced mid inspiratory flow FiV1 l sec Forced Inspiratory Volume 1 sec PIF I sec Peak Inspiratory Flow VEXT ml Extrapolated Volume back extrapolation PEFT msec Time to PEF 10 90 W Perform a test 1 Select Test Start Forced Vital Capacity pre or press the icon EI select Forced Vital Capacity p
130. aph select View Customize graph when viewing the graph or right click on the graph and select Customize graph Customize Graphs x m Autoscale Erom 00 00 00 To 00 01 21 Options Ignore 0 Grid Points only Markers Autoscale Autoscale Squared Min 288 050 Hin 21 8 866 723 088 596 393 Step 0 0000 Step 0 0000 recovery Mark points For each variable you have the option to specify the following parameters If a grid will be drawn If the scale is automatic or not if this option is deselected you may set the range of the axes and the grid step You may also enable or disable the following options e Ignore 0 removes all the points in which the measured value is zero Points only shows a dispersion graph without a line which connects the points e Markers highlights each point in which a marker was entered with a symbol e Squared makes the graph squared instead adapting it to the space No recovery excludes the recovery phase from the graph Mark points marks each measured point with a symbol 204 Exercise testing Viewing results Press OK to confirm Cancel to cancel changes or Restore to restore the default configuration E Viewing test information x Patient Calibration ID code 000001 Temperature C 34 STPO 0 807 AGA Humidity 5 55 BTP5 imap 1 046 Temp flow
131. arameters to view By selecting Options Parameters to view Test execution or the icon you may select the parameters to be displayed during a test The dialog box will appear the same as the box previously described under Options Parameters to view Test visualization Fast graphs Fast Graphs Label 1 Axis Axis Am Axis vco2 vest t Rt zu e loadt hr7t Load t feo2 feco2 7t Fe02 Feco2 Le ER tea By selecting Options Parameters to view Fast graphs you may preset up to five graph layouts which can be rapidly viewed by pressing the relative buttons Restore will restore the default graphs 76 User interface and settings CPET settings E Printing Parameters Eo Print X Select parameters to print m By selecting Options Parameters to print you may select the parameters to be printed The icon Will select all of the parameters and the icon X will deselect all of the parameters Press OK to confirm Cancel to cancel changes or Restore to restore to the default visualization Since the selected parameters could extend past the paper margins the remaining horizontal space will be displayed in the dialogue box This value will be displayed in red if the printout is going to exceed the paper width see above picture In this case it is advisable to hide some of the selected parameters E Sorting parameters x By selecting Options Sortin
132. ase Syst Diast pressure Syst Diast pressure ECG ECG End of test End of test for cycloergometers for treadmills User interface and settings CPET settings 81 8 To add a step to the protocol press Add and enter the time and the delta loads Select the command to send to the ergometer Command and if a phase change will occur at the selected step New phase The Syst Diast pressure dialog box will be displayed at each load change to allow you to enter the subject s measured blood pressure Checking the ECG checkbox will cause an ECG event to be automatically stored at each load change Checking the End of test checkbox allows the software to recognize the current step as the last step of the protocol Press OK to confirm Note The Speed parameter in the treadmill protocols must be entered and will be displayed as 10 times the desired value For example to set a 5 5 kmh speed you should enter the value 55 9 Edit will allow you to edit selected steps 10 Delete will allow you to delete selected steps one E Test protocols x E Ergometer E 258 xz zs Phase Command one Protocol no one Message Time sec 5 Delete Messages MV RMR Drive ergometer Generate Edit Add Delete Relative Increments Initial command no one H Final command no one B selecting Options Real time Test protocols or th
133. at least 30 seconds in order to visualise the variations When the FeCO has stabilized within the acceptable range press F2 or the icon i start acquiring data You should continue to verify that the measured FeCO is within the 0 796 1 396 range throughout the test and adjust the Flow adjustment handle as necessary value can be read on the right side of the screen Warning If the green led turns off during the test the red led flashes or the alarm beeps you should abort the test and remove the hood from the patient s head This indicates that the pump does not work or the mains is not powering the system If the mains is not powering the system the pump is being powered by the backup battery but the test must be stopped For further details about the test execution see later Performing a Resting Metabolic Rate test Ending the test without saving data 1 Select Test Abort or press Alt F3 2 Select Yes to abort the test or No to continue Ending the test and saving data 1 Select Test End or press the icon or press AIt F3 2 Select Yes to end the test or No to continue Note Always remember to turn off the Quark RMR and the Canopy pump at the end of the working session 226 Resting Metabolic Rate Test Performing a test using the canopy option Performing a test with mechanically ventilated patients Note Cellular phones should be turned off to eliminate potential electrical int
134. at the end of a FVC test when the following conditions are met e The automatic diagnosis option is enabled e patient s anthropometric data has been entered to allow for a calculation of the lower limit of normal range e Atleast one FVC maneuvre has been performed To enable disable the automatic diagnosis select deselect the Enable Automatic Interpretation checkbox In the LLN calculation field you may select the formula to be used for the lower limit of normal range calculation The formulas available include the following 1 ATS LLN Pred 0 674 SD 2 ERS LLN Pred 1 647 SD 3 80 Pred LLN Pred 0 8 specifications SD Standard Deviation Quality control The device has the option of implementing quality test controls The calculations refer to Spirometry in the Lung Health Study Methods and Quality Control A R R D 1991 143 1215 1223 The quality control messages are displayed at the end of the test To enable disable the quality control select deselect the Enable Quality Control checkbox BTPS It is possible to enable disable the BTPS correction and set temperature and humidity at flowmeter Other spirometry options The Print active window FVC in ATS format allows the active FVC window to be printed in two pages according to the ATS Standards The Reduce scale on small curves option magnifies the graph if it is too small in the standard scale Print display only best manoeuvres prints shows for eac
135. ath hold time must within a specific range which has been established by ATS and ERS standards You do have the option to customize the optimal range of wash out and collected volumes according to the Vital Capacity demonstrated by the patient being tested This function may be useful when patients demonstrate a lower than normal VC and have difficulty exhaling the typical collected volume required to obtain measurements with breath hold test procedure 1 Instruct the patient to begin the procedure by breathing normally Lung diffusing capacity DLCO CO Diffusing Capacity DLCO Test 135 2 Ask the patient to exhale completely to Residual Volume ATS ERS standards recommends that this portion of the manoeuvre be limited to 6 seconds In patients with severe obstructive lung disease exhalation to RV may require additional time 3 Next instruct the patient to inhale the DLCO gas mixture to Total Lung Capacity The inspiration should be rapid since the calculations assume instantaneous lung filling ATS and ERS standards state that 8596 of the patient s inspiratory volume should be inhaled in less than 4 seconds It should be noted on the post test notes if longer inspiratory times are necessary to achieve the recommended 85 Vi goal When the patient completes a full inspiration instruct him her to hold their breath for the required apnea time Last the patient should empty their lungs with a smooth unforced exhalat
136. atient s alveolar pressure airway resistance can be identified as the ratio between the mouth pressure and the value of flow before the interruption The Appendix reports bibliographic references which demonstrate a high reproducibility and correlation between values measured via the interruption technique and those measured by body plethysmography The parameters measured during airway resistance testing include Symbol UM Parameter Expiratory resistance 1 5 Expiratory conductance Racin kPa I s Inspiratory resistance ET l s kPa Inspiratory conductance Perform the test mS 1 Select Test Start Rocc or press the icon and select Rocc x Occlusion Random C Manual Press space bar Inspiration Expiration Trigger flow ml s 500 Post COSMED filter P N 182300004 Back extrapolation algorithm 15 ti 30 t2 msec 70 Cancel 2 The Test option window will open This window allows you to customize the following settings Whether the occlusion is generated randomly or manually by pressing the space bar You must select either Random or Manual under the Occlusion option If the occlusion will be generated during the inspiratory expiratory phase You should select either Inspiration or Expiration under the Occlusion option The flow threshold in ml s required to activate the occlusion wh
137. ation impossible please check Tank Qbax door RH T4 probe connection Qbox unit switched COSMED Calibration If the above dialog boxes appear it can be due to the following causes e Unit off e RH TA probe not properly connected e Door not closed e Cylinders closed or with insufficient pressure e Pneumatic tube not connected or damaged e Gasket damaged e Other minor causes 50 Calilbration Body Box calibration Calibrate the Quark i2m Note This calibration must be performed from the main program not from the calibration program We suggest to perform a calibration one time a day To calibrate the system 1 Connect the calibration piece to the Head without antibacterial filter 2 Select a patient in archive 3 Select Test Fot as you start a real test 4 PFT Suite 8 14 b1 ito LA CASA Esecuzione test Fot T _ Xl 2 Test Visualizza Finestra lej R X Freq R hpalsec 16 000 en TTE lt lt goo mmm Ex rere qo prom e m me e m m RU ado mem mM amp qom RR Wero me ru IH E ES kd Wp ee oe oe ee aperte 50 00 a 000 14 000 GU LEE DL ey Me ee ee Mg a ee ee 1 gt Hoc ee Weer ee gt pres spend aider pec eee uir eve eer px Eden Ub te ees
138. bled disabled 192 Exercise testing Performing the test Ignore 0 will remove all the points in which the measured value is zero Points only will show a dispersion graph without a line which connects the points e Markers will highlight each point in which a marker was entered with a symbol e Squared will make the graph squared instead of adapting it to the space No recovery will exclude the recovery phase from the graph Mark points will mark each measured point with a symbol Press OK to confirm Cancel to cancel changes or Restore to restore to the default configuration Moving within a data table Goto Go to hh mm ss Select View Go to and enter a time value hh mm ss to move to a selected time Viewing information of the current test Information about test in progress X Patient Calibration ID Code 1000 Temperature 25 STPD 0 804 Last name Humidity 3 56 5 insp 1 090 Temp flow C 34 BTP5 exp 1 020 AIDE Hum flowm 2 100 Press mmHg 741 Test M YWO2max ml min 0 Protocol no one Age 40 I 0 00 Ergometer no one Patient data Height 178 0 FE 1 I 0 00 Weight Kg 76 0 l min 0 0 Smoothing 5 steps BSA m 1 9 IC 0 0 00 cu bpm 180 User 0 00 Lost steps 0 VD 0 User B 0 00 UN g day 00 Use
139. bles you to select which lead is enlarged in the QRS visualization 196 Exercise testing Performing the test The LowPass section allows you to set the filter to be used to attenuate noises Press OK to confirm Cancel to abort All to enable visualization of all leads Zoom to enable the only selected lead or Restore to restore the default settings QRS Setup X Double click to show or hide Enlarged QRS 5 a track Update step by step 15 seconds 30 seconds seconds Restore Active track only the first 6 active tracks will be shown Show base QRS The setup window is slightly different when viewing QRS To view this window select ECG Setup QRS The Update section allows you to set the update frequency of the mean complexes Show base QRS enables the visualization of the base QRS superimposed on the actual one Arrhythmia configuration By selecting ECG Setup arrhythmia you may configure the arrhythmia options Enable Arrhythmia analysis rate thres bpm 130 run count thres beats Asystole delay 5 Run Pause avg 140 Ventricular Hhythm Couples Ventricular Bigeminy Pacemaker Ventricular Trigeminy Pacemaker rate bpm 72 Multifocal R on T Dominant rhythm cha ox Pacemaker spike OK Cancel Enable Arrhythmia a
140. bs Predicteds set and Formula definition User interface and settings PFT Suite settings 71 Predicteds set Predicteds x Predicteds set Farmula definition o HORNS Description Set current predicteds Name of the predicteds ERS 93 Save Age Copy Delete Modify predicteds Export Cancel Apply Help This tab allows you to manage the entire set of predicteds except prediction formulas The following information is necessary to define a set of predicteds Field Description Name Identifies the set of predicted values Description Free field Age The starting age that the predicteds values will apply to To enter a new set of predicteds click on the New button Enter a description of the set Description the name of the set Name of the predicteds and the ages above which the adult formula will apply to Age You must specify the age for both males and females Select the checkbox Modify predicteds if the new set is based on a predefined set of predicteds Press Save to save the new set To abort without saving press Cancel To delete a set of predicteds select it from the list and click Delete If a set is deleted the associated formula will also be deleted You may generate a new set of predicteds based on the same attributes and formulas of an alternative set Select the set of predicted you wish to copy press Copy specify a new name and confirm To imp
141. bstructive lung disease may not have the ability to meet all of the conditions described above In such cases DLCO measurements may not be completely accurate but can still be used when making comparisons to prior DLCO measurements obtained from the same patient E with apnea standard method 1 Select Test Start Single breath CO diffusing capacity or press the icon select Single breath CO diffusing capacity x Patient v Breath hold 10 sec H Simulated test Cancel 2 Press Patient to confirm or modify data for dead space haemoglobin and carboxyhaemoglobin you may either use the ATS recommended values or enter the actual patient s value for the first 2 parameters Press OK to confirm ATS 0 Cancel Hemoglobin Hb f ATS 7 Manual 45 g dl Carboxyhemoglobin 0 3 By selecting the checkbox Breath hold you may enter an alternative breath hold time the default time is set at 10 seconds 4 Select the checkbox Simulated test if you wish to conduct a procedure without having the patient inhale CO and CH This function may be useful when familiarizing the patient with the manoeuvre prior to performing the actual test 5 Press Start to begin the test 6 Wait until the automatic air calibration is completed 7 When the system is ready a message will be displayed on the lower part of the screen Instruct the patient to perform a Slow Vita
142. cal data uu shows breath by breath data If you would like to view more than one window at a time select New Window from the Window menu To display a list of tests of the current patient select Test current patient from the View menu or press the icon amp l 184 Airways resistance measurement The Airways Resistance measurement test Exercise testing _ Recommendations for exercise testing Evaluation of the cardiorespiratory function Exercise creates an increased demand of energy and gas exchange which must be supplied by the cardiovascular and respiratory systems The increase in metabolic rate during exercise creates an increase of oxygen in the muscles The muscles also generate excess which must be removed to avoid lactic acid build up E Precautions Laboratory The room in which testing is performed must be large enough to accommodate the necessary equipment and allow access to the patient in case of an emergency A thermometer and a hygrometer should be present in the testing area and monitored regularly The subject s heart rate and perceived exertion may rise with increased temperatures and or humidity levels greater than 6096 which may lead to variable cardiovascular responses An adequate temperature for testing conditions is 22 but temperatures as high as 26 C may be acceptable with efficient air ventilation Ending the test The patient should be monitored with an ECG in resting conditions
143. can be instructed to take two or three tidal breaths after the panting manouver prior to performing the linked ERV and IVC manoeuvres 2 At the end press or the icon E in order to view the test results together with the predicted values To abort o the test discarding the results press Alt F3 ej to start again the test press 3 To view graphs or the main parameters press of the following buttons displays the V T graph displays the loops 160 Performing tests with Body Box Test execution Problems and error messages related with the test execution If a door is opened during a test the following error message will appear It is possible to save the test PFT Suite Box depressurized during best execution If a test is started with the door open or with the RH TA not properly connected the test cannot be performed and the following error message will be shown PFT Suite x 1 Test impossible please check Tank Qbox door RH T4 probe connection Qbox unit switched an Performing tests with Body Box Test execution 161 L Body Box Post test execution The Body Box Post test is a Body Box test after bronchodilator administration comparing results before and after the administration Bronchodilators are administered during lung function studies to determine if the subject s airflow obstruction is reversible Bronchodilators can increase airway
144. cking the Signature field you may enter the text to be printed before the signature line and specify the desired width of the line Printed file name Page setup X Header Data Margins Footer Printed file name Format Available fields date of birth zi ID zd date of test zl last name Af first name SEH tae Printed file name allows you to define the name to be assigned to the pdf file if the report will be printed in this format Press the relative buttons in the section Available fields to enter a value for one of the fields listed If the format selected is for example 96d 96l 96f the filename will be composed by date of the test space line space last name space first name This tool is very useful for network archiving data particularly when the central unit requires that the file name is formatted in a specific manner User interface and settings PFT Suite settings 75 CPET settings The CPET software can be customized through the Options menu Viewing Parameters to view x Select parameters to view By selecting Options Parameters to view Test visualization or the icon you may select the parameters to be displayed when viewing a test The icon Will select all of the parameters and the icon X will deselect all of the parameters Press OK to confirm Cancel to cancel changes and Restore to restore to the default p
145. con ve you have the option to enter in values for Systolic Blood Pressure Diastolic Blood Pressure and or up to three user defined parameters When selecting the checkbox Automatic pressure measurement a pressure measurement with an external device is enabled Entering symptoms During the test you have the option to enter symptoms according to the modified Borg scale by selecting Events Insert symptom Borg Modified Borg scale Symptom Nothing at all 0 5 Yer very weak 1 weak 2 Weak 3 Moderate 4 Somewhat strong 5 Strong 6 Somewhat hard Mery strong 8 Cancel ir 9 10 Very verp strong 11 Maximum Select the symptom and press OK to confirm Modifying the phase To modify the phase select Events Exercise or Events Recovery depending on the desired phase yt i Phases can also be changed with the icons exercise and a recovery Performing events during the test During the test you may choose to perform one of the following events e F V loop e O CO graph e Spirogram Exercise testing Performing the test 195 Event to execute F V Loop 02 C0 Graph 5 pirogram To perform any of these events during the test select Events Event or press icon select the event and press to confirm For further information about the events during the test see Performing events during the test below Driving an ergometer Send comman
146. ction Note Cellular phones should be turned off to eliminate potential electrical interferences Analyzers Calibration X Gas is absent check the calibration tank Note If the window shown above appears during the calibration you should make sure the cylinder s residual pressure is above 10 bar and that the valves are open E Room air calibration Note After turning on the unit wait 45 minutes warm up time before starting the calibration procedure Important During calibration always remove the sampling tube from the optoelectronic reader Do not remove the sampling tube from the Portable Unit otherwise calibration could be affected Caution During Room Air calibration be sure to put the sampling line far from the expired gas otherwise calibration could be affected Caution Room Air calibration performed in small rooms high concentration of CO affects the calibration results and the accuracy of the following test 1 Connect the Portable Unit to the PC by the serial port Remove the sampling plug from the flowmeter Run the calibration program and choose Room air from the Calibration menu 3 The message Room air calibration in progress will appear and a graph will show in real time the O and CO calibration At the end of the manoeuvre the message Calibration done will be displayed 4 The following dialogue box will appear showing the calibration results press OK to confirm the calibration 44 Cali
147. culator User interface and settings User interface 63 L PFTSuite settings The PFT Suite software can be customized through the Options menu E Configuration Selecting Settings from the Options menu allows you to customize testing options x Forced Oscillations Body Single breath CO diffusing capacity Respiratory drive Preferences 5 pirometry w ash nut Graphs Interface Curve n 1 USB Device Selection Curve n 2 Quark 2008 Curve n 3 Flowmeter lm XS PNT n 4 Curve n 5 Unit of meas Cm Kg C Inch Lbs Grids Show InfoTest User Free Fields Patient Card Visit Card Test Card cancel The Preferences tab allows you to select and or customize the following e desired colours of the curves up to 5 curves may be overlapped on the same graph e Ifthe grids in the graphs will be displayed Ifthe test information will be displayed e The appropriate communication port between the PC and the device e The device being used flowmeter Turbine Flowsafe or X9 e The applied unit of measurement cm kg or inches Ibs e user definable fields The patient s database is organized in 3 different cards patient card visit card and test card which allow you to store patient visit and test information You also have the option to customize additional fields user free f
148. d James 0000 Test Test 00002 3 In the left side of the window you have the patient list of the device archive in the right side there is a list of the patients in the PC archive 4 You can link the selected patient tests to a patient already present in the PC archive Existing or to a new patient New In this case it will be created a new patient with the data stored in the unit 5 Press Existing or New to start the transmission Note the 6MWT test cannot be downloaded on the PC Archive management and printouts Receiving data from the unit 97 Archive maintenance We recommend that you perform an archive reorganization each month to free space on the hard disk and or to correct possible errors within the database In the event that you run out of additional space on the hard disk you may need to delete all stored data You would then want to perform an archive initializing We also recommend that you back up the archives at least once a month A warning message will appear if the archives have not been saved in the last 30 days This function can be very useful if hard disk or PC damages should occur Deleting the archive To delete the archive select File Archive Initialize Press OK to confirm Reorganizing the archive To reorganize the archive select File Archive Reorganize Press OK to confirm You will then be prompted to select if you would like a fast or thorough reorganization to be performed B
149. d to ergometer X Command TET To send commands to the ergometer select Events Ergometer commands Select the desired command and confirm with OK ECG related functions during a test The functions described below are only enabled when a COSMED is installed Storing an ECG To store 10 seconds of an ECG during a test select ECG Store ECG or press the icon You may also enter symptom to be associated with the ECG ECG snapshot In order to study an ECG you may freeze the display by selecting ECG Hold or pressing the icon To restart the ECG press ECG Hold again or press the icon eu Printing a stored ECG When ECG Print stored ECG is selected the ECG will print each time it is stored and at each phase change Leads setup ECG Setup X Double click to visualize or hide a track LowPass C Off 25 Hz C 40 Hz 15 oom Enlarged QRS Cancel Restore Y5 Select ECG Setup leads or right click on the ECG and select Setup leads or you may double click on the ECG to set options for ECG visualization Speed mm sec m Amplitude mm m n s Visualized track To view or hide a lead double click on its name in the list You may move the selected lead s up or down with the arrows Speed allows you to adjust the speed of the ECG leads Amplitude allows you to adjust the amplitude of the ECG leads Enlarged QRS ena
150. dicted values le x File View Test Options Window HT xl Into co 1 07 1 03 1 00 n 36 n 33 0 69 0 56 0 53 0 79 0 76 0 72 0 59 5 O 62 0 58 0 55 0 51 0 48 0 44 0 41 00 05 00 12 00 20 00 28 00 36 00 44 00 51 00 59 01 07 01 15 01 22 01 30 01 38 01 46 01 54 0201 0209 0225 z33 0241 Time mm sz Ti Ttot EV Fett uz FiCde FO 1 Time l min libtps libtps 20 55 19 35 0 49 0 87 2 40 n 78 2 39 0 00 00 05 19 17 0 46 1 10 2 40 1 15 2 39 0 00 00 18 87 n 45 n aa 2 40 1 09 2 39 0 00 00 11 21 40 0 45 0 2 40 0 88 2 39 0 00 00 14 18 40 0 40 0 80 2 40 0 89 2 39 0 00 00 17 21 58 0 49 0 61 2 40 0 94 2 39 2 00 00 20 amp 3 9n 0 39 0 94 2 40 0 94 2 39 0 00 21 05 0 47 0 99 2 40 0 91 2 39 0 00 00 25 21 74 n 46 0 64 amp 40 0 74 2 39 0 00 00 28 26 79 n 54 n 46 2 40 0 76 2 39 2 10 00 30 21 44 0 34 0 81 2 40 0 74 2 39 0 00 00 33 For Help press F1 22 04 2002 James BOND NUM Respiratory mechanics PO 1 Respiratory drive 149 6 In order to visualize the graph and the main parameters press the following buttons A shows the PO 1 graph E shows the Volume Time graph of the SVC Ed shows breath by breath data You may right click on the active window upon completion of the test to access the following options e Customize the current graph Customize graph e Build another graph using measured parameters
151. dilator and Bronchial Provocation Testing Bronchodilator testing Bronchodilators are administered during pulmonary function studies to determine if the subject s airflow obstruction is reversible Bronchodilators can increase airway size by relaxing the smooth muscle This test consists of comparing the results between the reference FVC FVC pre and the FVC obtained after administering the drug FVC post An increase in the FEV1 of 10 1296 with respect to the baseline value inidcates of reversible airway obstruction E Bronchoprovocation testing The most common indication for performing Methacholine and or Histamine bronchial challenges is to diagnose hyperresponsive airways Patients may demonstrate normal baseline pulmonary function testing and show little or no response when administered a bronchodilator despite repeated complaints of respiratory symptoms chest tightness wheezing cough In such cases bronchial challenges can be used to confirm or rule out a diagnosis of hyperreactive airways Indications for bronchial challenges include the following e Diagnosing Asthma e Confirming a diagnosis of Asthma e Documenting the severity of airway hyperresponsiveness e Following changes in airway hyperresponsiveness Patients with hyperreactive airways will demonstrate a response to the inhalation of challenging agents Methacholine or Histamine by displaying signs of airway constriction The testing procedure involves executin
152. ds E Page header Report header X Header Center C Right Print logo By selecting Options Printout header you may customize the page header with the following information e The text included in the header Header e The text alignment Justification If a logo will be included in the printout checkbox Print logo Selecting the button Logo will open the software Paint which allows you to draw a logo or modify the preset logo You may copy the bmp file into the software installation directory The file must be a bmp file 256x256 pixels Printed file name x Format Available fields zh date of birth zi ID zd date of test 41 last name Al first name zn test zh time of test SEX L ancel Name format defines the automatic name to be assigned to the pdf file if the report will printed this format section Available fields allows you to specify any of the listed fields If the format is for example 96d 96f the filename is composed by date of the test space line space last name space and first name This tool can be useful for network archiving of data particularly when the central unit requires that the file name is formatted according to specific rules User interface and settings CPET settings 85 K4 E Printout reports Reports Configuration x Printed pages
153. e I 0 00 0 00 FEV 1 I 0 00 0 00 User 0 00 HYY l min 0 0 User B 0 00 IC I 0 00 User 0 00 Hest Peak PaO mmHg 0 0 PaCO mmHg 3535 1 Notes Distance 0 00 Unit of meas m Load 1 Speed Unit of meas Kmh 10 Load 2 Elevation Unit of meas Cancel Load 3 N A Unit of meas T Modify allows you to edit the test information Exercise testing Viewing results 205 Calibration Data X Turbine Last calibration 00 00 0000 Calibration Warm up hh mm ss 00 00 Gas 08 05 2007 Delay 08 05 2007 Digital trimmer 1 Exp Insp Gain Environment Env Temp C 220 Internal Temp 220 Humidity 4 552 Press mmHg 02 x 02 4 02 Analyzer Base Line 28 Gam 1007 Delay CO Analyzer Base Line 3 Gain 994 Delay Calibration allows you to view the calibration data for the current test x Test type BxB Ergometer COSMED Treadmill Type Treadmill E Reason for Test Protocol Naughton Symptoms Response Reasons for Stopping Test Fatigue Physician Technician good Interpretation Comments allows you to view the results and add additional comments 206 Exercise testing Viewing results Lactate Threshold i X VCUZz ml min Fet zit 3297
154. e PC display which allows you to perform several operations in real time by pressing the relative button with the mouse You may also access these functions by pressing the relative numeric keyboard key To view or hide the Command Center select Window Command Center or press F12 The Command Center key functions are as follows Key Function 0 Stores an ECG event 4 Automatically controls the exercise protocol 5 Show or hides the Information Window with timer and instantaneous HR 7 Carries out an event Starts the exercise phase 8 9 Controls the ergometer Enters a symptom according to the Borg scale m Enters a marker during exercise testing Enters Systolic and Diastolic Blood Pressure and three user defined parameters Enters the load when an alternative load is desired during exercise testing 198 Exercise testing Performing the test Events management during exercise testing Flow Volume loops Pulmonary function measurements may be useful during exercise testing to detect abnormalities in the mechanics of ventilation in patients with ventilatory limitations to exercise The test consists in acquiring Flow Volume loops during exercise at different workloads and overlapping them on the subject s resting Flow Volume loop This comparison allows you to assess the subject s Flow Reserve the distance between the peak flow of the F V loop during exercise to the peak flow on the F V loop at
155. e icon E you may create edit or delete ergometric protocols Creating a new protocol 1 Press New and enter a name for the protocol 2 To add a step to the protocol press Add and enter the time and if a phase change will occur at the selected step New phase Checking the End of test checkbox allows the software to recognize the current step as the last step of the protocol Press OK to confirm Edit will allow you to edit selected steps Delete will allow you to delete selected steps E Restoring the workspace x Select workspace to restore o Cancel selecting Options Real time Restore Workspace you may restore the workspace according to a predefined layout Select the preferred workspace from the list and press OK to confirm Units of measurement x s Choose units of measurement ECG C 5T uy 5T Cancel 2 82 User interface and settings CPET settings By selecting Options Units of measurements you may select the preferred unit of measurement to be applied to parameters Available measurement options include cm kg and inches Ibs for length UM for weight and uV and mm mV for ECG leads You may also enter the scale factor in mm per mV for ECG leads E Summary settings Summary on Load 2 Load 3 _ Cancel Phase selecting Options Summary on you may select when the summary will be calculated The summary can be calcula
156. e shown the left one will show the patient s respiratory frequency the right one the pressure inside the Body Box gt PFT suite 10 0 b21 James BOND Real Time Test Raw Tav 8 S Test Window Help e x e om Plethysmographic Test DOPO 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 o M M M M OT
157. e to the dosimeter and to the proper connector on the Quark rear panel Connect a medical air cylinder to the proper connector on the Quark rear panel The output pressure must be adjusted at 4 bar Connect the parts as shown in the following page according to the flowmeter used Instruct the patient to apply the nose clips 122 The dosimeter General warnings po Sy MN simo e 5 QU with turbine 7 ent 3 88 4 with Flowsafe 2 OST 4 8 with PNT X9 Nebulizer mouthpiece Nebulizer Dosimeter adapter Antibacterial filter ID28 turbine Filter Flowsafe adapter Flowsafe PNT X9 The dosimeter General warnings 123 L Performing the test Warning During provocation testing the patient s response to the challenge agent may require the suspension of the test This procedure can be dangerous and should only be performed with a physician and appropriate emergency equipment available Always review the information provided with the challenge agent very carefully NV 1 To perform a dosimeter test select Test Start Dosimeter or press the icon and select Dosimeter 0X Next Step 1 Use concentration of 0 0000 mg ml 74 2 Confirm and start to breathe in the flowmeter Press for the delivery When all the set deliveries are done press E Perform an FVC Post test as described in the chapter Spirometry 5 When the test is saved the following dialog appears
158. ecommended interval Turbine Each week if the flowmeter is changed if the ambient conditions temperature humidity and pressure change significantly and in all the cases you suspect that the measurements are not reliable anymore PNT Flowsafe Sp SPIRO PFT Each time the flowmeter is changed the PNT Flowsafe is a disposable device Each day if the flowmeter is changed if the ambient conditions temperature humidity and pressure change significantly and in all the cases you suspect that the measurements are not reliable anymore PNT Rocc SPIRO PFT CPET Q Box Each day Ergo RMR RMR Each day and before each test FRC Each day and before each test DLCO Each day and before each test Air Each day and before each test ICU Each day and before each test Room air Each day and before each test Reference gas Each day and before each test Delay Each day and before each test Leakages SPIRO PFT CPET Each day Polytropic coefficient Each day or if the ambient conditions temperature humidity and pressure change significantly Running the Calibration Choose Calibration from the Options Menu or press the icon Fal Unless otherwise specified all the operation described in this chapter must be performed from the calibration program E Running the Body Box calibration program SPIRO PFT CPET
159. ed turns on you may begin the test If the green led does not turn on the test cannot be performed because the pump does not work or the mains is not powering the system 3 After performing these checks instruct the patient to lie in a supine position Place the bubblehood with the vail on the patient s head The tube should be placed near the patient s mouth Warning Do not place the canopy hood over a patient s head before the tube is properly connected and a continuous flow has been applied from the canopy blower 224 Resting Metabolic Rate Test Performing a test using the canopy option E Performing the test 1 Start the test as you would an exercise test but assure that RMR with Canopy is selected in the Mode section CICER x Hode Height 0 0 C Gas BxB Weight Kg 0 0 C Gas BxB ECG C Mixing chamber C Mixing chamber ECG C AMA with Mask RMR with Canopy C RMH with Ventilator C Stress ECG C Resting ECG Simulated test ine Ergometer no one Protocol no one Other data ERBEN Workspace RMR Details Cancel To choose a specific protocol to be carried out during the test select one listed under Protocol The Workspace list allows you to choose a default workspace or one defined by the user Pre exercise UB a dav a FEV1 0 4 37 AMR Kcal day 0 M VD ml 0 Ez MYY l min 0 0 RH X User 1 0 00 RH fluss s 100 User 2
160. edance graph Shows the pressure and flow graphs Shows the measured data Shows the bronchoprovocator response Shows data step by step Shows the trend Shows the last performed test Starts the calibration program Selects a test to be performed Creates a new window Places the windows in cascade Tiles the windows horizontally Tiles the windows vertically Closes all open windows j o o 5 Wn 5 F j N D v 3 D gt m wo c m re BS Ee gt 6 09 S 2 gt m m 1 o lt e 4 2 Y Tox gt E gt e Exits from the test mode Starts the test Restarts the test Ends the test Aborts the test Zeros the PNT X9 Delivers a bronchoprovocator dose Opens the Body Box vent valve Starts the sRaw measurement Starts the TGV measurement Captures a sRaw or a TGV Activates the filter for sRaw breaths Aligns the center of the sRaw loop with the origin of the axes Shows the F V graph CED User interface and settings User interface 59 m y e Shows the FRC graph Shows the CV graph Shows the DLCO graph Shows the MIP MEP graph Shows the PO 1 graph Shows the Oximetry graph Shows the Rocc graph Shows the Flow Time graph Rocc test Shows the Volume Time graph Shows the impedance graph Shows the coherence graph
161. el Select the folder to restore the archive from 108 Archive management and printouts Archive maintenance Restore v 5 5 x Select backup set Original position Information Backup executed on Friday 28 September 2007 at 14 58 300 files 29 Mb 1 disks used oo The dialog box will show the files when have been backed up Select the desired folder and press OK or press Browse and select the desired folder Select the checkbox Original position if you would like the archive to be placed in the folder it was located before the back up was performed Restore 5 5 Restore in progress Disk n 1 1 00000009 Total Hemaining 300 files 249 files 29 Mb 27Mb A bar will display the progress of the restore Archive management and printouts Archive maintenance 109 Data printouts The CPET software can print reports in the following four options e Active window o ECG summary e List of tests E Active window printing This printout function is only enabled when the active window the window with the title bar highlighted is a graph or test data To print the active window select File Print current window or press the icon gt set the desired printer properties press OK E Report printing PFT Report printing be enabled
162. elect Test Import test and choose the test to be imported Import test x Test Data Date of test 2070271997 Time of test 00 00 Duration 00 14 15 of steps 57 M of events 0 Press mmHg 60 Temperature 25 Humidity 5 50 incremental test cycloergometer Patient Data ID Code 1000 Last name BOND First name JAMES Birth date 06 03 1957 Height 178 0 Weight Kg 75 0 Eth Corn 100 Preview Hew patient Search patient Cancel Press Import to import the test Test data will be associated to the patient shown in the Link to section Press Preview to display a preview of the test Link To ID Code 1000 Last name BOND First name JAMES Birth date 06 03 1957 106 Archive management and printouts Patient s database 15 xj Vo ml min ml min 3033 3992 2775 3645 2517 3298 258 2951 z000 2604 1742 257 1484 1910 lzzb5 1563 367 1216 709 369 451 192 tihh mm s2 00 00 01 45 03 30 05 15 07 00 08 45 10 30 12 15 14 00 15 45 New patient will create a new patient using data from the imported test Search patient will search for a patient within the database to associate the imported test to Archive management and printouts Patient s database 107 Archive maintenance We recommend that you perform an archive reorganization each month to free space on the hard disk and
163. elect a previously performed SVC effort to be associated to the current procedure Right click on the active window select the desired SVC and confirm by pressing OK A preview of the selected test will be displayed below the window 08 06 2007 SVC EVE 08 05 2007 08 05 2007 5 45 FRY Cancel 244 Help Rt 15 00 Preview E Editing test When visualizing test results you may edit the data by right clicking on the active window To open the Edit window select Edit from the right click menu or double click on the graph Lung volumes Closing Volume test CV 131 W Edit James BOND 14 11 06 2007 09 49 8 x 211 Calculate ml 130 VDf ml 310 Single breath 02 LOL OLUL inu uL Tarm ILLA 0 1 2 3 1 5 6 BV Phase 1 ml Phase 2 ml Phase 3 ml S fa pm NES Ks esas 170 600 5650 Cancel Pressing Select SVC will allow you to associate another SVC to the test as shown above Placing the mouse on the vertical dotted lines allows you to change the limits between the four phases This can be achieved by dragging the lines with the right mouse button or by moving the horizontal bars in the lower part of the window Press OK to confirm or Cancel to abort the changes Viewing results To view results of a CV test 1 Select Patients from t
164. emain unacceptable you should contact Cosmed s technical assistance 42 Calilbration Analyzers calibration If the calibration cannot be performed because the soda lime absorber is exhausted a message requiring its replacement will be prompted to the user Contact COSMED technical support Calilbration Analyzers calibration 43 Analyzers calibration Preface The system allows three calibrations 1 Air calibration 2 Reference gas calibration 3 Delay calibration The Room air calibration forced by the system before every test consists of a sampling room air It updates the baseline of the CO analyzer and the gain of the O analyzer in order to match the readings with the predicted atmospheric values 20 93 for O and 0 03 for The Reference gas calibration consists of sampling a gas with a known composition i e 16 0096 for and 5 0096 for CO from a calibration cylinder and updating the baseline and the gain span of the analyzers in order to match the readings with the predicted values i e 16 00 for and 5 00 for The Delay calibration recommended to be carried out once per week or whenever the sampling line is replaced is necessary to measure accurately the time necessary for the gas sample to pass through the sampling line before being analyzed Before starting the calibration you should make sure that the reference values are correct see the Setting Reference Values se
165. er graph using the measured parameters select Graph builder Up to 2 parameters be displayed on the Y axis axis parameter Yi and Y2 axis parameters Occlusion Occlusion m in in Flow ncc Flow occ Configure allows you to customize the graph Airways resistance measurement The Airways Resistance measurement test 183 Customize Graphs Axis Occlusion n Options Grid Points only Autoscale Mark points Squared Hin 0 000 1 000 Step 0 200 Ignore zero Grid draws the grid Autoscale scales the graph according to the variable range If this option is deselected it you may set the range of the axes and the grid step Points only draws the graph without a line connecting the points Mark points draws the points with a symbol Squared creates a square graph instead of adapting it to the window Ignore zero ignores all points with a zero value E Viewing results To view the results of a Rocc test 1 Select Patients from the File menu or press the icon 2 Select the patient corresponding to the test you would like to view 3 Select the desired test from the list box and press OK To switch between graph and or data use the following buttons on the toolbar shows the graph f shows numeri
166. erence values Cylinders 4x100 Environment 2 1 00 02 30 0 02 2093 coz 500 300 02 100 100 0 02 3 UD Yolume 2009 Default Help 3 Type the volume of the calibration syringe ml i e 3000 for a 3 litres calibration syringe 4 Press OK to confirm changes Cancel to abort or Default to restore the default values CPET RMR K4 Q Box Note To obtain accurate measurements it is essential that the exact gas concentration values of the cylinders are specified in the Reference values dialog box These values can be located in the certificate of analysis E Body Box reference values 1 Enter in the Body Box calibration program 2 Select Setup from Options menu 30 Calilbration Introduction Cylinders Body Box Pressure Target fcmH2o Tau Target ms 10000 Polytropic Target mllcmHzO 800 Shutter closing time s Suggested Panting Manoeuvre 1 5 T Defaults Annulla Applica 3 Enter the requested values Pressure target and Tau target are respectively the overpressure to be applied to the Body Box during the time constant measurement and the target value of the time constant the calibration is good if the measured time constant falls within 1000 ms from this value Polytrophic target is the target value of the polytrophic coefficient the calibration is good if the measured
167. erferences E Measuring principles In the following technical details about the measurement of Resting Metabolism with ventialted patients with COSMED Quark RMR are explained Operating Principles Exhaled volume is measured at the exhalation port of the ventilator Fractional concentrations of inspiratory expiratory and are measured at the patient s airways It s mandatory that the Ventilator operates meeting the following conditions The volume exhaled by the patient comes out from the ventilator where the turbine flowmeter is connected e The eventual bias flow coming out from the exhalation port of the ventilator during the respiratory cycles must be set recorded and displayed on the Quark RMR Software Detection of the breathing cycle Expiratory detection is based on a flow threshold when the flow signal rises over a fixed threshold Bias Flow 80 ml s the expiratory phase starts Inspiratory detection is based on the first occurrence of the following conditions e falls below a threshold default 0 15 Flow falls below a threshold default BiasFlow 50ml s Note There are two possible IN EX detection modes Patient s exhaled gas detected and Patient s exhaled gas not detected If no CO is detected within the first 500ms from the beginning of expiration the algorithm assumes that there is no exhaled gas This mode is useful when testing the Quark connected to a ventilator w
168. esistance measurement test PFT Suite 9 0 b1 James BOND ROCC 19 19 06 2007 16 23 81 x File View Test Options Window Help lej Into 11 T E EEEE 0800 1 0500 1 4 0400 0200 peli 1 2 3 4 5 Occlusion n Parameter UM Pred TEST 19 Pred allis 0 200 0 175 87 65 in 5 00 5 70 114 1 ncc milfs 524 Palv kPa D 116 ncc msec 15 ti occ msec 30 t ncc msec 70 For Help press F1 18 06 2007 James BOND 8 To visualize the graph and the main parameters press one of the following buttons 4 shows the Rocc graph shows numerical data shows breath by breath data Upon completion of the test you may access the following options by right clicking on the active window Tocustomize the current graph select Customize graph e build anoth
169. ess the X in the top right section of the window 24 Installation Software installation Product registration CED In order to activate the software you must enter the activation codes The codes are printed on a label on the installation CD To enter the codes select Help Desktop Spirometer Registration and enter the two parts of the registration code in the boxes Then press OK to confirm In the Activated products section the active options will be listed as well as the software version that applies to the activation code Product Registration Enter Hegistration Code Activated Products Seral Number Until 55 Version cancel Note Registration codes are linked to the serial number of the device It is not possible to use the same code for more than one device Installation Product registration 25 Activate additional modules new software 6 Additional modules and or upgraded software can be activated after purchase The procedure for entering these activation codes is explained below 1 Run the COSMED software select the calibration program Test Calibration and retransmit the firmware Calibration Transmit program 2 Select Calibration Control panel Body Box If necessary change language selecting Options Change language 4 Select the communication port on the toolbar n 6 Calibration File Tests and Calibrations System Options Help
170. esting Metabolic Rate test 233 The following options may also be enabled disabled e Ignore 0 will remove all the points in which the measured value is zero e Points only will show a dispersion graph without a line which connects the points e Markers will highlight each point in which a marker was entered with a symbol e Squared will make the graph squared instead of adapting it to the space e No recovery will exclude the recovery phase from the graph e Mark points will mark each measured point with a symbol Press OK to confirm Cancel to cancel changes or Restore to restore to the default configuration Moving within a data table Go to hh mm ss Select View Go to and enter a time value hh mm ss to move to a selected time Viewing information of the current test Information about test in progress X Patient Calibration ID Code 1000 Temperature 25 STPD 0 804 Last name BOND Humidity 3 56 5 insp 1 090 Temp flow 34 BTP5 exp 1 020 2083 dense Hum flowm ZE 100 Press mmHg 741 Test YWO2max ml min 0 Protocol no one Age 40 I 0 00 Ergometer no one Patient data Height bem 8 2 DEG AML Acquisit Smoothing 5 steps Weight Kg 76 0 HYY L min 0 0 BSA m 1 9 IC 0 0 00 Suge 1 HRmax bpm 180 User A 0 00 Lost steps 0 VD 0 User B 0 00 UN g day 00 User C 0
171. esults Thermal equilibrium should be evident tracings should not drift on the display or recording The panting frequency is approximately 1 Hz if the filter is not applied Frequency should be held constant for within testing session comparisons ie pre and post bronchodilator testing and serial testing Raw and sGaw maneuvers may be considered acceptable if the open shutter panting maneuver shows a relatively closed loop particularly in the range of 40 5 to 0 5 L s Editing a test One or more maneuvers can be edited At the end of the test or when the test is shown you may edit the data by right clicking on the active window and selecting Edit or by double clicking on the graph 164 Performing tests with Body Box Viewing and editing test results Select the maneuver to be edited sRaw Tqv PMauthremH2C E ducc tute e uU IN ee CR M ae 0 08 0 06 0 04 0 02 0 02 0 04 0 06 0 08 PBax cmH20 0 20 0 45 0 40 0 05 0 05 040 0 15 0 20 20 ON RR Em 4 SS ENS IPRC PAN pues ce E pucr LOI rar ras tare M Md ictu ETT nem m AG
172. ettings CPET settings The Alternate colour printer detect checkbox has 3 options deselected selected grey and selected black This allows you to choose if the printout is in black and white or in colour e Checking Fast graphs will speed up the graphs visualization which can be useful for very slow PCs We suggest that you keep this box deselected unless the feature is absolutely necessary GPS coords 12 13 52 will allow you switch between units to hh mm ss units Selecting REE Black predicteds will allow the Black predicteds to be used for calculations When implementing the ECG some ergometers carry out a delay period so that no ECG data is lost When Ignore ergometer delay EKG compatibility is selected the ergometer timeout will be disabled However this operation could prevent the ergometer from being automatically controlled By selecting Disable Tango Sbp Dbp measuring device the Tango unit will not allow blood pressure measurements Press OK to confirm Cancel to cancel changes or Restore to restore to the default visualization E Communication port R5 232 serial port Select serial port CaP PFT Ergo COM1 Cancel X 12 selecting Options Communication port you may set the port to be used by the ergometer and device connections Realtime In the Real time Setup you may specify exercise testing options Settings x Test Execution
173. exercise testing may not be necessary depending on the clinical objectives of the test and is often reserved for clinical assessments athletic evaluation and or research A sub maximal exercise test is less expensive and is physically less stressful on the individual Although sub maximal testing is less sensitive when detecting disease or estimating maximal oxygen consumption a correctly performed test can be a reliable indicator of the subject s cardiorespiratory fitness Pre test screening Pre test health screenings are essential for risk stratification and for determining the type of test that should be performed Screenings should include and detect the following conditions 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 Orthopedic conditions that could prevent an adequate effort or compromise the validity of test results e Other unusual signs or symptoms that may preclude testing e Risk factors for coronary disease e History of major cardiorespiratory events e Current medications e Activity patterns e Nutritional habits e Reading and signing an informed consent 252 Sub maximal Exercise Testing Introduction Sub maximal exercise testing Heart rate should vary linearly with VO
174. f the SVC shows numeric data If you wish to view more than one window at a time select New Window from the Window menu To display a list of tests of the current patient select Test current patient from the View menu or press the icon amp l 148 Respiratory mechanics MIP MEP test P0 1 Respiratory drive The 0 1 or Respiratory Drive test evaluates the reduction of pressure which is caused by the patient s inhalation The subject must breathe into a mouthpiece which contains a shutter and a pressure detector The shutter becomes occluded for 100 msec at the beginning of the patient s inhalation while the patient continues to breathe normally Discontinuing the airflow to the patient allows the reduction of pressure to be measured Parameters measured during PO 1 testing include the following Symbol UM Parameter PO 1 cmH O Respiratory Drive FiCO Inspiratory CO RF 1 min Respiratory Frequency Vt Tidal Volume Performing the test NT Select Test Start Respiratory Drive or press the icon and select 2 Connect the patient to the breathing valve and instruct him her to breathe normally 2 3 Press F2 or the icon during the expiration inspiration The test data and graph will be displayed and updated breath by breath o 4 To abort the test press Alt F3 or To restart the test press B o 5 Press F3 or the icon to end the test The software will display the graphs measured parameters and pre
175. f the manual Keynotes The following are keynotes used to allow the manual to be easily read E Typographic keynotes Typographic keynotes used in the manual are as follows Style Description Bold Indicates a control or key to be pressed Italic Indicates a message displayed by the software Graphic keynotes Graphic keynotes used in the manual are as follows Illustration Description gt Activates the related feature STHET Availbility of functions Not all the functions described in this user manual are available to every user it depends on which device and options are purchased The icons listed below are for specific COSMED products and their configurations Device s microQuark Pony FX Pony FX Flowsafe Pony FX MIP MEP Spiropalm Spiropalm Plus Spiropalm 6MWT Quark Spiro Quark PFT Quark RMR KA b Q Box ar 02 X Quark i2m All the devices if 30 Quark PFT Quark CPET Quark RMR If a section refers only to a limited number of devices all of its sub sections refer the above mentioned devices unless differently specified Getting started Keynotes 17 Installation _ Minimum Computer PC Requirements Pentium 1350 MHz e Windows XP Vista 32 bit Windows 7 32 bit Windows 8 32 bit Note With Windows 8 it is necessary to activate the 16 bit support in the Windows Control Panel Su
176. g The dosimeter Include instructions for the use of the dosimeter for bronchoprovocation tests Lung volumes Describes the lung volume testing procedure FRC and CV viewing results and editing data Diffusing capacity DLCO Explains the diffusion capacity testing procedure DLCO for the three available methods with apnoea without apnoea and intra breath Describes the options of viewing results and editing data Respiratory mechanics Includes instructions for executing respiratory mechanics testing MIP MEP and 1 and viewing results Performing tests with Body Box Explains how to perform Raw TGV tests with the Body Box Forced oscillations Includes instructions for executing airway measurement tests and data viewing Oximetry Explains how to properly conduct oximetry testing and the view results Airway resistance measurement Outlines the procedure for executing airway resistance testing Rocc and viewing results Exercise testing Explains how to conduct exercise testing view results and edit data Resting Metabolic Rate Describes the Resting Metabolic Rate testing RMR procedure Describes viewing and editing test results Sub maximal testing Introduces concepts for sub maximal exercise testing while integrating the exercise testing chapter The mixing chamber Describes the mixing chamber and the preparation for exercise and resting tests with the classic mixing chamber technique 16 Getting started Overview o
177. g parameters you may sort the parameters as you wish them to be displayed Select and drag the parameters into the desired position with the mouse Connecting parameters x Connections By selecting Options Connecting parameter you may create connections between parameters A connection represents a linear formula which allows the calculation of a new parameter based on a previous parameter User interface and settings CPET settings 77 Edit Connection X Destination parameter Source parameter Multiplier Offset 0 Add will add a connection and Edit will allow you to edit a connection Select the destination parameter and the source parameter and specify the multiplier and the offset The connection will consist of the following formula Destination parameter Source parameter lt Multiplier gt Offset To delete a connection select the desired connection and press Delete Colours x Element Data window background Header data window Text data window Hark data window Graph window background Axis graph window Grid graph window curve graph window Y2 curve graph window Example JABCDEFGHO12 Change Cancel lise Restore By selecting Options Colours you specify the colours for all of the listed elements To modify a colour select the item and press Change Then select the desired colour and press Save Press
178. g repeated FVC manoeuvres following the inhalation of pharmacologic agents according to an established protocol A subsequent decrease in FEV1 can be used to determine the presence and severity of bronchial hyperresponsiveness The PD20 is the drug dosage mg ml that leads to a 20 reduction of the FEV1 with respect to the baseline value Parameters measured in bronchoprovocation testing include the following Symbol UM Parameter FallFEV1 Fall in FEV1 from baseline or post diluent Provocative dose causing FEV1 to fall 10 from baseline Provocative dose causing FEV1 to fall 15 from baseline Provocative dose causing FEV1 to fall 20 from baseline The plot displayed during the procedure is the Dose response curve which demonstrates the variation of FEV1 vs the drug dosage The software associates all FVC efforts conducted throughout the procedure to the FVC pre baseline FVC obtained during that date s visit The name quantity and unit of measurement of the drug being utilized can be entered in manually prior to the performing each FVC manoeuvre Performing the test Before beginning the procedure be sure to have defined the bronchoprovocation protocol that you are going to use Options Bronchoprovocation see the related chapter 1 Select Test Start Forced Vital Capacity post or press the icon and select Forced Vital Capacity post Spirometry Bronchodilator and Bronchial Provocation Testing 117 Choose a
179. h test only the best manoeuvres a test could include more than one manoeuvre normally three Perform tests with breathing valve allows the user to perform spirometry tests with the flowmeter attached to the breathing valve User interface and settings PFT Suite settings 65 GDT x Single breath CO diffusing capacity Respiratory drive Preferences Spirometry Multi breath N2 w ash out Forced Oscillations Body Box GDT Importing Settings Directory C PFTSUITE File name COSMXXXxX GDT Delete file Exporting Settings Directory C PFTSUITE File name XXXXCOSM GDT GDT Enabled Cancel GDT is a standardized protocol used by the software for the exchange of data between health facilities To enable the GDT protocol 1 Select the GDT enabled box in the lower part of the dialog box 2 Assure that the server s software has been properly installed and configured to exchange GDT messages with Cosmed s software 3 Have both software programs PFT Suite and the server running Importing and exporting directories must be specified within the relative fields For further information refer to the document Cosmed GDT Interface which can be requested from Cosmed Multi breath N Wash out x Forced Oscillations Body Single breath diffusing capacity Respiratory drive Preferences 5 pirometry Hulti hreath 2 W ash out Test data Select
180. he File menu or press the icon 2 Select the patient corresponding to the test you wish to view 3 Select the test to view from the list box and press OK To switch between graph and or data use the following buttons on the toolbar Em saj shows the Closing Volume graph shows the Volume Time graph shows numeric data If you would like to view more than one window at a time select New Window from the Window menu To display the list of tests of the current patient select Test current patient from the View menu or press the icon 5 132 Lung volumes Closing Volume test CV Lung diffusing capacity DLCO L General warnings DLCO testing must be performed using the ID 28 turbine or the PNT X9 with the sampling line connected The Quark must be properly connected to the PC with the appropriate communication port selected The DLCO cylinder must be open and the output pressure should be within 5 and 6 bars The name shown on the status bar should correspond to the patient carrying out the test A visit card for the date of testing must be created The mouthpiece should be connected to the flowmeter and the antibacterial filter appropriately For hygienic reasons the use of an antibacterial filter is strongly recommended In case of using the PNT X9 the use of an antibacterial filter is mandatory Note When performing several triels it is recommended that you wait
181. he test you would like to view 3 Select the test to be shown from the test list box and press OK To switch between graph and or data visualization use the following buttons on the toolbar lev shows the Volume Time graph F6 E shows numeric data F7 If you choose to visualize more than one window at a time select New Window from the Window menu To display the list of tests of the current patient select Test current patient from the View menu or press the icon amp l E Predicted values interpretation Predicted values for Raw and sRaw are the maximum predicted for the patient It means that a lower value is positive and the lower this value the more positive the result Predicted values for Gaw and sGaw are the minimum predicted for the patient It means that an higher value is positive and the higher this value the more positive the result Check the test quality TGV maneuvers are acceptable when the displayed or recorded tracing indicates proper panting technique the loop generated against a closed shutter should be closed or nearly so The patient should support his her cheeks with the hands to prevent pressure changes induced by the mouth This should be done without supporting the elbows or elevating the shoulders Recorded pressure changes should be within the calibrated pressure range of each transducer The entire tracing should be visible Pressure changes that are too large or too small may yield erroneous r
182. i amp l xi DI PIETRO A test n 1 t Rf VT VE voz vcoz VE VOZ VE VCO2 vos R Feoz Fecoe hh mm ss b min 1 l min ml min ml min ml min Eg bpm 00 00 30 12 2 0 4293 6 0 201 176 30 1 34 3 2 21 16 92 3 63 0 00 01 00 abs S E 0 560 Tod 258 222 28 1 Bo 0 56 16 64 3 82 00 01 30 11 4 0 512 5 8 202 172 28 9 33 9 2 93 0 85 16 77 3 68 0 00 02 00 ab 0 553 6 7 259 213 25 9 Bo Pe 0 82 16 33 a BS 00 02 30 11 8 0 552 6 5 248 203 26 4 32 2 3 59 0 82 16 42 3 87 0 00 03 00 155 0 652 5 6 341 294 25 9 30 1 4 94 0 26 16 29 4 14 00 03 30 12 0 0 595 7 1 24 229 31 1 3 58 0 92 16 71 4 00 00 04 00 12 8 0 574 Goal 258 230 26 5 31 9 Bota 0 69 156 67 3 90 00 04 30 12 7 0 560 7 1 251 221 28 3 32 2 3 63 0 55 16 66 3 87 0 00 05 00 qe 0 58 263 229 27 6 uem 3 851 D 97 15 56 a Be 00 05 30 11 4 0 592 6 3 238 202 26 6 21 2 3 45 0 84 16 42 2 55 0 00 06 00 13 0 571 38 293 247 ar Be a di Hoe 0 a4 16 50 3 89 00 06 30 12 6 0 500 6 3 238 196 26 5 32 2 3 45 0 82 16 43 3 86 0 00 07 00 18 3 0 4334 276 230 265 6 5 4 00 0 83 15 78 3 61 00 07 30 15 4 0 594 2 1 306 289 29 6 31 6 4 44 0 94 16 382 3 94 0 00 08 00 12 1 0 470 Bay 195 179 SEE 31 8 2 ote 0 92 16 76 a Eg 00 08 30 12 8 0 389 5 0 18 155 32 2 2 71 0 83 16 46 3 87 0 00 09 00 12 6 0 518 6 5 245 210 26 6 al l 3 56 BE Seal 43 01 00 09 30 12 6 0 493 6 2 218 18 26 5 33 2 3 16 0 65 16 7
183. ias flow sensitivity The presence of a bias flow affects the measurement of the exhaled volumes of air O and CO calculated by the Quark RMR An automatic correction is performed by the software according to the value set by the user The calculated exhaled patient s volume is corrected as follows Corrected Vt Vt BIASFLOW Te Where Te is the duration of the expiration Similarly other measured parameters such as exhaled oxygen volume O exp and exhaled Carbon Dioxide Volume CO exp are also corrected according to the value of bias flow specified by the user The correct specification of the bias flow guarantees the accuracy of the measurements e bias flow is significantly smaller than what specified Vt and all values are underestimated e bias flow is significantly higher than what specified it is possible that no breaths are detected Software configuration Breath values measured during ICU tests exceed the normal physiological ranges for spontaneous breathing In order to avoid that the SW eliminates all the breaths it s mandatory that the real time filter for invalid breaths be disabled Select Options Realtime Settings and disable Discard invalid steps and Automatic calibration 228 Resting Metabolic Rate Test Performing a test with mechanically ventilated patients Real Time Setup Test Execution Display all steps Smoothing 5 C Mixing Chamber E mm ss Discard inval
184. ibration will occur automatically prior to each test Note The air calibration is limited in comparison with the Ergo calibration and should not be used in place of the Ergo calibration You may also select up to 9 parameters to set visual thresholds for The right side of the real time window will display coloured bars which become yellow and or red when the values get too high You may also specify if the parameter s 96 of predicted or absolute value will be displayed The ECG section allows the user to determine if they want an ECG stored when the load changes as well as which device they want the HR to be determined from Arrhythmia PFT CPET K4 Arrhythmia Enable Arrhythmia analysis rate thres bpm 130 run count thres beats Asystole delay 5 Yentricular Run Pause avg 140 Ventricular Hhythm Couples Ventricular Bigeminy Pacemaker Ventricular Trigeminy Pacemaker rate bpm 72 Multifocal R on T Dominant rhythm cha ox Pacemaker spike T OK Cancel By selecting Options Real time Arrhythmia you may set arrhythmia analysis options to be applied during a test may only be used when a Cosmed ECG is installed Enable Arrhythmia analysis will enable or disable the arrhythmia analysis during testing The list Show events allows you to select the events that will be displayed The remaining parameters
185. ich can be set in the Trigger flow dialogue box If the Cosmed antibacterial filter is being used This be indicated by checking COSMED Filter The parameters used for the Back extrapolation algorithm in msec tO t1 and t2 Press OK to confirm selections or Cancel to exit the test 3 Wait until the calibration is completed Airways resistance measurement The Airways Resistance measurement test 181 4 Askthe patient to being breathing into the Rocc module 5 If manual occlusion is selected press F2 each time you wish to activate an occlusion 6 After each occlusion you are asked if you would like to accept or discard the results PFT Suite 9 0 b1 Test TEST Real Time Test ROCC 8 x 2 Test View Window Help ROCC Pressure kPa 1 0 o E aab ml d c RN d coc n o o E nini inc n r x kPa l s 0 259 04 POI Pressure kPa 0 153 20 40 B a 100 120 time Flow Flow lf 2 0 For Help press F1 13 05 2007 James BOND NUM 7 Press or the icon to end the test The software will then display the graphs measured parameters and o predicted values To abort the test press Alt F3 or 9 To restart the test press E 182 Airways resistance measurement The Airways R
186. id steps Details Memorize filtered test Automatic calibration Highlight parameters Parameter n 1 Parameter V 27Kg f Yellow value 75 0 Red value 100 0 on predicted Parameter Parameter 7 Parameter Parameter n 9 Store ECG when load changes HH reading from Quark T12X C12X B Calibrations Before the test an ICU calibration is necessary see Calibration chapter and a Turbine calibration is recommended see Recommendations in this chapter E Preliminary operations 1 Turn off the humidification system at least 5 minutes before starting the masurements Connect the ICU connector A1 or the filter A2 between the patient and the respiratory circuit as shown in the following picture 3 Connect the turbine flowmeter E at the ventilator output with the proper adapter F G adapters are available for the most common ventilators according to their types 4 Connect the ICU connector A1 or the HME filter A2 to the sampling inlet of the Quark RMR through the sampling line extension B the Permapure C and the antisaliva filter D Be careful to connect the items as described avoiding any air leakage Warning Do not interchange the Permapure B and the sampling line extension C QUARK RMR Antisaliva filter Turbine ID 18mm ICU adapter ICU wrinkled tube A1 ICU connector A2 HME filter B Sampling l
187. ields by entering measurements coming from additional devices that you wish to be displayed The customizable free fields include 3fieldsin the patient card patient information fields in the visit card visit information e fields the test card test information Preferences quu The Preferences tab allows you to select and or customize the applied unit of measurement cm kg or inches lbs 64 User interface and settings PFT Suite settings Spirometry Sp SPIRO PFT RMR K4 x Forced Oscillations Body GOT Single breath CO diffusing capacity Respiratory drive Preferences 5 pirrometre w ash nut Automatic Interpretation LLH Calculation 802 Predicted M Enable Automatic Interpretation M Enable Quality Control 5 Temperature at flowmeter 34 0 Humidity at flowmeter 100 0 BTPS enabled Print active window FYC ATS format pages Reduce scale on small curves Print Display only best manouevres Perform tests with breathing valve tae Automatic Interpretation The device has the option of performing a test interpretation for each patient and displaying an automatic diagnosis The algorithm has been calculated based on Lung Function Testing selection of reference values and interpretative strategies A R R D 144 1991 1202 1218 The automatic diagnosis will be calculated
188. in this tab apply only to arrhythmia detection settings B ICU Options x Bias Flow fml sect By selecting Options Real time ICU Options you can manually set the bias flow be used during a test 80 User interface and settings CPET settings E Test protocols PFT 7 CPET K4 Ergometric Tests Protocols E X HI Ergometer Cosmed Bike link to link to Phaze Command one no one one one no one Protocol Message Time sec Delete Messages RMR one one one no one one Generate Edit Delete Drive ergometer Relative Increments Initial command one Final command no one selecting Options Real time Test protocols or the icon E you may create edit or delete ergometric protocols The CPET software has several common cycloergometer and treadmill exercise protocols stored as well as the option to drive several different ergometers Customized protocols may also be entered which will automatically change the loads of a driven ergometer during testing The protocol definition does not depend on the selected ergometer Creating a new protocol 1 Press New and enter a name for the protocol 2 In the field Message Time you may choose to type a number in which a message will appear prompting you to switch to the next load Checking the Messages checkbox enables me
189. indow Archive management and printouts Patient s database 105 Export test Archive tests list ID Date Duration List Current patient 000025 20 02 1997 00 14 15 000026 13 03 1997 00 15 00 BOND J 000001 11 04 1997 00 10 43 TREADMILT All tests 000024 14 04 1997 00 05 16 CARDIAC OUTPUT C 000019 16 04 1997 00 07 14 LOOPS 000007 26 01 2000 00 15 05 NORMAL 5 000011 26 01 2000 00 15 05 NORMAL 5 0000422 26 01 2000 00 15 05 NORMAL 5 000002 09 04 2000 02 52 00 LEGER 000023 31 05 2001 00 35 34 FUSSELL M Em 000012 13 09 2001 00 15 11 GALLONETTO L Eme 000014 05 02 2002 00 23 45 CASTELLANO 000020 05 02 2002 00 23 34 GIAMBI 5 Notes 000015 28 03 2002 00 21 22 000021 13 06 2002 00 16 48 NORMAL 5 Hi 000009 09 09 2002 01 12 27 GPS 000018 03 10 2002 00 15 38 YAN DEN MEIJDENBER 2 000017 74 10 2002 00 14 37 FIORONI L 17012 ml min 3033 3991 azz8 1897 465 1328 1707 76 938 19 tthh mm ss 00 00 01 45 03 30 05 15 07 00 08 45 10 30 12 15 14 00 15 45 Hide will hide the preview You should then select the folder and the format for the test to be exported in Press OK to confirm Importing a test You can also import a test that has been previously exported in xpo format Note Test can be exported imported in xpo format only between the same software version S
190. indow i e Print active window option Toolbar Many of the functions available in the program s menu may be activated more rapidly by clicking the corresponding icon in the tool bar If you position the mouse cursor on one of the buttons on the toolbar the description of the corresponding function will appear when the option Hints is enabled Show hide toolbar In the PFT software select Toolbar from the View menu to show or hide the toolbar In the CPET software select Toolbar from the Options menu to show or hide the toolbar Show hide hints In the PFT software select ToolTips from the View menu to show or hide the hints In the CPET software select Hints from the Options menu to show or hide the hints Toolbar icons of the PFT software Opens the patients database Opens a test of the current patient Prints the report Prints the current window Preview print Shows the F V graph E m e Shows the FRC graph Shows the CV graph H Shows the DLCO graph kr Shows the membrane diffusion graph Por MRE Shows the MIP MEP graph 01 Shows the PO 1 graph Shows the Oximetry graph ROCC Shows the Rocc graph J Shows the Volume Time graph 58 User interface and settings User interface lt 3 a jd m 4 2 a r E EJ E a E Shows the Volume Time graph DLCO test Shows the imp
191. ine extension C Permapure Resting Metabolic Rate Test Performing a test with mechanically ventilated patients 229 The ventilator is not included in the packaging Warning Carefully re check ventilator functionality after connection of the parts Warning The ICU connector A and the sampling line extension B are disposable E Performing the test Starting the test 1 Start the test as you would an exercise test but assure that RMR with Ventilator is selected in the Mode section x Hode Height 0 0 C Bas Weight Kg 0 0 C Gas BxB ECG C Mixing chamber C Mixing chamber ECG with Mask C RMR with Canopy with Ventilator C Stress ECG C Resting ECG Simulated test Cancel Ergometer no one Protocol Other data Workspace Details To choose specific protocol to be carried out during the test select one listed under Protocol The Workspace list allows you to choose a default workspace or one defined by the user 2 Confirm and start the procedure by pressing OK Bias flow detection Once selected the ICU test option the Bias flow detection screen is prompted The graph shows the flow at the ventilator output Bias Flow Calibration x Bias Flow ml sec E 120 m Vt no 5 650 mi Rf 100 l min Fi02 25 03 x Save and Exit Checking In this window there are reported also the tida
192. information you must print the active window after creating the fittings Fitting a graph with a linear regression 1 Select the fitting type Linear 2 Select the first point X1 by placing the mouse on the desired location on the graph and press the Left key or use the and keys near the X1 field 3 Select the last point X2 by placing the mouse on the desired location on the graph and press the Right key or use the and keys near the X2 field 4 Select the Add checkbox if the fitting must be added to others already placed on the graph Otherwise the existing fittings will be deleted 5 Press OK to confirm The fitting is graphed and its equation is shown near the upper limit of the X interval Fitting a graph with a monoexponential regression 1 Select the fitting type Monoexponential 2 Select the first point X1 by placing the mouse on the desired location on the graph and press the Left key or use the and keys near the X1 field 3 Select the last point X2 by placing the mouse on the desired location in the graph and press the Right key or use the and keys near the X2 field Fittings 0 Insert initial factors for the formula B A 1 expi E Tau Constraint B 36818 Constraint Tau Constraint Max attempts o Cancel 2 4 Enter if necessary the initial values for A B and TAU parameters these are the values from which the iterative a
193. ing Metabolic Rate Test Data management L Data editing The software allows you to edit the data acquired during the test by performing any of the following functions e deleting one or more steps e editing data e entering new parameters e data filtering average or smoothing e advanced data elaboration Note When viewing Data double click the window to enable Data Editing After editing data you may restore the original data file by pressing the Restore button To save the changes select Overwrite This function replaces the original test and the original data may no longer be restored cr0r x Phase 1 C 1 Rest C 2 Warm up 00 00 06 1 1 C 3 Exercise C 4 Recovery Marker 10 DK Cancel Preview Filtering Delete step Advanced Restore Overwrite _ 00 00 08 00 00 12 00 00 15 00 00 18 00 00 20 00 00 24 00 00 26 00 00 29 00 00 32 00 00 34 00 00 41 PEE EET 2 Test n 1 Step n 1 7226 Duration 00 10 21 cw To open the Edit test window select Test Edit test or press the icon or double click on the data window Editing a step value 1 Place the cursor on the step to be edited and enter the new value 2 Press OK to confirm The software will recalculate all parameters with the edited information Both the t
194. ion 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 tight seal around the subject s face The mixing chamber The mixing chamber 259 Complete the patient preparation as indicated in the chapter Exercise testing E Performing the test 1 Calibrate the analyzers as described in the Calibration chapter 2 Select Test Execute Test or press the icon or press F2 3 Select Mixing chamber in the Execute test window and perform the exercise resting test as illustrated in the chapter Exercise testing 260 The mixing chamber The mixing chamber Wwww cosmed com COSMED srl Headquarters Via dei Piani di Monte Savello 37 Albano Laziale Rome 00041 ITALY Phone 39 06 931 5492 Fax 39 06 931 4580 COSMED info cosmed com Pulmonary Function Equipment
195. ion Reviewing Cal Results Checking the system signals E The control panel The control panel allows you to check the main hardware functions of the device Control panels are different depending on the device Quark series Control panel SPIRO PFT CPET RMR Q Box To open the control panel enter in the Body Box calibration program Select the appropriate communication port in the top toolbar 5 Calibration File Tests and Calibrations System Options Help 44 ee Select Tests and calibrations Control panel 5 Calibration Senza titolo 181 x Ele Help 18 xi y Flowmeter Sampling pmp ot valves Dosimeter i Calibration Bypass Room Air Purge Digital Trimmers Cylinders 9 rom CH4 Body Box Pressurize leak test Sinusoidal Pump Breathing Valve Open Occlusion POL Shut Test Connector Board Body Box Pressure cmH2O Sensors O2 Range COJCH4 0 30 Ergo 256 256 200 o2 I Box Valve Double click a channel to edit parameters 0 1000 On Channel Min Max Graph 0 0980 Analyzers Pressure mmHg 743 743 743 0 0960 CH4 Analyzer 0 45 0013 0016 0 0940 CO Analyzer 0 038 0 038 0 39 i mol Barometric Pressure mmHg 750 749 750 Ambient Temperature ec 25 7 25 7 25 7 0 0900 Box Pressure cmH20 0 0512 0 0512 0 0530 0 088
196. ion The expired breath should not contain any hesitations or interruptions and the total exhalation time should not exceed 4 seconds It should be noted in the post test notes if the patient requires a longer expiratory time to provide an adequate alveolar gas sample The following is an example of a correctly performed test 0 390 ps CH4 CO Time i i i Wash out Vol Sample ESP IVC j o T TLC 1 JONES ERV FRC OGILVIE RV Y Y 0 1 2 3 4 5 6 Time Volume Time Correct manoeuvre Stepwise inhalation or exhalation Maximum exhalation not completed exhaled volume larger than inhaled volume 136 Lung diffusing capacity DLCO CO Diffusing Capacity DLCO Test Exhaled gas leak Inhalation too slow Transient overshoot from high flows changing gas temperatures Tips for obtaining acceptable DLCO testing efforts 1 Askthe patient to perform the simulated test see below as many times as necessary until he she is comfortable with the procedure prior to performing the test Open the cylinder and the pressure regulator completely Assure that the patient s inspiration IVC DLCO is at least 9096 of the maximum SVC Maintain the apnoea time between 9 and 11 seconds E A Obtain a sampling volume near 1000 ml Patients with severe o
197. ions can be selected from the lower part of the window Check box Meaning ATS Displays the report in ATS format One page no ATS Prints both the graphs and data on one page Preview Displays a print preview Press OK to confirm Printing a series of report It may be useful to printout a series of reports at times i e all tests carried out by a specific company s employees all tests carried out on a specific date etc 1 Select Visit List from the File menu 2 Setthe criteria of the visits to be added in the list from to 3 Select Print Report from the File menu 100 Archive management and printouts Data printouts W Electronic reports pdf If an Adobe PDF writer is installed you may store the printout report automatically in any location of the HD or LAN path according to a customizable filename format You may define the created filename format by selecting File Page Set up see Page set up Archive management and printouts Data printouts 101 Archive management and printouts Patient s database The patient database allows you to e Enter a new patient e Find patient data e Edit patient data e Delete patient data Select Patients from the File menu or press the icon m Search for Ix Find Last name Mew code Progressive List Cancel Hext Patient Pragr ID code Previous Last name First
198. istered If a subsequent response test yelds normal values Post values are equal to the Pre ones the test can be terminated Otherwise if the values are still limited one more additional dilatation steps must be performed We recommend to periodically check the nebulizer supply quantities according to page 316 Nebulizers for the five breath dosimeter method of the ATS Recommendation Guidelines for Methacholine and Exercise Challenge Testing 1999 Am J Respir Crit Care Med Vol 161 pp 309 329 2000 The test must be performed with the flowmeter attached to the nebulizer see diagram later in manual without the breathing valve connected The sampling line should be disconnected from the flowmeter The Quark must be properly connected to the PC with the appropriate communication port selected 10 The name shown on the status bar must correspond to the patient performing the test 11 A visit card must exist for the current testing date 12 If you are using the pneumotachograph Flowsafe or X9 do not breathe into the flowmeter until the proper message appears Note Cellular phones should be turned off prior to testing to eliminate potential interferences Preparation for tests Disconnect the sampling line from the flowmeter if present If necessary calibrate the flowmeter ID28 turbine Flowsafe or PNT X9 as shown in the chapter Calibration ATS Guidelines for Calibration Connect the dosimeter hos
199. isualize the graphs or the main parameters press the following buttons shows the FRC graph shows the Volume Time graph y shows numeric data mu shows breath by breath data The following functions may be accessed by right clicking on the active window e Associate a SVC to the test Edit then Select SVC e Build a graph using measured parameters Graph builder Up to 2 parameters be displayed on the Y axis 128 Lung volumes FRC test N2 washout Press Configure to customize the graph Customize Graphs 1 Axis WO time mm ss as Autoscale Cancel 00 03 Help Max 03 23 Step 00 10 2 1 Axis FetN2 3 M Grid Autoscale Hin 7 68 53 Points only Mark points Autoscale Squared Ignore zero Grid will allow you to draw the grid Autoscale will scale the graph according to the variable range If this option is deselected you may set the range of the axes and the grid step Points only will draw the graph without a line connecting the points Mark points will draw points with a symbol Squared will create a square graph instead of adapting it to the window Ignore zero will ignore all points with a value of zero Viewing results To view the results of a FRC test 1 Select Patients from the File menu or press the icon 2 Select the patient
200. ithout a real patient anesthesiology bag connected in this case only Flow is used to detect the end of exhalation The maximal duration of the expiratory phase is 10 sec even if no inspiration is detected CO threshold can be changed accessing the file CalibPFT ini and setting the INEX Threshold SW2 parameter e g 15 means 0 1596CO The following pictures explain how the detection works Expiration based CO Flow 96 C02 e Validation Condition Inspiratory Detection BF 80 l X CO2 gt CO2ExTh CO2 gt CO2ExTh 0 15 02 HAL2 BF 30 Kits time 500ms 500ms Expiration based on Flow level Resting Metabolic Rate Test Performing a test with mechanically ventilated patients 227 Flow 96 02 e Validation Condition e Inspiratory Detection ExpTime 500ms 1 ExpTime gt 500ms e 80 BF 50 l 30 time 500ms 500ms Bias Flow Most of the ventilators use a bias flow based detection system when operating according to spontaneous breathing modes A continuous flow bias flow circulates within the breathing circuit of the ventilator its decrease from the base value is used to rapidly detect the beginning of the spontaneous inhalation of the patient and to trigger the activation of the vent Usually the ventilator allows the user to change two parameters bias flow value or b
201. l 600 Acceptable Range 500 750 Cancel Factory Settings Help When the calibration is complete the software will display the new calibration factors Values within the acceptability range will appear black and those outside of this range will be red If one or more values are not acceptable the calibration must be repeated If you continue to receive unacceptable calibration factors you should contact Cosmed s technical assistance B Air calibration PFT CPET RMR The air calibration adjusts the baseline of the sensor and the gain of the sensor to ensure the accuracy of measurements Unlike previous calibrations the sampling line does not need to be connected to the front panel of the Quark Select Calibration Gas Air and follow the prompts Press OK and wait until the procedure automatically ends 40 Calilbration Analyzers calibration Analyzers Calibration E B X not breath near the calibration valve 10 15 20 Sampling reference gas Oxygen analyzer 12 Response Adjustment Actual Acceptable Hange Gain 800 1200 Zero mv 200 200 Delay 500 1200 fer Hw 0 511 Response Time ms 50 Response Time ms 0 200 Response Factor Enable 0 Adjustment Carbon Dioxide analyzer Actual Acceptable Hange 904 600 1200 Gain mv 3b4 Zen mv 10 600 Cancel Delay ms 730 Delay m
202. l Capacity if desired This manoeuvre is used to allow for the calculation of the patient s lung volumes You may also choose to select a SVC effort previously performed by that patient when the DLCO procedure is complete gt 8 Ask the patient to breathe normally and press F2 or the icon during a maximal exhalation to begin the test Next instruct the patient to inspire the DLCO gas mixture up to a TLC level At the end of inspiration the valve will close and the patient will be forced to hold their breath When the breath hold time is completed instruct the patient to o 6 exhale to Residual Volume To abort the test press Alt F3 or To restart the test press B On the lower graph a dotted horizontal line represents 9096 of the patient s best VC If there is no FVC or SVC manoeuvres stored in the patient s archive then the line indicates 90 of their predicted value 10 The test will end automatically Lung diffusing capacity DLCO CO Diffusing Capacity DLCO Test 137 11 In order to visualize the graph and the main parameters press one of the following buttons E 53 shows the DLCO graph shows the Volume Time graph of the SVC effort shows numeric data 2 shows the Volume Time graph of the DLCO effort SS PFT Suite 9 0 b1 James BOND DLCO 3 08 06 2007 10 40 E a xl a File View Test Options Window al Single breath diffusing capacity Into
203. l volume the respiratory frequency and the FiO measured values only if the sampling line extension is connected to the ICU filter Since the turbine at the ventilator output measures only the patient exhaled air the dotted horizontal line must be placed onto the measured flow during the inspirations usually the minimum In order to properly place the line drag it with the mouse This operation is very important in order to avoid inaccuracies when measuring flows and volumes 230 Resting Metabolic Rate Test Performing a test with mechanically ventilated patients The best way to adjust the bias flow in the right way is to proceed manually starting from a value of 50 ml s and comparing the Vt BTPS read on the Quark RMR with the Vte BTPS read on the ventilator monitor Since the Vte values can vary depending on patient s conditions the comparison between Vt and Vte must take into account a range of admitted variability i e 1096 Press Save and Exit to exit from the bias flow detection and to start the test The bias flow can be also verified during the test by selecting Events Check Bias Flow see below Starting the data storage To start the data storage press F2 or the icon For further details about the test execution see later Performing Resting Metabolic Rate test Checking and adjusting the bias flow during the acquisition During the acquisition it is possible to check and adjust the bias flow
204. lbration Analyzers calibration Analyzers Calibration Results ES Date 21 01 97 Time from start up 0 06 33 Air temperature Internal temperature lalalala Atmospheric pressure mmHg 3 Analyzers pressure mmHg 31 Humidity Oxigen Carbon Dioxide Cylinder 15 05 Cylinder 4 6 02 Base line mV 236 Base line mV 926 G ain 1023 B ain 1605 Delay ms 5 3 Delay 332 OK Cancel Default Help Reference gas calibration The software allows to automatically calibrate zero gain and alignments of the gases sensors Even if the program doesn t force you to carry out the calibration the system should be calibrated before each test To perform a sensor calibration a cylinder with a known concentration of mixed gas is necessary It is suggested to use CO 5 0096 16 concentrations for balance Notice Do not use mixtures with a O concentration above 24 out of the sensor range or under 15 Notice Before calibrating be sure the Reference values of room air and reference gas are properly entered The calibration unit The gas regulator has an adjustable second stage that must be open every time the cylinder is used for the calibration This is necessary to avoid a small leakage in the connections can discharge the bottle in few time 1 Make sure you wait for warm up time before starting calibrating Be sure the high pressure tube s
205. lgorithm begins The more attempts made to obtain the best fit curve the more accurate the curve will be 5 Select the Constraint checkbox next to the parameter if that value must be the exact parameter that is entered 6 Select the Add checkbox if the fitting must be added to others already placed on the graph Otherwise the existing fittings will be deleted 7 Press OK to confirm The fitting is graphed and its equation is displayed near the upper limit of the X interval Calculating the mean value 1 Select the fitting type Mean value 2 Select the first point X1 by placing the mouse on the desired location the graph and press the Left key or use the and keys near the X1 field 210 Exercise testing Data management 3 Select the last point X2 by placing the mouse on the desired location in the graph and press the Right key or use the and keys near the X2 field 4 Select the Add checkbox if the fitting must be added to others already placed on the graph Otherwise the existing fittings will be deleted 5 Press OK to confirm The fitting will be graphed and its equation will be shown near the upper limit of the X interval E Oxygen kinetics This function is available only if the active window is a VO vs Time graph that was recorded during a constant load Exercise Test This function is able to find the dynamic response of the rising and falling edges of the VO with the Oxygen Deficit and Oxygen Debt
206. lly used to ensure a steady state e The maximal heart rate for a given age is uniform HR 220 age Heart rate and VO have a linear relation over a wide range of values Therefore the slope of HR VO regression can be accurately extrapolated to an assumed maximum heart rate e Mechanical efficiency VO at a given work rate is consistent Although sub maximal exercise tests can provide valuable information concerning cardiorespiratory fitness diagnostic capabilities are limited and results should not be used as a replacement for maximal exercise tests or other and or clinical modalities Sub maximal exercise testing considerations Physical or clinical limitations that may preclude certain types of exercise include the subject s age weight level of fitness exercise preference a history of arthritis or other orthopaedic complications These factors should be taken into consideration when selecting the type of protocol and equipment used for each test Some individuals may perform better on a non weight bearing modality cycle vs treadmill while others may not have the required range of motion in the hip or knee to pedal adequately Deconditioned weak or elderly subjects may need to begin the test at a low work level and increase the workload in small increments Field testing would not be appropriate for those requiring strict supervision during testing do not understand the concept of pacing or whom you do not expect to demon
207. mask being used in the VD area 5 Confirm with OK 190 Exercise testing Performing the test Test type Ergometer COSMED Bike Reason for Test Protocol 5 Walt Ramp Exercise capacity Response Reasons for Stopping Test Physician Technician Lana Wand Hr Q Interpretation Medications teen Pressing Details allows you to enter in additional test data Confirm with OK 7 When selecting Simulated test the software uses the gas calibration cylendar in order to perform the test This may be useful when attempting to check the accuracy of gas measurements 8 Confirm all entered data and begin the test by pressing OK 9 The software will display a new menu and tool bar and data will be shown in a table form 10 The initial data displayed by the software will not be saved 11 Verify that the HR signal is properly detected and that the other data are properly displayed 12 To begin saving data press F2 Ending the test without saving data 1 Select Test Abort or press Alt F3 2 Select Yes to abort the test or No to continue Ending the test and saving data 1 Select Test End or press the icon g or press Alt F3 2 Select Yes to end the test or No to continue Realtime visualization During the test you may view windows which display the measured data graphs ECG recordings and or information about the test The selected workspace will determine which wind
208. mat Note Test can be exported imported in xpo format only between the same software version Select Test Export test to export the archived tests Export test Archive tests list X ID Date Duration List 2070271997 00 14 15 B ND J Current patient 000026 13 03 1997 00 15 00 BOND J 000001 11 04 1997 00 10 43 TREADMHIL T All tests 000024 14 04 1997 00 05 16 CARDIAC OUTPUT 000019 15 04 1997 00 07 14 LOOPS 0000017 26 01 2000 00 15 05 NORMALS 000011 26 01 2000 00 15 05 NORMAL S 000027 26 01 2000 00 15 05 NORMALS 000002 09 04 2000 02 52 00 LEGER B 000023 31 05 2001 00 35 39 FUSSELL M 000012 13 09 2001 00 15 11 GALLONETTO L 000014 05 02 2002 00 23 45 CASTELLANO 000021 05 02 2002 00 23 34 GIAMBI S 000015 28 03 2002 00 21 22 000021 13 06 2002 00 16 48 NORMALS 000004 09 09 2002 01 12 27 GPS 000018 03 10 2002 00 16 38 YAN DEN MEIJDENBER 24 10 2002 00 14 37 FIORONI L Cancel Find Hotes Show The window will display all of the archived tests You may sort the list by patient code last name or date by selecting the relative option on the right side of the window Select the test to be exported and press OK Find will find a test based on the search string entered Notes will show the notes of the selected test Show will show a preview of the selected test in the lower part of the w
209. me nebulizer or to different nebulizers For each step the user can specify the nebulizer output Nebulizer output this is a feature of each nebulizer the agent concentration in the solution Concentration how many deliveries must be performed in this step Breaths and the duration of the delivery Actuation The two last rows show the doses and the cumulative doses calculated from the user input Buttons Press Default to load the default protocol according to the ATS methacholine test recommendation Recalculate in order to recalculate doses after entering modifying values OK to confirn Cancel to cancel E Page setup Selecting Page setup from the File menu will allow you to set the page layout options Header x Header Data Margins Footer Printed file name Line 1 Line 2 Via dei Piani di Monte Savello 37 00040 Albano ROME ITALY Line 3 Tel 29 06 9315492 Fax 39 06 9314580 e mail infoicosme Print line below the header Print bitmap tae All printouts are preceded by 3 rows of a customizable header which usually contains the name and the address of the institution using the device You may enable a line to be printed below the header by checking Print line below the header customized logo may also be included in the printout by checking Print bitmap The logo must be a bitmap file in the software installation directory named Header bmp 256 x 256 pixels
210. me or an ID by typing one of the two in the Search for field You may also select the patient directly from the list in the lower part of the window Another option is to enter the first letter of the string you wish to search in the field Type the first letters of the string you re looking for The software will display the list in alphabetical order beginning with the first letter of the entered string Editing a patient card To edit an archived patient press the icon Eil A window similar to the New patient window will be opened in which you may edit the data Adding a visit card James BOND Yisit dated 28 09 2007 x Patient Data Height cm EEE Estimate from arm span Smoke Information Technician 90 Weight MH 23 8 3 Yeas 0 U Text C Yes zer Text Mix E 0 K g m ERC 0 User Text Description Company Profession Notes Diagnosis To enter new visit card press the icon E A window will open in which you may enter the patient s anthropometric data Estimate height X Estimate patient s height from arm span Cancel ames 40 year old Male Race i White C Black Arm span cm fo Estimated height cm By pressing the button Estimate from arm span you may enter the patient s arm span in order to estimate their height You may also indicate the patient s race Press OK to confirm 92 Archive ma
211. meter Value E E C Formula C Correction X 7 All steps C Formula Save settings Load settings Steps smoothing Cancel 2 By pressing Advanced you may perform advanced editing on the numerical values Function Delete steps Deletes the steps which meet the selection criteria Smoothing Applies a moving average on the number of steps indicated in the Steps smoothing field or on a parameter as specified in the Edit parameter section Edit parameter Edits a parameter according to the criteria in the Edit parameter section Edit parameter Specifications Parameter Allows the parameter to be edited Value Replaces the value of the selected parameter with the new value for all steps occurring in the time range 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 the results of a mathematical function entered see Formula editor Time range Specifications From To Specifies the time range for editing 248 Resting Metabolic Rate Test Data editing All steps Applies the editing from the beginning to the end of the test Apply to Specifications Parameter Specifies the reference parameter pem d lt lt gt Specifies the condition for the parameter higher than higher or equal equal to lower than lower or eq
212. mportant that the operator remain at the bedside during measurement to check for the quality of the study 5 Quark RMR cannot be used during nebulization therapy 220 Resting Metabolic Rate Test Recommendations Performing a test A physician s presence is not necessary during RMR testing as long as the clinical staff has been adequately trained and educated on the testing procedure and device Note Cellular phones should be turned off to eliminate potential electrical interferences B Calibrations Before performing the test an ERGO RMR calibration must be performed see Calibration chapter and a Turbine calibration is recommended see Recommendations in this chapter B Preparing the patient Connect the RMR reader to the bacterial filter and to the soft mouthpiece gro You should verify that the subject s health status is acceptable prior to executing the test Ask the subject to sit or lay on a comfortable chair or bed Let the subject apply the nose clips and the mouthpiece accoridng to the following picture VA At c E Performing the test 1 Start the test as you would start an exercise test only assure that the box RMR with mask has been selected in the Mode section Resting Metabolic Rate Test Performing a test 221 Execute Test Hode Height cm 0 0 C Bas BxB Weight Kg 0 0 C Gas ECG C Mixing chamber C Mixing chamber ECG x with Ma
213. n ALTRE NOR LH RADAR AR 186 Evaluation of the cardiorespiratory function e eee e e eee eee eee ee eee enne nnne esses seo nue 186 imme 186 gt 2 186 BCI 186 E PriBarip ee eee ee 186 Rr 186 AEE ES oN f c 186 Ending the 1 MIN M pela Edid aM SM ME 186 O Measured parameters iusus coner s em tibi urb RE cna PUR Er nuE DERE SUME ERE UE RE URUF ERU C NE RUE NE MERE UNES E URN EGER S 187 B Breath Dy Breath exercise testing 187 indirect Calorimetry 18
214. n time E Performing MVV test gt 1 Select Test Start Maximum Voluntary Ventilation or press the icon select Maximum Voluntary Ventilation and wait until the green led appears on the right side of the screen 2 Explain the testing procedure prior to beginning data acquisition breathe as deep and fast as possible for 12 seconds 3 When the patient is ready instruct him her to begin and press the F2 key or the icon to start recording data 4 When the effort is completed press F3 or the icon 9 or wait for the automatic end of the test after 5 seconds passes without detecting flow The software will display the V T graph the main parameters and the predicted values To abort the test press Alt F3 or To restart the test press 5 visualize the F V graph V T graph or the main parameters press one of the following buttons shows the Volume Time graph y shows numeric data 6 Repeat the testing procedure until the desired number of efforts has been obtained correctly 7 Press to visualize the test list and results from the current session x HYY Heas 4Pred Meas 4Pred Meas Test n 154 5 0 0 71 20 0 0 231 00 153 4 0 0 63 10 0 0 2 40 00 1 Tests are sorted from best to worst Save all Discard all Cancel Help 8 Select the test you would like to save sorted from best to worst according to ATS criteria and press OK 116 Spirometry Maximum Voluntary Ventilation Broncho
215. nagement and printouts Patient s database The BMI field is automatically updated with the BMI index which is calculated from the patient s height and weight In the FRC field you may enter the patient s FRC value if known In the Smoke section you should select if the patient is a smoker Yes is not a smoker No or was a smoker Ex If the patient does have a smoking history you should select how many years the patient smoked and approximately how many cigarettes per day Press OK to confirm Note Testing can only be performed after a visit card for that specific date has been created Finding a visit card x Search by ee Search for 01 06 2007 ts To find visit card in archive press the icon EN You may search for a visit card by date or perform a company search by typing the appropriate information in the Search for field You may also select the visit directly from the list in the lower part of the window The other option is to enter the first letter of the string you wish to search for in the field Type the first letters of the string you re looking for The software will display the list in alphabetical order beginning with the first letter of the entered string Editing a visit card To edit an archived visit card press the icon e A window similar to the New visit window will be opened in which you may edit the data Editing a test card x Test Information
216. nalysis enables or disables the arrhythmia analysis during the test In the list Show events you may select the type of event to be displayed The remaining parameters are useful for arrhythmia detection settings Showing the QRS and 12 lead view To switch between the 12 lead view and the QRS view 6 leads QRS mean complexes and an enlarged QRS mean complex select ECG ORS press the icon Viewing the QRS parameters You may set the parameters for QRS calculation for the selected lead QRS Parameters E dit Onset 4 Offset 4 Jams af M Automatic Auto Track Select ECG ST segments When Automatic is selected an automatic QRS calculation will occur If this checkbox is deselected you may drag the Onset and Offset horizontal bars to manually calculate the QRS Exercise testing Performing the test 197 Track allows you to select which lead will show the QRS Resetting the QRS Select ECG Relearn QRS to recalculate the QRS Setting the BPM alarm threshold To set an alarm threshold select ECG BPM BPM Alarm e Alarm threshold HA 100 Acoustic alarm Cancel 2 Drag the horizontal bar to the HRmax percentage that you would like to trigger the alarm Select the checkbox Acoustic alarm if you would like to hear an acoustic signal when the alarm threshold is overcome E Command Center The Command Center is a numeric keyboard on th
217. name Sex Delete W Entering a new patient 1 Press New to show the Patient dialog box Patient data x ID code Progressive 7 Last name First name Birth Date DD HH ZvYrY Ethnic Corr X 100 Cancel 2 2 Enter the data of a new patient and press to confirm E Finding a patient in the archive Enter a search string into the Find field and press Find to view the data of a subject already in the database You can sort the patients by their Last Name ID code or Progressive x Progr ID Code Last First iun 000001 BOND Last Name 000003 BOND ID Code 000001 BOND 000001 LA CASA C Progressive 000002 NOSARZEWSKA 000010 5 Pressing List allows you to view the list of patients in the database Select a patient from the list and press to confirm The Next and Previous buttons will move to the next or to the previous patient in the database 104 Archive management and printouts Patient s database E Editing patient data 1 Select the desired patient 2 Press Modify to view the patient s data 3 Edit the desired values and press OK to confirm Deleting a patient 1 Select the patient you wish to delete 2 Press Delete Exporting data Test data may be exported in the following formats e txt ASCII e xIs Microsoft Excel wk1 Lotus 123 e xpo Cosmed proprietary file for
218. nchoprovocation Vil JP VEND QUEUE Qi P EDO E 73 pad iod xeu o ePi olt 73 APA 74 PEON CNO DII OT mE 74 Bronec HO CHIENNE E RI EL 74 E TE o oom mmc 74 JA AZ pli e 74 P 74 przi 74 MAII RERO TOR 75 c P 75 Pisis MI RIA 75 2 A 76 idc imet mm M M RI 76 AIC CTS COV CW DNE T TT me 76 Fast el 35e osse MN NM UE ND UNE 76 _ istisPite dH ORNA NEN NNNM NH NUN I UR DUUM UIN EU EOM id PNE DUM IM NUMAE 77 Parame 77 E Connecting Da Aamelefs ssesi c nesngixa UNSERE QU 77 _ e M 78 BN
219. ncrease the measured TGV due to compression effects Plethysmography is a complex test Careful calibration of multiple transducers is required Attention to frequency response thermal stability and leaks is necessary Choice and application of reference values affect interpretation Reference values for TGV using plethysmographically determined lung volumes are not widely available Make a tentative selection from whatever published reference values are available The characteristics of the healthy reference population should match the study group with respect to age body size gender and race The equipment techniques and measurement conditions should be similar Following selection of seemingly appropriate reference values compare measurements obtained from a representative sample of healthy individuals 10 20 subjects over an appropriate age range to the predicted values obtained from the selected reference values If an appreciable number of the sample fall outside of the normal range more appropriate reference values should be sought Performing tests with Body Box Limitations of the measurement method 163 Viewing and editing test results Visualization functions will apply to the test carried out by the Current Patient whose name is indicated on the left side of the status bar E Viewing a test To view tests results 1 Select Patients from the File menu or press the icon 2 Select the patient corresponding to t
220. nd left click e Click on OK with the left mouse button to confirm the information input in the dialog box or click Cancel to cancel the changes B Scroll bars Some windows are provided with scroll bars that allow you to see data exceeding the window space available e move the scroll bar by row click the arrows at the end of the scroll bars e move the scroll bar by page click the grey area on either side of the scroll field E On line help The software has a complete on line reference tool available at all times To access on line help press the F1 key E Software version To identify your software version and the serial number of the software select About PFT Suite from the Help menu select About from the menu The formula editor Formula Editor allows you to enter additional formulas in the format required by the software 62 User interface and settings User interface Formula Editor 1 6 4 X Parameters Best Best _8 3 ES _t A MEP idu aj s e rad E deg exp Tem E 4 abs int Formula Cancel Calculator You may select parameters by double clicking the parameter in the list on the left Mathematical functions can be selected by clicking the relative key on the right side of the window Selecting Calculator will open the Windows cal
221. nd press OK Test encouragement It may be useful to implement the test encouragement software tool if you are testing children or having difficulty achieving patient cooperation To utilize the encouragement function follow the steps listed above for the FVC test but select View Encouragement prior to performing step 2 Incentivazione The predicted value is represented by the dotted bubble and the actual manoeuvre is represented by the cyan bubble 114 Spirometry Forced Vital Capacity pre L Slow Vital Capacity The Slow Vital Capacity measurement is an important tool in the assessment of COPD Chronic Obstructive Pulmonary Disease Parameters measured during SVC tests include the following Symbol UM Parameter Vt ti l sec Vt ti ratio Perform a SVCtest 1 Select Test Start Slow Vital Capacity or press the icon select Slow Vital Capacity and wait until the green led appears on the right side of the screen 2 Explain the procedure to the patient prior to beginning the test breathe normally then perform a maximal inspiration followed by a slow maximal exhalation 3 Pressthe F2 key or the icon to begin the test and follow the instructional prompts on the monitor 4 When the effort has been completed press or the icon E or wait for the automatic end of the test after 5 seconds passes with no flow detected The software will then display the V T graph the main parameters
222. network please follow these steps if you are interested to install only a software skip the steps related to the other one a Archive installation 1 Install PFTsuite on PC A select standard folder C PFTSUITE Installation Software installation 21 Install ERGO SW on PC A select standard folder C PFTSUITE Launch PFT SW it is necessary to initialize the archives Launch ERGO SW it is necessary to initialize the archives Close PFT SW Close ERGO SW Share the Folder where the SW are installed to everyone with Read Write Permission Level gt S Se a dee gt b i Workstation installation 1 Map the Archive shared folder located on PC A as a Network Drive e g Z see later 2 Install PFTsuite on PC i select standard folder C PFTSUITE 3 Install ERGO SW on PC i select standard folder C PFTSUITE 4 Launch PFT SW it is necessary to create PFT ini file 5 Launch ERGO SW it is necessary to create PFTERGO ini file 6 Close PFT SW 7 Close ERGO SW 8 Modify PFT ini file adding the following lines under Settings section Settings Lan 1 Archive path Z 9 Search for EnableSearchLock in PFT ini file and modify it O if present 10 Modify PFTERGO ini file adding the following lines under Lan section Lan Locks 5 Enable 1 Archive Directory 2 Note Ergometry software allows only a single instance between workstation and archives only one machine in the network can run an ergometry sof
223. new calibration factors and the acceptability ranges Press OK to store the new values Cancel to abort the operation or Factory Settings to set the default values 1018 turbine calibration The ID18 turbine used for Resting Metabolic Rate testing is different than the flowmeter used for ergo spirometric testing Since the correction factors for the two turbines are not the same you must perform a separate calibration before using each one The turbine calibration should be performed using the same procedure described above for the ID28 turbine Since ventilation is very low during RMR testing normally 10 litres min the turbine calibration should be performed with very slow manoeuvres each manoeuvre lasting between 10 15 seconds B Rocc calibration Open the calibration program and connect the syringe to the Rocc PNT 1 Select Calibration PNT Rocc and follow the prompts 2 Press OK and wait 10 seconds before moving the piston in order to zero the pressure sensor Then perform 10 inspiratory and expiratory strokes with the syringe and the values will be automatically displayed Pnt ROCC calibration results Hew Acceptable Previous Gain Exp 1000 Gain Inz 1000 Gain Exp 500 1500 Ins 500 1500 Gain 1031 968 Gain In Cancel Factory Settings Help 3 The software will then display the new calibration factors and the acceptability ranges Press OK to store the
224. nformation page Example of a test protocol HR at the end of the previous step 90 100 gt 100 15 step workload set at kgm min 150 150 2 step workload set at kgm min 450 300 3 step workload set at kgm min 600 450 step workload set at kgm min 750 600 256 Sub maximal Exercise Testing Performing the test The mixing chamber The mixing chamber E Overview The mixing chamber is a 8 7 litres plexiglas box for exercise or resting lt 40 l min tests For resting tests only a part about 2 5 litres of the mixing chamber is used The mixing chamber is shown in the following picture D B Connector for the sampling line for resting tests or tests with VE lt 40 l min Connector for the sampling line for exercise tests or tests with VE gt 40 l min Inlet for patient s exhaled air Connector to be closed with the proper plug supplied with the equipment Outlet for patient s exhaled air Preparing the mixing chamber for a test Connect the corrugated tube to the inlet 43 of the mixing chamber Disconnect the sampling line from the turbine and connect it to the connector 1 for resting tests or 82 for exercise tests of the mixing chamber Close the connector 2 for resting tests or 1 for exercise tests of the mixing chamber with the little plug 4 Connect the RH TA probe to the connector 4 Close the connector 4 with the proper plug supplied with the equipment Tw
225. ng normally into the breathing valve Instruct the patient to perform a Slow Vital Capacity manoeuvre in order to allow for the calculation of lung volumes You may also select a SVC effort previously performed by the patient when the CV testing procedure is complete gt 4 When the patient and the program are ready press F2 or the icon during a maximal exhalation to begin the test 5 Ask the patient to inspire oxygen to the TLC level and then expire slowly while maintaining a constant flow rate The two lines displayed represent a flow rate between 250 ml min and 500 ml min and can be used as a target interval To 9 abort the test press Alt F3 ej To restart the test press On the right side of the graph a column is displayed which represents the instantaneous flow This column is green if the flow is within the acceptable range and red when it is outside the acceptable range 130 Lung volumes Closing Volume test CV EM PrT Suite 9 0a b1 Test TEST Real Time Test Cv E 81 x l Test View Window Help la x Start Reda Stop Abort Zero Press begin the test Far Help press F1 01 10 2007 Test TEST 6 Thetest will stop automatically 7 In order to visualize the graph and the main parameters press one of the following buttons shows the Closing Volume graph lem shows the Volume Time graph shows numeric data At the end of the test you may choose to s
226. ng with the risks of the testing procedure Ending the test The test should end when the maximum value of the oxygen consumption has been reached and the patient s response has been established or when the subject requests to stop the test 186 Exercise testing Recommendations for exercise testing Measured parameters Breath by Breath exercise testing i UM Parameter VCO ml min Carbon Dioxide production FeO FeCO Averaged expiratory concentration of e CO B Indirect Calorimetry 7 UM Parameter EE BSA Kcal day m Energy Expenditure Body surface area EE Kg Kcal day Kg Energy Expenditure pro Kg FAT Kcal day Fats CHO Kcal day Carbohydrate Exercise testing Measured parameters 187 B Lactate Threshold V Slope Symbol UM Description VO LT Lactate Anaerobic Threshold STPD Respiratory Quotient LT Time 9 LT hh mm ss Time 9 LT VCO ml min CO output 9 LT STPD VE l min Ventilation LT BTPS HR bpm Heart Rate LT O Kinetics Parameter UM Calculation O deficit VO work tau O debt VO Owork tau 188 Exercise testing Measured parameters L Performing the test Before starting the exercise test type in the new patient information or choose the desired patient from the list of patients in the file The name of the active patient will be displayed on the status bar of the program window Note After turning the device on
227. nning to the end of the test Apply to Specifications Parameter Specifies the reference parameter gt gt lt lt lt gt Specifies the condition for the parameter higher than higher or equal equal to lower than lower or equal different Value Formula Specifies the value or the mathematical expression to be compared with the value of the specified parameter All steps Applies the control to all steps Save settings Allows the settings to be saved to an external file to be recovered later Load settings Will recover settings from a file in which the settings were previously saved Press Apply to apply the editing information W Restoring the original test To restore the original test and cancel all the editing press Restore Storing editing The editing can be permanently saved and replace the original test by pressing Overwrite Smart edit This function is useful to correct data from artifacts To open the smart edit select Test Smart edit Ergo SmartEdit File Test Events View Options Window SmartSmooth Parameter no corr max corr G25 FA oo UU Value Execute Undo Find Fix if Smart Edit 00 00 00 20 01 00 01 20 02 00 02 20 02 00 02 20 04 00 04 30 05 00 05 20 06 00 06 30 07 00 07 30 08 00 08 20 09 00 09 20 10 00 10 20 ajo xi 2101 BOND James Exercise testing Data editing 215
228. nts RMR RN c NS 227 E Measuring principles E T SETTE 227 OBSESUDEPFIBEIDI SS MENU 227 Detection of the breathing 227 228 E Software CONT GUI ation 228 o 229 E Preliminary NER EB ROS GEI NES UE 229 E Performing Me P 230 Ue mcm 230 sica Netze recente css este E LS LUE 230 Starting the data SEOTdEBB ues iocis poit eei eb Qv REP SIM D PUPA d PI NM IS NP NIME NR QUUM PI SS EE RENE CONI UH 231 Checking and adjusting the bias flow during the 231 E Epding the test Without saving CALS VIC MER Gn Rua Oa 231 E Ending the test and saving data PORE dE RP NER QE NN 231 E Limitations of Emm 231 O Performing a Resting Metabolic Rate
229. o 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 E A A I p N o l N XK Sea d A posi TOUS d SS N X 2 1 Valve inlet 2 Connector for the mask 258 The mixing chamber The mixing chamber 3 Valve outlet Note be very careful in order to differentiate inlet from outlet These two are not interchangeable to guarantee proper functionality Connecting the two way non rebreathing valve to the mask Depending on the turbine used new one or old one the following schemes apply Config A new turbine Config B old turbine 1 VO max mask with adapter for turbine 5 max mask with adapter for old turbine 2 1028 Turbine 6 Turbine 3 Adapter for 2 way valve 7 Optoelectronic reader 4 2 way valve 8 Adapter for 2 way valve 9 2 way valve Please be careful to firmly connect all the parts Close the sampling line connector on the reader turbine or optoelectronic reader by means of the little plug attached to the 2 way valve Connecting the above assembly to the head support B Patient s preparat
230. ocol Shows information of the current test Enters a marker during testing ede r e n Changes the load or phase during testing Enters a parameter Systolic Diastolic Blood Pressure or a user defined parameter Starts the exercise phase during testing Starts the recovery phase during testing T LT e m e Stores the ECG Shows the QRS Shows 12 lead r ITI n e Takes a snapshot of the ECG iH BB Tiles the windows horizontally User interface and settings User interface 61 Tiles the windows vertically A Closes all open windows Enter an ABG marker for entering arterial blood gases data B Status bar The status bar in the bottom part of the screen displays additional testing information when activated i e location of mouse selected patient etc Show hide the Status bar In the PFT software select Status Bar from the View menu to show or hide the toolbar Dialog windows The typical operating environment of Microsoft Windows is the Dialog box This window includes a series of fields which allows you to enter information Using the keyboard the cursor among fields press the Tab key until you reach the desired field e Press Enter to confirm the information input on the dialog box or press Esc to cancel the changes Using the mouse e move the cursor among fields move the mouse to the desired field a
231. od veil and gasket before testing E Resting Metabolic Rate test on mechanically ventilated patients eu Warning Carefully re check ventilator functionality after connection of the parts Warning Accurate measurements occur only if 1 Ventilator output provides only patient s exhaled air and ventilator bias flow 2 Ventilator bias flow is properly detected and set in the Quark RMR All the ventilators and or functioning modes which do not comply with these requirements are not compatible with the measurement Warning This equipment must only be used under the supervision of qualified medical staff so that help is available immediately if any faults or malfunctions occurred 1 Quark RMR cannot be used with FiO higher than 60 Measurements are less reliable when FiO overcomes 50 according to the bibliographic reference Resting Metabolic Rate Test Recommendations 219 2 Besure that all the parts of the pneumatic circuit are properly connected since no leakage is a major requirement for the reliability of the measurements At the output of the ventilator only the exhaled patient air and the ventilator bias flow must be present Maximum RMR test duration must be 30 minutes and the humidifier cannot be on during the test 4 Any study which reveals data outside of acceptable limits should be questioned for accuracy During measurements efforts should be made to correct for errors in sampling of exhaled gases It is i
232. om the breathing valve The system automatically performs a PNT baseline every 4 minutes in any case The patient can start breathing into the flowmeter in order to familiarize with the device and the technique 4 When the 60 seconds period is elapsed the vent valve closes and the pressure monitored in the right column oscillates following the patient s breaths If the value drifts towards higher or lower values the thermal equilibrium Performing tests with Body Box Test execution 157 was not reached and it is necessary to open the vent valve by pressing the icon gl gt prr Suite 10 0a b21 James BOND Real Time Test Raw E LA laj x 1 Test Window Help 18 x 423 123 2 1 5 a ERE ALGAE e m sRaw Redo Abort Capt Valve Zero Filter Align VT Plethysmographic Test v 5 e o e XI E o D 3 0 x 5 gt t 17 06 2011 James BOND NUM 5 When the vent valve closes after 4 seconds observe the pressure column and if necessary repeat the previous step until the pressure no longer drifts For Help press F1 6 Atthis point the system is ready for the test Ask the patient to breathe quietly with the nose clips supporting their cheeks with their hands sRaw test 1 Press the icon E In the lower part of the screen the software will show the current Flow Pressure loop and the last captured sRaw graph with real
233. on Eables sent 9 To be sure that the procedure has been carried out correctly select System Linearization Tables again and check that both fields Linearization Tables stored on PC and Linearization Tables stored on device contain the right serial number related to PNT X9 you are using 32 Calilbration Introduction L Calibrating flows and volumes In order to perform flow and volume calibrations you should connect the syringe to the flowmeter of choice as shown in the following picture You should check that the correct reference values are being used before performing the calibration Note If a bacterial filter is used for testing you should also include one during the flowmeter calibration Note The PNT X9 must be calibrated with the COSMED antibacterial filter Calilbration Calibrating flows and volumes 33 1 Calibration syringe C00600 01 11 2 Wrinkled tube A 108 300 012 3 Silicone tube C00311 01 20 4 1018 turbine adapter C03047 01 20 5 Antibacterial filter 182 300 004 6 Conic adapter C00063 01 20 7 PNT Rocc C02420 01 08 8 PNT C02580 01 06 9 D18turbine C02500 01 04 10 PNT X9 C03600 01 05 11 1D28 turbine C03400 01 04 12 Spirometry adapter 02106 01 08 13 Pony turbine 02235 01 05 14 Quark adapter 15 Closing ring 16 Wind shield C02229 01 08 C02155 01 08 C02107 01 08 Note You may need to set a faster refresh time if your PC is running slowly
234. on the list in order to select a single test Date Test Time Drug Dose 26 01 2007 0870672007 12 42 0870672007 12 42 0870672007 12 42 0870672007 SYC 12 56 0870672007 SYC 12 56 0870672007 SYC 12 56 0870672007 MYY 12 59 0870672007 MYY 12 59 0870672007 F C Post 14 12 Salbutamol 0870672007 F C Post 14 13 Salbutamol 20 000 0870672007 FRC 15 08 Graph 1 v Graph 2 Parameter 1 xl Parameter 2 Predicted C Select Parameter 1 fd W Parameter 2 Predicted C Select Select the tests you would like to view and the graphing options you would like to be displayed Press OK to confirm Spirometry Viewing results 119 The dosimeter General warnings 8 9 The dosimeter must only be used for bronchial provocation tests The substances and their doses must be choosen by the physician which uses the dosimeter Overdosage must be avoided especially with specific bronchoprovocation tests allergenes Severe overdosage can result in anaphylactic shock Please note that specific provocation tests are part of an allergy test and should be performed only when an experienced allergist is present Non specific bronchoprovocation tests also require tremendous experience and are not without risks when performed by physicians in private practice After provocation tests are performed with or without response a bronchodilator must be admin
235. or to correct possible errors within the database In the event that you run out of additional space on the hard disk you may need to delete all stored data You would then want to perform an archive initializing We also recommend that you back up the archives at least once a month A warning message will appear if the archives have not been saved in the last 30 days This function can be very useful if hard disk or PC damages should occur Deleting the archive To delete the archive select File Initialize archive Press OK to confirm Reorganizing the archive To reorganize the archive select File Reorganize archive Press OK to confirm You will then be prompted to select if you would like a fast or thorough reorganization to be performed Backing up the archive To back up the archive select File Backup archive Backup v 5 5 xj Statistics Backup to 299 files 30 Mb Browse Description Cancel Enter the archive description and the folder you wish to back up the archive to Press OK to confirm Backup v 5 5 xj Backup in progress Disk n 1 c swapp i phto0en test 00000004 Total Hemaining 299 files 258 files 30 Mb 28Mb A bar will show the progress of the back up Restoring the archive To restore the archive select File Restore archive Restore v 5 5 X Restore from C Nswapp k Browse rr Canc
236. ort FRC calibration 3 Warning After turning the Quark you should allow the system to warm up prior to beginning any calibration The FRC calibration should be performed daily and be repeated before each FRC or CV test Select Calibration Gas FRC and follow the prompts Press OK and wait until the procedure ends automatically 38 Calilbration Analyzers calibration Analyzers Calibration B x not breath near the calibration valve 35 40 45 50 55 60 Gampling calibration gas 12 Response Adjustment Acceptable Hange Gain 800 1200 Zero 200 200 Response Factor Delay ms 400 1200 feo 40 feo 0 511 Response Time ms 5 Response Time ms 0 200 Enable 0 Adjustment Carbon Dioxide analyzer Actual Acceptable Hange 318 Gain 600 1200 Gain mv 33b Zen mv 10 600 Cancel Delay ms 680 Delay Ann 1200 Ea ero 227 ero 0 511 Response Time ms Response Time ms 0 200 Help Analyzer pressure mmHg Actual 600 Acceptable Range 500 700 Sampling flow ml min Actual 400 Acceptable 300 500 At the end of the calibration the software will display the new calibration factors Values within the acceptability range will appear black and values outside of this range will be red If one or more values are not accept
237. ort a set of predicteds click on Import select a file type prd and confirm If the name entered already exists the software will ask you to enter a different name To export a set of predicteds click on Export enter a name for the file prd and confirm In the list Set current predicted you may choose the set of predicteds you wish to print and view Formula definition x Predicteds set Formula definition Predicteds set Description Use the predicteds Formulae C customized Formulae Male C Female Formula Standard Deviation Young Adult Paste Parameter Save Delete This tab allows you to manage the formula associated to set of predicteds Select the set of predicteds from the list Predicteds set 72 User interface and settings PFT Suite settings To create a new parameter click New select a parameter and confirm The Description field will display the default parameter description which may be edited The parameter formula may be e calculated according to the predicteds set chosen from the drop down menu in Use the predicted formula e customized by specifying the parameters under or the customized formulae To enter the formula and the standard deviations for both males and females young and adult press the icon which opens the Formula Editor When finished press Save to save the ne
238. ows are automatically displayed InfoCenter window InfoCenter 00 07 49 Low 00 05 49 stage 20 Next 95 00 00 09 00 00 11 The InfoCenter window contains information about the current test The parameters that are displayed will depend on the selected options the lower section will appear only if a protocol was selected The three sections can be viewed or hidden by pressing the icons 199 and l on the top bar Exercise testing Performing the test 191 The upper section shows the patient s actual heart rate their maximum HR and the percentage of HRmax they are demonstrating The middle section shows the total duration of the test the duration of the current phase the current load and the current phase rest warm up exercise or recovery The lower section shows the current stage of the protocol the duration of this stage the load to be applied during the next stage and the time remaining until the next stage begins To view or hide the window select Window Show BPM window Other data displayed during the test During the test the main parameters VO Kg VE R and VO2 are displayed on the right side of the screen For each value the actual value is shown in a big font and the minimum and maximum values reached during the test are shown in a smaller font The colored bar displays the range of the actual value Parameters colors and thresholds may be customized through Options
239. pendence 4 48 Hz Mean Resistance 4 24 Hz Mean Resistance 4 48Hz Mean Reactance 4 24 Hz Mean Reactance 4 48Hz Resistance at 4 Hz Resistance at 6 Hz Resistance at 8 Hz Resistance at 10 Hz Resistance at 20 Hz Reactance at 4 Hz Reactance at 6 Hz Reactance at 8 Hz Reactance at 10 Hz Resistance at Resonant Frequency NV 1 Select Test Start Fot or press the icon E selecting Fot 2 After few seconds a graph will be displayed with the real time flow and pressure 3 The patient must breathe at rest pressing the cheeks with the hands see the following picture 4 4 Pressthe F2 key or the icon in order to start the test 5 Test will stop automatically after about 8 seconds 6 The upper part of the window shows a graph with resistance and reactance vs frequency The lower part of the window shows the coherence graph Forced oscillations Perform a test 171 The interdependence of the measured pressure signals and measured flow signals is expressed by the coherence function in the range 0 1 The coherence function is zero if the two signals are uncorrelated and has the value 1 in the case of an ideal linear relationship between the two signals Since is is recommended to calculate the linear relationship only accept measured points which has a value of the coherence function above 0 95 A Suite 8 1 1 ito LA CASA Esecuzione test Fot BAF Test Visualizza Finestra x
240. pporto applicazioni a 16 bit supporto applicazioni a 16 bit amp attualmente disattivato Per esequire applicazioni a 16 bit necessario abilitare il supporto per questo tipo di applicazioni Ulteriori informazioni E Abilitare il supporto applicazioni 16 bit per consentire l esecuzione delle applicazioni a 16 bit a Disattiva Disabilitare il supporto applicazioni a 16 bit per impedire l esecuzione delle applicazioni 16 bit 64MB RAM e with 50MB free space e CD DVD drive e VGA SVGA monitor Available USB or RS232 port ns2232 port available If no RS232 port is available it is possible to use a USB to Serial Adapter Cosmed part number A 388 410 001 Available USB port e mouse and printer compatible with the MS Windows operating system e monitor compliant with the IEC60950 Standard CZE if using an external printer the printer must support PCL language and be connected via USB 20 Installation Minimum Computer PC Requirements Software installation Note The software can be installed on Windows XP Vista 32 bit Windows 7 32 bit or Windows 8 32 bit It is not compatible with previous versions of Windows The software consists of two programs the spirometry program uses a green CD labelled PFT and the program for ergometry uses a blue CD labelled CPET These programs sha
241. pressure and flow graphs 1 shows the measured data n shows the data for each frequency If you choose to visualize more than one window at a time select New Window from the Window menu To display the list of tests of the current patient select Test current patient from the View menu or press the icon amp l Forced oscillations Viewing results 173 Oximetry SPIRO PFT K4 Q Box General warnings 1 oximeter probe must be connected to SpO Rocc port on the rear panel of Quark when performing oximetry testing 2 The oximeter probe should be connected to RS232 port on the bottom side of b portable unit when performing oximetry testing GB The test can be performed only in holter and telemetry mode 4 The Quark must be properly connected to the PC with the appropriate communication port selected 5 Qui The name shown the status bar must correspond to the patient carrying out the test 6 A visit card for the testing date must be created 7 Besure that the sensor has been properly disinfected 8 Only use the original COSMED sensor 9 Operation and accuracy of the measurement may be affected by the following e bright ambient light e fingernail polish or artificial fingernail e excessive motion Note Cellular phones should be turned off to eliminate potential electrical interferences E Patient preparation SPIRO CPET 20 Connect the oximeter probe
242. r C 0 00 Kcal day 0 Select View Information or press the icon to view information about the current test Selecting parameters to view in real time Parameters En view Select parameters to view You may select the parameters to be viewed in real time by selecting View Parameters to view or pressing the icon Selecting a different workspace Workspace x Select workspace to set Te Cancel To change the workspace select View Set Workspace and choose the desired workspace from the list Press OK to confirm Select View Save Workspace to save the current workspace Exercise testing Performing the test 193 Workspace x Select workspace to save CREE Cancel Select the name of the workspace and press to confirm E Other events during a test Entering a loading phase or marker If the device is connected to a treadmill or a cycloergometer without a serial interface you may manually enter the event load phase rest warm up exercise recovery or marker through the PC Phase 3 C Rest C Warm up Exercise 4 o ean o B em o 29 Hecovery Cancel To enter a load and or phase select Events Loads or press the icon Bl C Recovery On the left side of the window you may enter the phase rest warm up exercise recovery On the right side of the window you may specify the values of three different loads
243. r when viewing the test results right click on the active window and select Edit or double click on the graph W Edit James BOND DLCO 3 08 06 2007 10 40 l 8 x System Patient Default Fowler 3 Equations Single breath CO diffusing capacity a4 Washout 0 30 9 00 ran he lett M dM rere ut i i E a i 4 i i i 4 sebeccccsccess 7 7 7 7 7 1 7 7 7 7 7 7 7 7 7 7 7 i 7 7 7 7 7 t 7 7 7 7 7 7 7 7 7 7 E i 7 7 7 7 7 7 7 0 25 450 1 1 1 4 5 1 5 1 5 1 5 020 600 1 2 i e 1 1 1 TEE LH 045 4 50 3 i i5 ae D Messen duo Scere SER THEE ee ene lt lt eR lt lt b E i 7 7 7 7 L L 7 i 7 7 B J J 1 200 358 Se ee ee eee ee eer c u c d ma ccc eee ae i i 7 7 7 7 7 7 i L
244. rameter iz Export Close selecting Options Customize predicted you may add edit delete export or import a set of predicteds To create a new predicteds set press New You must then enter the predicteds name the unit of measurement Unit of meas the number of digits to be displayed before and after the decimal point ntegers and Decimals the age limit between young and adults for both Males and Females and the reference parameter Related to Formula will open the Formula editor which allows you to enter formulas for the calculation of predicted values Press OK to confirm or Cancel to abort the operation To select a set of predicted press List and confirm by pressing OK To find a set of predicteds by name enter the name in the Name box and press Find After selecting a set of predicted you have the option to 84 User interface and settings CPET settings e Delete it by pressing Delete it by pressing Import it from predicteds file by pressing Import and selecting the file xtr from which the predicted must be imported Export it a predicteds file by pressing Export and typing the filename xtr which the predicted must be exported User fields User Fields x User 1 User 2 User 2 User 3 User 3 Selecting Options User fields allows to enter optional information up to three fiel
245. raph of the DLCO procedure If you would like to view more than one window select New Window from the Window menu To display a list of tests of the current patient select Test current patient from the View menu or press the icon amp l 142 Lung diffusing capacity DLCO CO Diffusing Capacity DLCO Test Membrane diffusion test The membrane diffusion test is performed by completing at least two DLCO tests using different oxygen concentrations The oxygen concentrations typically used are 2196 60 and 100 CO and CH concentrations are always 0 3 Dm Membrane Diffusion and Vc Capillary Volume values are measured during this test which is used in the following formula to calculate the DLCO value MM DLCO D 0 is the reaction velocity between CO and haemoglobin For additional information refer to the test Cotes Lung Function If the user selects more than 2 tests the software will automatically select the lower oxygen concentration value to be associated with test 1 and the higher oxygen concentration value to be associated with test 2 Any additional tests are graphically represented but are not involved in the calculation of Dm and Vc E Performing the test Before beginning the membrane diffusion test at least two DLCO manoeuvres with different O concentrations must have been performed 1 Select Test Start Membrane Diffusion or press the icon and select Membrane Diffusion x 1
246. raph when viewing the graph or right click on the graph and select Customize graph Customize Graphs pom M Autoscale From 00 00 00 To 00 01 21 Options Ignore 0 F Grid Points only Markers Autoscale MV Autoscale Squared Min 288 050 Min 21 8 866 723 088 596 393 Step 0 0000 Step 0 0000 recovery Mark points For each variable you have the option to specify the following parameters e Ifa grid will be drawn e Ifthe scale is automatic or not if this option is deselected you may set the range of the axes and the grid step You may also enable or disable the following options e Ignore removes all the points in which the measured value is zero e Points only shows a dispersion graph without a line which connects the points e Markers highlights each point in which a marker was entered with a symbol e Squared makes the graph squared instead adapting it to the space e recovery excludes the recovery phase from the graph e Mark points marks each measured point with a symbol Press OK to confirm Cancel to cancel changes or Restore to restore the default configuration E Viewing test information x Patient Calibration ID code 000001 Temperature 34 0 807 Last name LA CASA Humidity 4 55 BTP5 imap 1 046 Temp flow 34 BTP5 exp 1 020 First name Vito Hum flowm z 100 Press mmHg 7
247. ration turbine 1028 PNT flowsafe or PNT 9 rnnrnnun 34 NEN DIS oeseipo n abb Ur Red HOLT DRE eR Sa IP 35 MEL TES i TOEIC 35 Analyzers calibration 2 36 Ub erred NIIT Momm 36 ERGO RMR calibration 22 37 FRC calibration 38 E D CO calibration WEN oo imt xr x pd c iv eap Su adu tet ei a d di 39 Air calibration PF CPET RMR 40 ICU calibration 41 Analyzers calibration o 44 _ rdc TITIO ES 44 E Posm qe gt oo odo nen Ren ere recente Renn M Mni add Mm eer nM ane FCU MM aM EE 44 E Reference gas callbraEIOT a 45 NE CSS et COV Iq TI 45 Reference gas calibration using the PC software 46 E
248. re Microsoft strongly recommends that you stop this installation now and contact the hardware vendor for software that has passed Windows Logo testing STOP Installation 6 During the installation the warning message shown above will appear if a hardware device driver is not submitted or does not qualify for Microsoft Certification This is a message from Microsoft encouraging your company to submit hardware solutions for certification COSMED drivers will not impair or destabilize your computer You may choose to ignore this message and select Continue anyway Hardware Update Wizard Completing the Hardware Update ey Wizard The wizard has finished installing the software for Cosmed All models USB Driver Click Finish to close the wizard Finish 7 The drivers will then be properly installed Opening and closing the software When the installation is complete a Cosmed program group will be added to the Windows Start Programs Running the software 1 Open the Cosmed program group in the Windows Start menu 2 Click on the desired program icon A dialog box will be automatically opened the first time the PFT software is run Select the proper device the communication port USB or COM units of measure and the type of flowmeter Press OK to confirm CED Open the tab Forced oscillations and set the communication port Press OK to confirm Closing the software Select File Exit or pr
249. re and wait until the green led appears on the right side of the screen 2 Explain the manoeuvre to the patient prior to testing breathe normally then perform a maximum inspiration followed by a maximum forced exhalation 2 3 When the patient and the software are ready press the F2 key or the icon to execute the test Spirometry Forced Vital Capacity pre 113 4 When the effort is completed press F3 or the icon 9 or wait for the automatic end 5 seconds without flow software will display the F V and V T graphs the main parameters and the predicted values To abort the test press or KA To restart the test press 5 To visualize the F V graph V T graph or the main parameters press one of the following buttons displays the Flow Volume graph E displays the Volume Time graph displays all numeric data 6 Repeat the test until it the desired number of manoeuvres has been obtained ATS recommends 3 acceptable reproducible efforts 7 Press to visualize the test list carried out during the current session x FYC FEV1 FEV1 FVUX FEF 25 75 Meas 4Pred Meas 4Pred Meas Pred Meas Pred Testn 487 101 2 6 23 1102 481 999 771 9 3 395 00 1 6 11 108 0 472 96 1 FF2 914 392 0 0 3 Tests are sorted from best to worst Save all Discard all Cancel Help 8 Select the test you wish to save results sorted from best to worst according to ATS criteria a
250. re the same archive and calibration program One or both software programs may need to be installed depending on the device purchased and its configuration Network compatibility The software is network compatible Database can be located on a different PC and accessible from different workstations Ergometry software allows only a single instance between workstation and archives only one machine in the network can run an ergometry software while spirometry software allows multiple instances among workstations and archives To install one or both the software in a network see later Network installation E Installing the software Note The software is copyright protected and should only be installed from the original disk 1 Insert the installation CD into the CD ROM DVD ROM drive 2 Installation will begin automatically If the disc does not start automatically you will need to run Setup exe on your CD DVD drive Follow the instructions in the dialog boxes to complete the installation 4 When the installation is finished the program will confirm that the installation has been completed successfully Note If both programs are installed the directory for the CPET software must be the same as the PFT directory default is C PFTSUITE E Network installation The scenario is the following AJ 1 1 Workstation Workstation Archive location In order to install the archives in a
251. represents the average concentration of N expired after the patient s initial Residual Volume has been diluted with the inspired oxygen The slope of this plateau is a useful tool for assessing distribution disorders Normal subjects typically demonstrate a slope of 1 596 whereas patients affected by severe emphysema may display a slope of up to 1096 PhaselV end of Phase III corresponds to the beginning of the Closing Volume which includes the last portion of the Vital Capacity before the Residual Volume has been reached The quick increase of the 96 which can be seen in Phase IV is due to the emptying of the last alveoli which contain the highest concentration of The nitrogen concentration increases because this air has not been contaminated by the inspired oxygen Increased values of CV can be used to determine the presence of lung disease The parameters calculated during this test include the following Symbol UM Parameter CV Closing Volume VC C V Expired volume during wash out V Related volume at the end of phase V II Related volume at the end of phase II V Il Related volume at the end of phase III m q R 2 Parameters of the linear fitting on the alveolar plateau CV VC CV as a percentage of VC VDf ml Dead space volume via the Fowler method E Performing the test 1 Select Test Start Single breath O or press the icon selecting Single breath 2 Askthe patient to begin by breathi
252. rest and the Volume Reserve the distance between the maximum volume of the F V loop during exercise to the maximum volume on the F V loop at rest The order of the procedure is as follows e Acquire Flow Volume loops during exercise e Instruct the patient to inspire to TLC level this is necessary to place the loop correctly on the resting F V loop e Overlap the F V loop acquired during exercise and the F V loop performed at rest Flow Volume loop event during the test 1 Start with normal exercise test and begin collecting data F2 or 2 During the desired phase rest or exercise select F V loops from Events Event BOND J Event F Loop B x Fil z rt hh mm ss8 00 01 44 3 When 2 or 3 F V loops have been acquired ask the patient to inspire to the level of TLC and press Event End or F3 or the icon to stop the data acquisition O CO graph The event allows you to check the real time readings of the O and CO signals during the test O CO graph event during the test 1 Begin storing data in an exercise test F2 or Bm 2 During the desired phase rest or exercise select O CO Graph from Events Event Exercise testing Events management during exercise testing 199 BOND J Event 02 COZ Graph loj x nzi amp 21 1 12 00 20 00 3 00 6 00 15 00 3 00 10 00 04 na t hh mm ss OO 06 21
253. rforms its calculations with Cosmed filter values In order to have a correct measurement use only Cosmed antibacterial filters Note Use antibacterial filters in order to control and prevent cross contamination and infections e noise signal level we suggest to set this value to 40 e f the coherence filter must be enabled in this case the frequencies with coherence less than the specified value will be shown vith a X on the grapf and won t be displayed among data e If tests are displayed one by one or grouped by date e If the flow curve is filtered in order to smmothen it Ambient conditions xj Relative Humidity 27 at Barometric Pressure mmHg 760 Temperature 28 Lancel Help When selecting Ambient conditions from the Options menu you may enter in the actual values of relative humidity and barometric pressure E Parameter management To simplify the analysis of the results you may wish to view print and sort only certain parameters Select the menu item Options Parameters manager and the management options will be divided among the following tabs User interface and settings PFT Suite settings 69 View x View Print Sort Customize Not selected Parameter Selected parameters To view parameters select those you wish to view from the left list and move them to the right list To hide parameters move each one from the right list to the left list The bu
254. rm Displays the numeric values of testing parameters in columns corresponding to each of the steps in rows Graphic form Displays a graphical presentation on Y1 Y2 X charts Report Displays the results of the test and statistical analysis of the blocks You may also view the events that were stored during the test Viewing data in table form 1 Select Data from the View menu or press the icon CAEN x4 ID Date Duration ia 2070271997 00 14 13 B ND J f Current patient 000002 13 03 1997 00 15 00 J 0000013 11 04 1997 00 10 43 TREADMILT All tests 000004 14 04 1997 00 05 16 CARDIAC OUTPUT 000005 15 04 1997 00 07 14 LOOPS 0000016 26 01 2000 00 14 45 GAS ECG 000007 0909 2002 01 12 27 GPS 000008 1206 2007 00 12 34 BOND J 000004 12 06 2007 00 12 34 BOND J 000010 12 06 2007 00 12 34 BOND J 000011 12 06 2007 00 12 34 BOND J Enos 000012 12 06 2007 00 12 34 BOND J 000013 12 06 2007 00 12 34 BOND J Notes Cancel Show 2 list of all tests performed by the current patient may be viewed as well as a list of all tests stored in the archive Select the test to be displayed and press OK to confirm Find finds a test based on the search key entered Notes shows the notes of the selected test Show shows a preview of the test below the window Hide hides the preview 238 Resting Metabolic Rate Test Viewing results
255. rol panel LIA 55 K4 b Control panel a SQ 55 Control panel in other devices 5 A 56 MR 58 MIO imeem 58 show hide 58 Show Exod o NIE E ME ED ME LM E EE 58 Toolbar icons of the PFT software Toolbar icons in the PFT software real time Toolbar icons of the CPET software 2 2 1 00 4 60 Toolbar icons in the CPET software real time sss eene 61 E cu cock 5 o o OP REINN 62 STOW Dide RTT TEE 62 E Disp ecient erm eden aS ER one adi dna emotes 62 t Eum dM ME IMEEM 62 dd ci m rm 62 a iR T m M 62 NEL ADR TET TT UTERE p nn 62 _ Software versioi aia 62 E PNG TORU iles 5522 o 62 LI Suite settings REPRISE ERES SEREPPNESEMENER ENRS IERI SINGU E DURER GEM RE RUE DIRAS VE QE VE DU eU PA S
256. s 5D 1200 Ea ero 228 ero 0 511 Response Time ms Response Time ms 0 200 Help Analyzer pressure mmHg Actual 600 Acceptable Range 500 50 Sampling flow ml min Actual 400 Acceptable 300 500 At the end of the calibration the software will display the new calibration factors Values within the acceptability range will appear black and those outside of this range will be red If one or more values are not acceptable the calibration must be repeated If you continue to receive unacceptable calibration factors you should contact Cosmed s technical assistance If the calibration cannot be performed because the soda lime absorber is exhausted a message requiring its replacement will be prompted to the user Contact the COSMED technical support B calibration RMR Warning After turning the Quark on you should allow the system to warm up prior to beginning any calibration The ICU calibration should be performed daily and repeated before each test on mechanically ventilated patients Before performing the ICU calibration connect the sampling line extension to the Quark RMR front panel through the adapter for ICU calibration as shown in the following picture Calilbration Analyzers calibration 41 OC RN a ie NLA tuae Mme tete Se ot ene e MANARE MAS ta 7724566 Rx 21 4 441
257. s E Resting Metabolic Rate RMR The Resting Metabolic Rate represents the calories that the vital organs need to properly operate at rest heart brain lungs liver kidneys etc The RMR accounts for 60 75 of the Total Metabolic Rate Importance of measuring RMR RMR measurements are very helpful when attempting to determine the subject s nutritional needs and how to properly manage them E Measuring Rest Metabolic Rate with Indirect Calorimetry Energy Expenditure can be measured with direct calorimetry by putting the subject in a calorimeter and measuring the amount of heat produced by the body mass Direct calorimetry can be very expensive and impractical and is not commonly performed in the clinical setting Energy Expenditure can also be measured indirectly with a metabolic cart Gas exchange is analyzed to determine the volume of air passing through the lungs the uptake of oxygen VO and the amount of Carbon Dioxide expelled to atmosphere CO output VCO These measurements allow the Resting Energy Expenditure RMR and the Respiratory Quotient RQ to be calculated The RQ represents the ratio of carbon dioxide exhaled to the amount of oxygen consumed by the individual RQ assists in the interpretation of the RMR results The abbreviated Weir equation is a commonly used method to calculate the RMR Abbreviated Weir equation RMR 3 9 VO2 1 1 VCO2 1 44 E Performing a RMR test Important considerations
258. s the TGV is often much higher than the FRC Parameters measured 1 the tests include the following a Parameter SRAW cmH20 s Specific Airway Resistance sGAW 1 cmMH20 s Specific Airway Conductance RF_raw 1 min Respiratory Frequency RAW kPa kPa l s Airway Resistance GAW kPa I s kPa Airway Conductance kPa kPa s Specific Airway Resistance SGAW kPa 1 5 Specific Airway Conductance kVp ml cmH20 Polythropic Coefficient Rsys cmH20 I s System resistance E Performing a test Test is mainly divided in three phases 1 sRaw test 2 TGV test 3 Slow Vital Capacity test Nota Concerning the timing the test is divided into two parts preliminary operations and the test Each part cannot last more than 150 seconds If the duration of the first part exceeds 150 seconds the test will be automatically terminated if the duration of the second part exceeds 150 seconds the test will be automatically ended and the collected data will be saved 156 Performing tests with Body Box Test execution Preliminary operations 1 Select Test Start Body Box or press the icon selecting Body and wait until the green led appears on the right side of the screen 2 The following screen will be shown In the upper part the volume time graph representing the patient s breaths is shown now he is not breathing in the flowmeter and then the system is not measuring anything In the lower part two vertical bars ar
259. signals 55 Control panel Refresh M x 200 CO Trimmer 02 1 03983 4041 o C02 mV 102 Iv Ambient temp mV 267 Internal temp mV 395 Messages M Barometric press mV 3712 Analyzers press mV 3566 Battery voltage mV 3800 7 Heart rate msec 676 Turbine Flow ml sec 312 M Turbine Volume ml 401 neo Deselect all mV real valves Select all Deselect all Signal refresh Prey on off on off msec a x lt CO Trimmer 1 k edit parameters Sampling Transmitter name unit pump on off on off Digital CO trimmer Control panel in other devices The Control Panel can be activated by entering into the calibration software and then selecting the menu item Calibration Control panel edit parameters name unit mV real values Select all display hannels Deselect all 8 x channels Ambient temp 25 4 Power Supply mV 4840 Iv Turbine flow ml s 0 Turbine volume ml 0 Signal refresh Refresh Rate ms me Spo zd 56 Calilbration Checking the system signals User interface and settings User interface E Display The program may display several windows at one time The active window will always be highlighted with a different colour Certain functions of this program will only apply to the current active w
260. sis code in the Code field and its description in the Text field Deletes the selected diagnosis To edit a diagnosis select the name and type in the new code and or text Visits list By selecting File Visits list you may view or print the list of visits List of Visits Date From To All visits Company If you wish to filter the visits you can set a time range From to or you may filter them by company Company You also have the option to list all the archived visits E Exporting tests Data may be exported in the following formats e txt ASCII xIs Microsoft Excel wk1 Lotus 123 xpo Cosmed proprietary file format Note Test can be exported imported in xpo format only between the same software version Selecting File Export test to export the archived tests Archive tests list 11 06 2007 BOND James Select test to export 000001 A Fot 25 01 2007 BOND James 000001 FYC 08 06 2007 BOND James 000001 select by 08 06 2007 BOND James 000001 08 06 2007 BOND James 000001 e re SYE 08 06 2007 BOND James 000001 Pn 08 06 2007 BOND James 000001 08 06 2007 BOND James 000001 08 06 2007 BOND James 000001 08 06 2007 BOND James 000001 Post 08 06 2007 BOND James 000001 Post 08 06 2007 BOND James 000001
261. sk C RMA with Canopy with Ventilator C Stress ECG C Resting ECG Simulated test Ergometer no one Protocol Other data Workspace Details Cancel To choose a specific protocol to be carried out during the test select one listed under Protocol The Workspace list allows you to choose a default workspace or one defined by the user Execute Test Other Data X Pre exercise 1 FEVI l 4 37 MYY 0 0 0 00 l Post exercise FYC 1 10 00 FEV1 1 0 00 l min 0 0 I 10 00 UN g day 12 0 AHR Kcal day 0 WE RH X User 1 0 00 RH 100 User 2 0 00 T 34 User 3 0 00 Marker Distance 0 lin meas m 2 Pressing Other data allows you to enter additional testing measurements obtained from the patient the flowmeter humidity RH fluss and the temperature T fluss The humidity and temperature should be maintained respectively at 100 and 34 3 Confirm and start the test pressing OK When selecting RMR the system will automatically set the following options e Data acquisition with 30 second average e protocol which is defined as follows First 5 minutes discarded 10 minutes of which the software will average measured values upon completion of the test Automatic end of the test after the 16th minute e
262. spond to the patient carrying out the test A visit card must exist for the current testing date If you are using the pneumotachograph Flowsafe or X9 do not breathe into the flowmeter until the proper message appears If you are using the turbine either a paper mouthpiece or an antibacterial filter should be connected to the flowmeter prior to executing the tests For hygienic reasons the use of an antibacterial filter is strongly recommended In case of using the PNT X9 the use of an antibacterial filter is mandatory Implementing the encouragement software tool may be useful when performing spirometry testing on children The ID28 turbine the PNT Flowsafe or the PNT X9 should be the flowmeter used during spirometry testing FVC SVC MVV Note Cellular phones should be turned off prior to testing to eliminate potential interferences Patient preparation Using the turbine Disconnect the sampling line from the flowmeter and attach flowmeter to the handle Calibrate the turbine as indicated in the chapter Calibration ATS recommends a daily calibration Using the PNT Calibrate if needed the PNT as indicated in the chapter Calibration Connect the PNT to the unit through its pneumatic line Other operations Instruct the patient to apply the nose clips Y 112 Spirometry General warnings Forced Vital Capacity pre FVC testing is used to verify obstructive and restrictive lung disorders Qu
263. ss Delete step to delete all data from the row Advanced editing x Hode Delete steps Time Range From 00 00 02 1 To 00 10 21 1 2 steps C Smonthing Edit parameter Value zl C Formula C Correction X 7 All steps C Formula Save settings Load settings Steps smoothing Cancel 2 By pressing Advanced you may perform advanced editing on the numerical values Function Delete steps Deletes the steps which meet the selection criteria Smoothing Applies a moving average on the number of steps indicated in the Steps smoothing field or on a parameter as specified in the Edit parameter section does not decrease number of points Edit parameter Edits a parameter according to the criteria in the Edit parameter section Edit parameter Specifications Parameter Allows the parameter to be edited Value Replaces the value of the selected parameter with the new value for all steps occurring in the time range Correction 96 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 the results of a mathematical function entered see Formula editor Time range Specifications 214 Exercise testing Data editing From To Specifies the time range for editing All steps Applies the editing from the begi
264. ssages to appear before the load changes The Drive Ergometer check box allows the software control the ergometer Enabling the option Relative Increments causes each new load to increase in proportion to the previous step oe Entering values for the nitial command and Final command will control when the ergometer begins and ends storing the test data x x M of step to add Delta time Lancel Cancel oem Delta Speed M of step to add Delta time Delta Power Delta link ta 5Bp Delta link to DBp Delta Elevation EN Delta E Syst Diast pressure Syst Diast pressure ECG ECG for cycloergometers for treadmills 7 Generate will allow the software to automatically generate a new protocol at a constant time interval You must enter the number of steps the delta time and the delta load which will occur from one step to the other The Syst Diast pressure dialog box will be displayed at each load change to allow you to enter the subject s measured blood pressure The ECG checkbox will cause an ECG event to be automatically stored at each load change Press OK to confirm Time hh mm ss 00 02 Time 5 o Lancel i Cancel link to 5 Elevation link to Command no one Command Hew phase Rest New ph
265. ssion 1 2 3 4 Select the parameter to be edited the Parameter field The graph of the selected parameter will then be shown Click on the point to be edited and drag the mouse to the desired place To cancel the edit left click before releasing the right button Repeat the above procedure for all parameters and press OK to confirm Threshold noise suppression 1 2 Select the parameter to be edited in the Parameter field The graph of the selected parameter will be shown Enter a noise threshold as a percentage of the parameter value by moving the horizontal Noise 6 bar in the SmartSmooth section Every point outside of the selected range will be considered an artefact Press Execute to run the editing Undo to undo the editing Find to find all the points to be corrected or Fix to correct only the selected point Press OK to confirm 250 Resting Metabolic Rate Test Data editing Sub maximal Exercise Testing CPET K4 Introduction Physiological responses to exercise including oxygen consumption heart rate and blood pressure are used to evaluate cardiorespiratory fitness These variables are also assessed during exercise when attempting to determine the presence of coronary artery disease or pulmonary disease Maximal exercise testing can be impractical at times due to the expense clinical supervision required and the level of physical stress that the patient is subjected to Maximal
266. stomized through Options Real time Settings in the 725 section Highlight parameters Su Viewing graphs in real time Select View Graph or right click on the data window and select Graph or press the 1 09 Graph 0 74 axis parameter 1 07 2574 288 2574 vo vcn2 vert r t load hr 7 t 2 feco 7 Cancel p The window allows you to select the parameters to be graphed up to 2 parameters may be graphed on the Y axis Select the parameters from the two lists or by choosing one of the fast graph buttons below them You may customize the buttons with Options Parameters or View Fast Graphs Graph customization When viewing a graph in real time you may customize it by selecting View Customize graphs or by right clicking on the graph window and selecting Customize graphs Customize Graphs a X M Autoscale From 00 00 00 To 00 01 21 Options Ignore 0 Grid Points only Bite Autoscale Autoscale Squared Min 288 050 Hin 21 8 866 723 088 596 393 Step 0 0000 Step 0 0000 recovery Mark points For each variable you may set the following options e Ifa grid will be drawn e Ifthe scale is automatic or not if this option is deselected you may set the range of the axes and the grid step Resting Metabolic Rate Test Performing a R
267. strate a valid effort In such cases a laboratory setting may allow you to obtain more consistent results When selecting protocols you may choose to make alterations to commonly used protocols to accommodate athletes competing in specific sports The same type of exercise and protocol should always be used if exercise testing is repeated to allow for a valid comparison of the results E Staffing Staff members conducting the testing are responsible for the following Establishing rapport with the subject and assuring that he she is comfortable prior to executing the test Recognizing normal acute and chronic responses to exercise Recognizing abnormal signs and symptoms during exercise Providing basic life support measures as needed Adhering to established procedures and protocols wv ME Clearly explaining test results to the individual Sub maximal Exercise Testing Sub maximal exercise testing 253 Testtermination Sub maximal tests should be terminated when necessary according to ACSM or other preferred guidelines see the following table In the event of an abnormal response the test should be terminated the medical director of the facility and the individual s primary care physician should be notified and all appropriate follow up procedures should be performed If a mechanical or electrical failure occurs the test should be stopped until the problem has been corrected Indications for stopping an exercise test
268. t Window Help l x Start Redo Stop Abort Zero DLC O WT Single breath CO diffusing capacity 035 pee pee pee pee pee p p pu pu pA pA jte PII MEC ALONE VU QUE NE UE E NM MN EE rm M S tt ME ANE E spen 1 2 3 4 5 B T 8 9 10 11 12 13 14 15 16 17 18 19 205 1 2 3 4 5 B Y 8 8 1 11 12 13 14 15 16 17 18 18 20t s For Help press F1 11 05 2007 James BOND NUM GR 10 The test will stop automatically Lung diffusing capacity DLCO CO Diffusing Capacity DLCO Test 139 11 In order to visualize the graph and the main parameters press one of the following buttons eee shows the DLCO graph vt shows the Volume Time graph of the SVC shows numeric data Y eT lt shows the Volume Time graph of the DLCO Editing a test The gas sample used to determine the diffusion capacity is obtained immediately after the wash out period is performed The automatic phase detection is not always appropriate when particular curve morphologies are present In such cases it is possible to modify the starting and ending points of the phases At the end of a test o
269. t Open the Body Box calibration program Select File View results Show Calibration Results x Calibration Type 17 06 2011 14 09 17 06 2011 09 47 15 D6 2011 14 29 14 D6 2011 14 20 14 06 2011 14 13 14 D6 2011 11 00 13 06 2011 14 50 10 D6 2011 11 35 09 06 2011 09 29 09 06 2011 09 15 08 06 2011 17 06 08 06 2011 17 02 08 06 2011 16 46 08 06 2011 16 42 08 06 2011 16 12 08 06 2011 16 10 08 06 2011 15 40 08 06 2011 14 19 08 06 2011 11 54 06 05 2011 16 29 05 05 2011 16 26 05 05 2011 14 07 04 05 2011 10 18 03 05 2011 15 04 14 s Cancel Import Export BodyBox Leakage Check System Information Select the chosen calibration e Press Import to import a file with the calibration results e Press Export to export the selected calibration into a new file Calilbration Reviewing Cal Results 53 e Press OK to view the selected calibration Printing the calibration report When the calibration program is running select Print from the File menu W Editing the calibration factors The software allows you to view and edit the most recent calibration factors Select the desired results Gas Results Turbine Results or Pnt Results from the File menu to edit any of the factors Note Press Factory Settings to restore to the default values You must then perform a new calibration before performing another test 54 Calilbrat
270. t and close the cylinder E Gas delay calibration The delay calibration procedure is a calibration included in the software due the time alignment between flow and gas concentration measurements is one of the potential problems to consider to assure accurate readings during test The gas delay calibration is the measurement of time required by the gas to reach the gas analyzer For breath by breath analysis it is essential that the instantaneous flow rate must be multiplied by the proper time matched expired gas concentration Although flow can be instantaneously measured gas concentration measurements can be calculated with a delay related both to the time necessary for the gas to be transported to the sensor and to intrinsic characteristics of the analyzer principle Two factors contribute to the time alignments delay K4 b uses a capillary sampling tube with a pump to draw a continuous gas sample into the analyzers The gas transport time depends on the dimensions of the tube and on the pump flow rate Additionally the gas sensors have a response time that must be added to the above delay for calculating the total delay The software of the K4 b by carrying out the Gas Delay procedure calculates this delay and introduces a correction to realign both flow and gas measurements This procedure must be carried out each time some changes occur in the sampling system i e when the sampling tube is changed However it is recommended to carry out
271. t from the View menu View Report Archive tests list x List ID Date Duration 20 02 1997 00 14 13 BOND J Current patient 000002 13 03 1997 00 15 00 BOND J 000003 11 04 1997 00 10 43 TREADMIL T Al testi 000004 14 04 1997 00 05 16 CARDIAC OUTPUT 000005 16 04 1997 00 07 14 LOOPS F 000006 267 0172000 00 14 45 5 ECG 000007 09 09 2002 01 12 27 GPS T 000008 12 06 2007 00 12 34 BOND J 000009 12 06 2007 00 12 34 BOND J 000010 12 06 2007 00 12 34 BOND J 000011 12 06 2007 00 12 34 BOND J 000012 12 06 2007 00 12 34 BOND J 00001 3 12 06 2007 00 12 34 BOND J Hotes Show Find 2 2 You may view a list of tests performed by the current patient or a list of all of the tests in archive Select the test to be displayed and press OK to confirm The software will open the relative windows according to the selected report Report Wasserman C EPX cardio C ST trends C ERS 98 The Report section specifies the type of report to be viewed among the predefined and or user customized reports Find finds a test based on the search key entered Notes shows the notes of the selected test Show shows a preview of the test below the window Hide hides the preview Viewing an event Select Events View or press the icon ay Event x Event to view Stage 2 Stage 5 Stage 8 Stage
272. t the inspiration expiration with maximal force against the shutter until it opens automatically 6 Repeat the same procedure for the opposite manoeuvre expiratory or inspiratory It is not necessary to repeat the test since both MEP and MIP measurements can be obtained during the same procedure o 7 Press or the icon to end the test The software will display the graphs measured parameters and predicted values PFT Suite 9 0 b1 James BOND MIP MEP 5 08 06 2007 11 36 E F x File wiew Test Window alu 8 a a TEST 5 08 06 2007 i 3B 125 100 75 100 125 150 Parameter UM Pred TEST 5 Pred FRO 3 46 2 46 71 2 crmmH20 104 3 123 0 115 0 MEF cmmH20 137 9 134 0 97 1 For Help press F1 30 05 2007 James BOND Respiratory mechanics MIP MEP test 147 8 To visualize the graph and the main parameters press the following buttons mee shows the MIP MEP graph shows the Volume Time graph of the SVC 11 shows numeric data E Viewing results To view tests results of a MIP MEP test 1 Select Patients from the File menu or press the icon 2 Select the patient corresponding to the test you wish to view 3 Select the desired test from the list box and press OK To switch between graph and or data use the following buttons on the toolbar nm mee shows the MIP MEP graph shows the Volume Time graph o
273. tach which calculates the flow by measuring the pressure differential between the two sides of a screen A PNT Rocc calibration should be performed daily Analyzer calibration Q Box The software allows you to automatically calibrate the zero gain and delay of the gas sensors We strongly recommend that you perform these calibrations prior to each test Note Before using the device you must allow for the required warm up period which is different depending on which test is being performed The first chapter of the User manual of the device specifies the minimum warm up times The device should be powered on in order to warm up the system It is not necessary that the PC software is open during the warm up period You should not perform calibrations or testing procedures until the system has completed the required warm up period 28 Calilbration Introduction E Body Box calibration The software allows to verify the box leakage and the polytrophic coefficient The first operation checks that the global system time constant is within the acceptability range the second one checks that the polytrophic coefficient is within the acceptability range If one or both these calibrations fail please don t perform any test and contact COSMED technical support Calibration frequency The table below shows a summary with the calibration intervals recommended by COSMED Calibration Device s R
274. tal Lung Capacity Single breath CO diffusing capacity Test options i x Preferences 5 pirometry Multi breath w ash nut Forced Oscillations Body GOT Single breath CO diffusing capacity Respiratory drive Patient TLC DLCO correction for obstruction severity Breath hold Time Effective time 10 sec 0 7 Ti 0 55 ample Vt stability threshold 100 ml 200 ml 400 ml tae The Single breath CO diffusing capacity tab allows you to customize DLCO testing options Checking the checkbox TLC DLCO correction for obstruction severity will apply an automatic correction to the measured DLCO value of severely obstructed patients For further details see Correction of Single Breath Helium or Methane Lung Volumes in Patients With Airflow Obstruction Naresh M Punjabi David Shade Robert Wise Chest 114 3 September 1998 Additional parameters included in the DLCO settings are as follows Parameter Description Time Apnoea time for the DLCO with apnoea test ATS ERS Standard is 10 s Vt stability threshold Recognition criterion of regular tidal volume respiration System MEE System dead space 0 Cylinder concentration 2 21 cancel By pressing System you may define the following parameters Parameter Description System dead space VDs Dead space volume of the antibacterial filter if used Cylinder concentration Fi
275. ted before each CPET or RMR test Select Calibration Gas ERGO RMR and follow the prompts Press OK and wait until the procedure automatically ends Calilbration Analyzers calibration 37 15 20 25 30 35 45 50 55 60 65 Sampling calibration gas Acceptable Hange 8001200 Response Factor Zero 200 200 Delay 500 1200 Zero Hw Hw 051 Enable 02 Adjustment Response Time ms 50 Response Time ms 0 200 Carbon Dioxide analyzer Actual Acceptable Hange 404 Gain 800 1200 Gain mv 366 mv 10 600 Cancel Delay ms 730 Delay ms 5D 1200 3 ero 23 ero 0 511 Response Time 60 Response Time ms 0 200 Help Analyzer pressure mmHg Actual 600 Acceptable Range 500 50 Sampling flow ml min Actual 400 Acceptable Range 300 500 When the calibration is complete the software will display the new calibration factors Values within the acceptability range will be appear black and those outside of this range will be red If one or more values are outside of the acceptable range the calibration must be repeated If calibration values remain unacceptable you should contact Cosmed s technical assistance If the calibration cannot be performed because the soda lime absorber is exhausted a message requiring its replacement will be prompted to the user Contact the COSMED technical supp
276. ted on either a phase or load change E Steady State PFT CPET VE threshold 5 Minimum n of steps 5 V2 threshold X 3 Cancel 2 threshold x By selecting Options Steady State you may set the following options Minimum n of steps The number of consecutive data acquisition steps required to qualify as a steady state VO threshold The maximum variation allowed that will still be considered within a steady state e VE threshold The maximum VE variation allowed that will still be considered within a steady state e R threshold The maximum R variation allowed that will still be considered within a steady state Press OK to confirm Cancel to cancel changes and Restore to restore the default configuration E Anaerobic Threshold CPET K4 x Graph 1 X Axis Y1Axis 2 An FetC Autoscale v02 VE VU2 VE VCO2 Autoscale By selecting Options Lactate threshold you may set the parameters to be displayed on the axes of the two LT graphs and if the graph scale will be automatic Press OK to confirm Cancel to cancel changes and Restore to restore the default configuration User interface and settings CPET settings 83 E Parameter customization x hus Delete Mew List Find Import Unit of meas Integers Close Decimals Export
277. teria and press OK 8 Continue to acquire FVC Post efforts until the number of steps included in the protocol has been reached or until the subject demonstrates a 2096 reduction of FEV1 from their baseline value 118 Spirometry Bronchodilator and Bronchial Provocation Testing L Viewing results Visualization functions will apply to the test performed by the Current Patient whose name is indicated on the left side of the status bar To view tests results 1 Select Patients from the File menu or press the icon 2 Select the patient corresponding to the test you would like to view 3 Select up to 5 tests to view from the test list box FVC VC IVC or MVV and press OK To switch between graph and or data visualization use the following buttons on the toolbar shows the Flow Volume graph F5 shows the Volume Time graph F6 shows numeric data F7 FEV shows the broncoprovocator response graph F8 If you choose to visualize more than one window at a time select New Window from the Window menu To display the list of tests of the current patient select Test current patient from the View menu or press the icon amp l E Trend To display a trend of more than one test performed by the same patient select View Trend x Select the test to include in the trend graph Hold SHIFT key the keyboark and click on the list in order to select a range of test Hold CTRL key on the keyboard and click
278. the automatic air calibration has been completed 2 Ask the patient to begin by breathing normally into the breathing valve 3 Instruct the patient to perform a Slow Vital Capacity manoeuvre in order to allow for the calculation of lung volumes or select a SVC effort previously performed when the Nitrogen Wash out has been completed 2 4 When the program and the patient are ready press F2 or the icon to begin the wash out procedure 5 Askthe patient to continue to breathe normally until the test comes to an automatic end A normal breathing pattern can be identified when the bars on the right side of the screen are in the green sector You may also choose to end the amp test by pressing F3 or the icon 9 when the FeN is measured below 2 596 To abort the test press Alt F3 or 24 restart the test press 22 Lung volumes FRC test N2 washout 127 i i Ti WO time E FetW2 CFEC 02 02 Fet z FetCoe IV Fi z FiCde2 Fede Fel mm 33 l min sec sec libtps E libtps E E libtps E E E 5 00 03 17 19 1 70 1 79 0 23 45 0 08 153 5 35 15 4 40 0 28 70 0 02 67 40 00 07 15 35 1 62 2 2 0 43 68 53 1 51 54 13 25 60 5 87 0 50 100 00 0 00 59 95 00 11 15 87 1 84 2 09 0 41 62 63 1 62 258 ll 31 61 5 76 0 56 100 00 0 02 65 05 oe 00 15 14 89 1 70 2 43 0 62 60 10 2 54 157 23 33 86 6 04 0 62 100 00 0 01 57 95 da 00 19 14 74 1 73 2 24 0 69 53 33 2 45 420 2b 4
279. this calibration each week in order to prevent wrongs measurements 1 Connect the K4 b unit to the PC by the serial port Remove the sampling plug from the optoelectronic reader 2 Runthe calibration program and choose Delay from the Calibration menu 3 The message Gas calibration in progress will appear and a graph will show in real time the O and CO calibration The software first runs the Room Air calibration At the end of the Room Air calibration the following message appears Analyzers Calibration ES i Connect the sampling line to the flowmeter and press OK button to continue Calilbration Analyzers calibration 47 Connect the sampling tube to the optoelectronic reader and press OK button to start breathing at a constant rate Synchronise the breath inspiration and exhalation with the acoustic signal Continue breathing some cycles until the message Calibration done appears The software open a dialogue box with the new calibration factors and the new delay value Press OK to confirm the calibration 48 Calilbration Analyzers calibration Body Box calibration Enter the Body Box calibration program E Box leakages check Warning Calibrate the body box when it is empty without the patient and closed Wait at least 2 minutes after closing the door before starting the check Select Tests and calibrations Body Box Leakages check The procedure is fully automatic At the end the results will
280. time constant falls within 10 from this value Shutter closing time specifies how long the shutter is closed during a test Suggested panting manoeuvre is the target respiratory frequency We suggest not to modify this value 4 Press OK to confirm changes Cancel to abort or Default to restore the default values E Sending the PNT X9 linearization tables Please follow this procedure after any SW installation or FW transmission if you are using the PNT X9 or when you are using a new PNT X9 1 Enter in the Body Box calibration program 2 Insert the included USB pen drive into the PC 3 Select System Linearization Tables 4 Choose Import a new table and search for XXXXLinTables xml file which is located on USB pen Linearization tables X Import a new table Close Restore default tables 5 Checkthat the number XXXX matches the S N written on the label of PNT X9 you are using as shown below COSMED PREUMOTACH C03800 01 05 S N 6 Select the file it will be stored on your PC Calilbration Introduction 31 Linearization tables Linearization Eable stored an PC 00000155 Close Send Table Restore default tables 7 Select Send Table A warning message alert you that linearization tables are going to be transmitted Select Yes x 2 Sending linearization tables are vou sure COSMED Calibration X 1 1 Linearizati
281. time values Note If the last captured sRaw graph is not visible the loop may not be centered Press to align the loop with the origin of the axes 158 Performing tests with Body Box Test execution gt PFT Suite 10 0 b21 James BOND Real Time Test Raw Tgv x 2 1 Test View Window Help 18 x Abort Capt Valve Zero Filter Align VT sRaw VC 5 E CE PERMET P TEN uoo t 4 4 4 4 4 FEE MEME 50 60 70 80 90 190 110 120 130 140 150 t s nhs Bnd is een rch keel en kd aun ek ke ea sen E ik use im i n tS PIC ICITI S lt nS sect Tos Tm QR tow ow OG sss So tle AR c D fo Dn nb Sut e Wu BC in wn Son com m S n n iu n eS m san on St cs Sd ss S s Filter ON Press CAPT button to capture loop Flow Body Bo
282. to automatically calculate the Anaerobic Threshold Press OK to save changes 212 Exercise testing Data management L Data editing The software allows you to edit the data acquired during the test by performing any of the following functions e deleting one or more steps e editing data e entering new parameters e data filtering average or smoothing e advanced data elaboration Note When viewing Data double click the window to enable Data Editing After editing data you may restore the original breath by breath data file by pressing the Restore button To save the changes select Overwrite WARNING This function replaces the original test and the original data may no longer be restored cr0r 9 i x Phase 1 C 1 Rest C 2 Warm up 00 00 06 1 1 C 3 Exercise C 4 Recovery Marker 10 DK Cancel Preview Filtering Delete step Advanced Restore Overwrite _ 00 00 08 00 00 12 00 00 15 00 00 18 00 00 20 00 00 24 00 00 26 00 00 29 00 00 32 00 00 34 00 00 41 PEE EET 2 Test n 1 Step n 1 7226 Duration 00 10 21 cw To open the Edit test window select Test Edit test or press the icon or double click on the data window Editing a step value 1 Place the cursor on the step to be edited and enter the new value
283. to the Hardware Update Wizard This wizard helps you install software for Cosmed USB Device If your hardware came with an installation CD lt 6 or floppy disk insert it now What do you want the wizard to do Install the software automatically Recommended Click Next to continue 4 Select Install from a list or a specific location and press Next gt Hardware Update Wizard Please choose your search and installation options Pha ta gt Search for the best driver in these locations Use the check boxes below to limit or expand the default search which includes local paths and removable media The best driver found will be installed Search removable media floppy CD ROM L D Don t search will choose the driver to install Choose this option to select the device driver from a list Windows does not guarantee that the driver you choose will be the best match for your hardware 5 Select Search removable media and press Next Installation Software installation 23 Hardware Installation The software you are installing for this hardware Cosmed All madels USB Driver has not passed Windows Logo testing to verify its compatibility with Windows me why this testing important Continuing your installation of this software may impair or destabilize the correct operation of your system either immediately ar in the futu
284. to the next patient in the archive Move to the last patient in the archive Finds a patient in the archive Enters a new patient in the archive Deletes the current patient from the archive 24 Edits the current patient card Note After deleting a record patient visit or test you should reorganize the archive to free additional disk space Visit Card The visit card stores information relative to each visit diagnosis visit description as well as patient information that could change between one visit and another height weight smoking hx Several visit cards may be created for each patient provided they have been created on different days Before carrying out spirometry testing you must either create a new visit card or open a visit card that has been created for that date The following is a description of the buttons within the visit card Moves to the first visit in the archive 90 Archive management and printouts Patient s database Moves to the previous visit in the archive Moves to the next visit in the archive Moves to the last visit in the archive Finds a visit within the archive Enters a new visit card in the archive Deletes the current visit card from the archive Edits the current visit card Test Card The test card stores all of the information about a specific test The following is a description of the buttons within the test card
285. tor in the event of a power failure 2 Constant attention by a qualified individual is required whenever a patient is mechanically ventilated Some equipment malfunctions require immediate action A malfunction may pass unnoticed in spite of equipment alarms 3 Constant attention by a qualified individual is required whenever a patient is measured with the canopy Problems in delivery of fresh gas may pass unnoticed in spite of alarms Use a pulse oximeter to ensure that the patient is sufficiently oxygenated 4 Verify before and during the test that the falls 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 i VE stment amp VE FI RA ow auj stment NOS e GL The knob for flow adjustment is very sensitive For this reason the adjustment must be performed by rotating the knob very carefully After having modified the flow please wait at least 30 seconds in order to visualise the variations 5 Do not place the canopy hood over a patient s head before connecting the tube and applying a continuous flow from the canopy blower 6 In order to obtain reliable results check the integrity of ho
286. ttons gt move the selected parameters from one list to the other The buttons move all the parameters from one list to the other In the section A tests you may choose to view a description beside each parameter by checking the checkbox Show description Checking the checkbox Show SD will show the standard deviation beside each predicted value In the section FVC post you may check the checkbox Show Pre to show the FVC Post as 96 of the FVC Pre Checking the checkbox Show Pred will show the FVC Post as a of the predicted value Print x View Print Sort Customize Not selected paramotor Selected parameters All tests FYC Post Show description Show X Pre Show 5D Show X Pred Select and move the parameters you wish to print by moving them from the left list to the right list Move the parameters you do not wish to be printed from the right list to the left list The buttons gt move the selected parameters from one list to the other The buttons 4 move all of the parameters from one list to the other In the section A tests checking the checkbox Show description will print a description beside each parameter Checking the checkbox Show SD will print the standard deviation beside each predicted value In the section FVC post selecting the checkbox Show Pre will print the FVC Post as 96 of the FVC Pre Checking Show 96
287. tware while spirometry software allows multiple instances among workstations and archives c How to Map Network Drive Before proceeding with installation on each single workstation it is necessary to Map the Folder containing the archive located on the PC A as a Network drive 1 Locate the Archive folder on the net 2 Right click on the folder 3 Select Map network drive 4 Assign a Drive e g Z 5 Select the option Reconnect at logon B Installation of the USB driver mQ Sp SPIRO PFT CPET RMR Windows XP only 1 Insert the Installation CD in the CD ROM drive 2 Connect the device to the PC with the included USB cable The Hardware Update Wizard will be prompted after a few seconds 22 Installation Software installation Hardware Update Wizard Welcome to the Hardware Update Wizard Windows will search Far current and updated software by looking an your computer on the hardware installation CD or on the Windows Update web site with your permission Head our privacy policy Can Windows connect ta Windows Update to search Far software Yes this time only CO Yes now and every time connect a device No not this time Click Next to continue 3 When this screen appears select No not this time when asked if you would like to Allow the connection to Windows update to look for new software then press Next gt Hardware Update Wizard Welcome
288. ty of each gas Measurement of the diffusing capacity is usually performed by using an inspired gas containing Carbon Monoxide CO because of its high affinity for Hemoglobin approximately 210 greater than its affinity for oxygen Carbon Monoxide is soluble in the blood and has an insignificant concentration in venous blood DLCO measurements may be obtained by the following methods 1 Single Breath with Apnea ATS ERS standard 2 Single Breath without Apnea requires a fast response CO analyzer The main parameters measured during DLCO testing include Symbol UM Parameter DLco ml min mmHg Diffusion Capacity DLco 3eq ml min mmHg computed with the Three Equations method DLco VA ml min mmHg Krogh factor ml min mmHg Membrane Diffusion capacity Dm TLC DLCO Total Lung Capacity BW DLCO with breath hold standard technique This procedure consists of instructing the patient to carry out a maximal inspiration and an 8 10 second breath hold during which the expiratory valve is closed followed by a slow exhalation to the level of Residual Volume The inhaled mixture contains a low concentration of CO 0 396 and a tracer gas which is not metabolized CH4 Methane DLco corr ml min mmHg Diffusion Capacity corrected for Hb COHb PB The expired concentrations of CO and the Tracer gas CH are analyzed and the test results are determined The wash out volume collected volume and bre
289. u to conduct the RMR test with a canopy see relative chapter e Stress ECG enables the recording of an ECG during the exercise test e Rest ECG displays the resting ECG e Ifyou choose to drive an ergometer during the test select the device from the Ergometer list e To choose a specific protocol to be carried out during the test select one listed under Protocol e The Workspace list allows you to choose a pre defined workspace or one of three customizable workspaces x Pre exercise Uhren 20 FEV li 437 AHR Kcal day 0 VD ml 0 MVV l min 0 0 RH X User 1 0 00 RH 100 User 2 0 00 ic p 0 00 Post exercise EVE IJ 10 00 T fluss 34 User 3 0 00 FE 1 Ij 10 00 Marker MYY l min 0 0 Distance 0 lin meas IC 1 0 00 4 Pressing Other data allows you to enter additional data obtained from the patient the flowmeter humidity RH fluss and the temperature T fluss The humidity and temperature should be maintained respectively at 100 and 34 You may also choose to set the distance between consecutive testing markers by entering a value in the field Distance Un meas enables the software to calculate parameters if markers are entered at the same distance x Pediatric Small 50 ml Medium 60 ml Cancel Large 70 ml You have the option to enter the dead space created by the
290. ual different Value Formula Specifies the value or the mathematical expression to be compared with the value of the specified parameter All steps Applies the control to all steps Save settings Allows the settings to be saved to an external file to be recovered later Load settings Will recover settings from a file in which the settings were previously saved Press Apply to apply the editing information E Restoring the original test To restore the original test and cancel all the editing press Restore Storing the editing The editing can be permanently saved and replace the original test by pressing Overwrite Smart edit This function is useful to correct data from artefacts To open the smart edit select Test Smart edit PFT Ergo 63 SmartEdit File Test Events View Options Window SmartS mooth Parameter Noise 7 100 0 Ewecute Undo Find li Smart Edit 2 00 00 00 20 01 00 01 20 02 00 02 20 02 00 02 20 04 00 04 30 05 00 05 20 06 00 06 20 07 00 07 30 08 00 08 20 09 00 09 20 10 00 10 20 lol xi Pri Ergo BOND James There are two types of editing graphical noise suppression using the mouse directly on the graph and threshold noise suppression using threshold filtering on the measurements Resting Metabolic Rate Test Data editing 249 Graphical noise suppre
291. upplied together with the system is connected to the Cylinder plug 2 Open the cylinder valve by turning the valve counter clockwise the pressure value must be set within a range of 300 500 Kpa 3 5 bars or 44 73 Psi Calilbration Analyzers calibration 45 5 CO2 16 O2 79 2 Caution Be sure that the cylinder pressure out is regulated to 3 and 5 bar Notice If the pressure regulator is set at a different pressure from what specified room air could be mixed together with reference gas and the calibration could be affected After these operation please operate as follows Reference gas calibration using the PC software 1 Connect the K4 b unit to the PC by the serial port Remove the sampling plug from the optoelectronic reader 2 Runthe calibration program and choose Gas from the Calibration menu Analyzers Calibration 3 The message Gas calibration in progress will appear a graph will show in real time the and CO calibration The software runs first the Room Air calibration so do not connect the sample plug to the calibration kit until the message Sample reference gas will be displayed At the end of the procedure the message Calibration done will be visualized 46 Calilbration Analyzers calibration Analyzers Calibration 4 The dialogue box showing the calibration results will appear press OK to confirm the calibration 5 Remove the sampling line from the ki
292. uring the test 1 Begin storing data in an exercise test F2 or B 2 During the desired phase rest or exercise select CO Graph from Events Event BOND J Event 02 COZ Graph ioj x 02 4 21 1 12 00 20 00 3 00 6 00 15 00 3 00 10 00 z 04 na t hh mm ss 00 06 21 3 When 5 or 6 complete breaths have been acquired press Event End or F3 or the icon g to stop the data acquisition E Spirogram The spirogram event allows you to display and store the Volume Time plot Spirogram event during the test 1 Begin storing data in an exercise test F2 or BH 2 During the desired phase rest or exercise select Spirogram from Events Event 236 Resting Metabolic Rate Test Events management during resting metabolic rate testing BOND 1 Event Spirogram E 101 xi Vil t hh mm ss 00 00 00 10 00 20 00 30 00 40 00 50 hh mm ss 00 09 23 9 2 3 Press Event End or F3 or the icon to stop the data acquisition and store the curve Resting Metabolic Rate Test Events management during resting metabolic rate testing 237 L Viewing results When the test is complete all data that has been stored can be retrieved for complete management Note Many of the following operations are also accessible by right clicking on the active window Data viewing Data can be viewed in the following formats Format Description Table fo
293. w formula To delete a parameter select it from the list and press Delete The Copy button will store the selected parameter in the memory The name of the parameter and predicted set of the stored parameter will be displayed below The Paste button will create a new parameter from the copied parameter If the name already exists you will be asked to specify a new name or to replace the existing parameter Bronchoprovocation mQ PFX Sp SPIRO PFT CPET K4 0 The program allows definition of the bronchoprovocation protocol Select Bronchoprovocation from the Options menu Bronchoprovocation Options X Dosimmeter Parameters Start delay 0 msec Nebulizer driving pressure 37 psi Accepted pressure error 0 x Flowmeter Turbine H 5 ave Display Print Select Protocol ATS Concentration C Dose C Cumulative Dose COSMED Dosimeter Broncho Dilator Agent Salbutamol Quantity 400 0000 Unit meg Logarithmic Graph Broncho Challenge Agent Methacholine Unit mg ml Step H Step 2 Step 3 Step Step 5 Step 6 Step Step 8 Step 9 Step 10 Nebulizer output ml min 0 oso 9 foso oso oso Concentration mg ml 0 0625 02590 16 0000 ES lb bi h js Actuation ms 600 600 eoo soo so eon Dose mca 0 00
294. wait at least the warm up time before beginning calibration or testing procedures E Preparing the device and the patient Follow the instructions described in the chapter nstallation of the User manual for the specific device you have B Starting the test 1 Calibrate the analyzers as described in the Calibration chapter 2 Select Test Execute Test or press the icon gt or press F2 Exercise testing Performing the test 189 Execute Test X Mode Height cm 27 Gas BxB Weight Kg 0 0 C Gas ECG C Mixing chamber C Mixing chamber ECG C RMA with Mask C RMA with Canopy C Stress ECG C Resting ECG Simulated test Ergometer no one Protocol no one Other data Workspace User 1 Details poro bet NN Cancel 3 Enter or modify the anthropometric data of the patient and select one of the following test modes Gas BxB allows you to calculate oxygen consumption during an exercise test breath by breath e Gas BxB ECG calculates oxygen consumption and displays an ECG during the test breath by breath e Mixing chamber allows you to conduct the exercise resting test with the mixing chamber technique e Mixing chamber ECG allows you to conduct the exercise resting test with the mixing chamber technique and displays an ECG during the test RMR with Mask allows you to conduct the RMR test with a face mask see relative chapter RMR with Canopy allows yo
295. window at once select New Window from the Window menu To display a list of tests of the current patient select Test current patient from the View menu or press the icon amp l Respiratory mechanics PO 1 Respiratory drive 151 Performing tests with Body Box General warnings Note Please note the contraindications listed in the first chapter of the User manual of the QBox prior to testing The test must be performed with the included PNT X9 with the sampling line connected The Qbox must be properly connected to the PC and the Quark PFT with the appropriate communication port selected The Cal 5 16960 Bal N2 cylinder must be opened and contain a pressure between 5 and 6 bars R The name shown on the status bar must correspond to the patient carrying out the test di The patient s weight must be as precise as possible in order to guarantee a proper application of the correction factor for the polythropic coefficient A visit card must exist for the current testing date The use of an antibacterial filter is mandatory Do not touch the Body Box the pneumatic tubes and the cart during the test Avoid air displacements in the room where the test will be performed e g a slamming door an opening window etc since the pressure transducers are very sensitive 10 When ending a test please wait for adequate air change inside the Body Box before starting another one Note
296. x Pressure sRaw 44 0004 29 Poet ewe ee eee eee eee eee et ee eee epee eee eee a 1 0 04 01 0 04 PBox cmH20 0 50 0 25 0 50 PBox cmH20 N Se ee 5 hed E 9 gt a E EM 3 2 2 gt sRaw 2 68 cmH20 sec sGaw 0 37 1 cmH20 sec 3 For Help press F1 17 06 2011 James BOND A start beta21 gt PFT Suite 10 0a b21 Immagine Paint cam tp OA O D 12 44 2 The patient must breathe at a constant rate If is selected he se can breathe at current frequency otherwise the frequency must be faster than normal about 1 breath second 60 breaths minute The physician must indicate to the patient if he she needs to increase or decrease his her respiratory frequency in order to normalize the breath Panting frequencies 1 5 Hz 90 breaths minute may lead to errors and those 0 5 Hz 15 breaths min may cause problems with the controlled leak of the body plethysmograph system It is possible to use a metronome to give rhythm to the patient G l 3 To capture a sRaw press In the upper part of the screen a bar will be shown with the measured sRaw and Raw values The values shown calculated based on the predicted TGV because no TGV has been
297. y be higher than the values measured during the initial stages of exercise Having the subject repeat the test may improve reliability particularly if the subject has never previously performed exercise testing Factors that can cause variation in the heart rate response when testing include the following Dehydration e Prolonged exercise prior to testing e Environmental conditions heat humidity ventilation e Fever e Use of alcohol tobacco or caffeine 2 to 3 hours prior to testing The following standard procedures should be followed during each test to ensure accurate and reproducible results and avoid inconsistencies in testing conditions e Standard testing protocol e Consistent ergometer and protocol used for repeat testing e pedal speed maintained during cycle ergometry testing e Cycle seat height properly adjusted recorded and duplicated in repeat testing e Consistent time of day when performing repeat testing e Data collection procedure used is standardized and consistent e Test conditions are standardized e Subjects are free of infection and display a normal sinus rhythm e Subjects do not engage in intense or prolonged exercise for 24 hours smoke for 2 3 hours ingest caffeine for 3 hours or eat a heavy meal for 3 hours prior to the test Room temperature is maintained between 18 20 C 64 68 F with adequate ventilation Sub maximal Exercise Testing Considerations for accuracy 255 L

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