Vol. 14 •Issue 24 • Page 24
Best PFT Labs Share Common Denominators * Best PFT Labs Share Common Denominators
BY francie scott
The largest pulmonary function labs in the U.S. share a few common threads that keep them on the cutting edge: they are busy and they are innovative. In terms of technology, state-of-the-art pulmonary function labs have switched from volume replacement devices to pneumotach, computerized technology. They also offer therapists opportunities to develop new tests to help pulmonary and cardiac patients live productive and interesting lives.
Take the high altitude simulation test as an example. Healthy people don’t notice fluctuations in oxygen concentration when they fly, but compromised patients may well need supplemental oxygen to remain comfortable and safe on long flights. Most airlines pressurize their cabins for comfort at 5,000 feet, but airliners frequently cruise at heights of 35,000 feet, explained Alan Backman, CRTT, RCPFT, technical director of pulmonary diagnostics at the Deborah Heart and Lung Center in Browns Mills, N.J.
By mixing gases that mimic the oxygen concentrations in flight at 35,000 feet, Backman and his team identify patients who need the additional oxygen boost in flight.
The PFT laboratory staff perform as many as 70,000 procedures per year under the leadership of Carl Mottram, BA, RRT, RPFT, FAARC, at the outpatient lab at the Mayo Clinic in Rochester, Minn. Recent innovations include nitric oxide analysis that enables clinicians to identify markers for inflammatory airways disease. Mayo Clinic PF staff collect exhaled air and analyze it for nitric oxide content and use esophageal balloons to measure lung compliance, resistance and diaphragmatic function. Mottram explained that the laboratory has several technologist-driven protocols which allow staff to select or guide the testing sequence in a manner that best meets the needs of the patients and provides the highest diagnostic yields for their physicians..
Backman and his team at Deborah conduct tests for gastroesophageal reflux to identify the subgroup of patients who struggle with this condition as part of their clinical picture. Backman noted that many COPD and asthma patients are included in this group. Symptoms for patients with significant reflux include chronic cough, nocturnal exacerbations, sub-clinical bronchitis and micro-aspiration. Current data indicate that as many as 80 percent of asthmatics suffer from gastroesophageal reflux as a contributing factor.
Deborah’s team also conducts flow-volume loops on sleep apnea patients to document the status of the soft tissue at the back of their throats.
Therapists staffing inpatient pulmonary function testing departments also have developed innovative tests to help them identify problems patients encounter. At the Mayo Clinic, for example, Kris Hammel, RRT, RPFT, and her staff came up with an “interrupter technique” to conduct pulmonary function tests on mechanically-ventilated patients. Hammel described it as “a hybrid system,” designed especially for patients in the chronic ventilator unit.
Other innovative procedures include measuring bone density, assisting with upper endoscopy and gas exchange measurements during maximal VO2 studies. Mayo therapists see their fair share of complex patients, both cardiac and pulmonary. They conduct pre-operative bedside spirometry and assess cardiac patients with arrhythmias. Even then, standard PFT tests account for “barely one third of the work load,” at the Mayo Clinic, Hammel said.
Therapists run a metabolic cart, assessing the nutritional status of patients with eating disorders and predicting the calorimetric needs of patients who are critically ill. They staff a sputum induction lab and conduct cytology studies on patients who may have lung cancer.
Therapists at Mayo also enjoy research opportunities, which they conduct in collaboration with 79 clinical research mentors.
You can reach Francie Scott at fscottnz@ email.msn.com.