SESSION TYPE: Physiology/PFTs/ Rehabilitation I
PRESENTED ON: Sunday, October 21, 2012 at 01:15 PM - 02:45 PM
PURPOSE: Pulmonary function testing (PFT) in patients with tracheostomies has been perceived as difficult to perform and clinically unreliable. We studied the feasibility, quality, and repeatability of PFT, as well as its clinical significance in these patients.
METHODS: Patients with tracheostomies that underwent PFT from 01/01/2010 to 2/29/2012 were identified. Clinical history and PFT data were reviewed retrospectively. PFT included spirometry and diffusing capacity (DLCO).
RESULTS: Fifty patients (44 male, 6 female) were studied. Forty-nine had cancer: head and neck (33), lung (8), and other (8). Tracheostomies were performed as part of surgical treatment (33), for airway management (15), and due to prolonged intubation (2). Sixteen had known preexisting lung diseases: chronic obstructive pulmonary disease (10), asthma (4), and pulmonary fibrosis (2). The majority (41) had laryngectomies. Indications for PFT included respiratory symptoms (37), pretreatment assessment (10), and abnormal chest imaging (3). Forty-seven (94%) patients were able to perform PFT. Usable spirometry curves were achieved in all, except 4 patients who did not meet American Thoracic Society (ATS) back extrapolated volume criteria. Acceptable repeatability was obtained for FVC in 39 (83%, mean difference 0.07L) and for FEV1 in 41 (87%, mean difference 0.05L). Patients with tracheostomies showed difficulty in meeting ATS end-of-test criteria; only 9 (19%) met plateau criteria and 25 (53%) had exhalation times of greater than 6 seconds. Despite not meeting stringent end-of-test criteria, these tests were reportable. Obstructive pattern was observed in 30 (64%) and restrictive pattern in 9 (19%). DLCO measurements were attempted in 43 patients and satisfactorily obtained in 34 (79%). All met ATS criteria for breath hold time and 26 (76%) met inspiratory vital capacity criteria. Acceptable repeatability was obtained in 32 (94%, mean difference 0.89 ml/min/mmHg). DLCO was decreased in 12 (35%) patients.
CONCLUSIONS: PFT can be performed with reliability in patients with tracheostomies, and they are useful for detecting and classifying types of lung dysfunction.
CLINICAL IMPLICATIONS: PFT in patients with tracheostomies are feasible, reliable, and clinically useful.
DISCLOSURE: The following authors have nothing to disclose: Leendert Keus, Lara Bashoura, Rodolfo Morice, David Blanco, Cheryl Kellner, Xiudong Lei, Saadia Faiz
No Product/Research Disclosure InformationThe University of Texas MD Anderson Cancer Center, Houston, TX