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[Problems in measurement of forced vital capacity--quality assessment with extrapolated volume].

In 1994, the American Thoracic Society proposed criteria for the start of expiration, middle of expiration and end of expiration in order to improve the accuracy of forced vital capacity measurement. Extrapolated volume (EV) and percent extrapolated volume (%EV), which serve as the criteria for the start of expiration, were studied in this paper. It was demonstrated that the values of %V50 and %FEV1.0% increased incorrectly when EV or %EV were outside the criteria because of an erroneous start point for expiration or poor technique. Similar results were obtained in the same subjects, who underwent FVC measurement more than twice with different effort levels. The present study demonstrated that obstructive ventilatory impairment may be underestimated if EV or %EV is outside the criteria. We concluded that the values of EV and %EV are parameters which indicate a rapid rise of the internal pressure of the thoracic cavity at the start of expiration and should be considered in seeking correct measurement of respiratory function including FVC.

Adult↗

Use of vital capacity for cardiac failure risk estimation in persons with coronary disease and left ventricular hypertrophy.

Cardiac failure is a common lethal outcome of coronary heart disease and left ventricular hypertrophy. The efficacy of forced vital capacity (FVC), measured biennially, in predicting the onset of cardiac failure was explored in 818 Framingham Study subjects with those predisposing conditions, among 324 developed cardiac failure. Among the men and women who had coronary disease or left ventricular hypertrophy, those with FVCs in the lower quartile were at substantially increased risk of developing cardiac failure. For men, comparing the lowest quartile with men whose FVCs were in the highest quartile (<2.7 L vs >5.6 L), the risk ratio was 1.8; for women with FVCs <1.7 L, the risk was 2.3 times those with FVCs of > or = 3.5L. The excess risk of cardiac failure imposed by a low FVC was similar in those with coronary disease and left ventricular hypertrophy. The simple FVC is an inexpensive and robust predictor of cardiac failure in persons predisposed by coronary disease or left ventricular hypertrophy. FVC determination should help identify candidates for cardiac failure needing echocardiographic examination for ventricular dysfunction.

Aged↗

Reduced vital capacity in insulin-dependent diabetes.

Spirometry was performed on 88 children with insulin-dependent diabetes mellitus (IDDM) and 216 healthy controls living in Sheffield. Children with IDDM had significantly lower percentage predicted forced vital capacity (FVC) than did control children or reference norms. There was no evidence that the reduced FVC was confined to a subgroup of children, and there was no correlation with duration of IDDM or glycemic control. A longitudinal study of 27 children with IDDM did not show progressive deterioration in percentage predicted FVC with age. These findings suggest that a tendency toward reduced lung volumes exists in IDDM and may not be a direct result of the metabolic disturbances in the disease.

Adolescent↗

Rapidly decreasing forced expiratory volume in one second or vital capacity and development of chronic airflow obstruction.

In a prospective study of 2,406 members of the Belgian Air Force, followed for 3 to 15 yr, 325 demonstrated a yearly decline in FEV1 and/or in vital capacity (VC) that was significantly faster than that expected in healthy nonsmokers. Such rapid declines were met more frequently in heavy smokers and in subjects with a reduced FEV1 or VC. There was no clear-cut association between rapid declines and a history of respiratory diseases. It may be predicted, if the rates of declines do not vary with aging, that about 0.5% of nonsmokers and 4% of heavy smokers in the investigated population will reach disabling airway obstruction (FEV1 of 1.2 L or less) at 65 yr of age. At least 6 to 8 yr of follow-up are required to appreciate with precision the rates of declines in FEV1 or in VC.

Forced Expiratory Volume↗

Surrogate measures of physical activity and physical fitness. Evidence for sedentary traits of resting tachycardia, obesity, and low vital capacity.

Studies on physical activity, physical fitness, and health have been hampered because of invalid, unreliable, or impractical measures of physical activity. This report examines the validity of sedentary traits (resting tachycardia, obesity, and low vital capacity) as predictors of physical fitness as assessed by a maximal treadmill exercise test. Study participants were women (n = 3,943) and men (n = 15,627) with at least one visit to the Cooper Clinic in Dallas, Texas. Association of the sedentary traits with physical fitness was examined by multiple regression analyses. Sedentary traits were associated with physical fitness in all age and sex groups, accounting for 12-40% of the variance in treadmill time. When smoking, a simple physical activity index, and sedentary traits were included in a model to predict physical fitness, R2 values ranged from 0.20 to 0.53 in women and 0.45 to 0.61 in men and were significant at p less than 0.0001. These models account for approximately twice as much variance in physical fitness as has been reported previously. The addition of sedentary traits measurements to a simple physical activity index provides a valid estimate of physical fitness in epidemiologic studies.

Adult↗

Forced vital capacity in Malaysian females.

Spirometry was performed on 614 female subjects ranging in age from 13 to 69 years and comprising all the main races in Malaysia. They were divided into six age categories. Mean forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were 2.51 +/- 0.02 and 2.31 +/- 0.02l, respectively. Both FVC and FEV1 correlated negatively with age. Regression analysis revealed an age-related decline in FVC of 220 ml per decade of life. Multiple stepwise regression of the data for the prediction of an individual's FVC above the age of 20 years gave an equation: FVC(l) = 0.0312 (height)-0.022 (age)-1.64. Predicted FVC values derived from equations based on other populations were considerably higher than the observed mean in this study. Our study, therefore, reemphasizes the need to be cautious when applying formulae derived from one population to another. Grossly erroneous conclusions may be reached unless predicted equations for lung-function tests for a given population group are derived from studies based on the same population group.

Adolescent↗

Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) variability in asymptomatic never-smoking men.

We examined the effects from subjects, technicians and spirometers on within-session variability in successful recordings of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) in 4989 asymptomatic never-smoking men. All eligible men aged 30-46 years living in western Norway (n = 45,380) were invited to a cross-sectional community survey. Information on respiratory symptoms, smoking habits and occupational exposures was obtained from a self-administered questionnaire. Three successful FEV1 and FVC recordings were obtained in 26,368 attendants using three dry-wedge bellow spirometers operated by 10 different technicians. Within-subject standard deviation (SD) from three recordings of FEV1 and FVC was on average 102 and 106 ml, respectively, and increased with height (14 and 17 ml, respectively, per 10 cm) and body mass index (BMI) (11 and 14 ml, respectively, per 5 kg m-2). Between-subject SD of the mean of three FEV1 and FVC recordings was 591 and 754 ml, respectively, and increased in groups of increasing height (43 and 40 ml, respectively, per 10 cm). Small, but significant, differences were observed between technicians in within-subject SD and in levels of FEV1 and FVC. Homogeneity of between-subject variability, necessary for linear regression analysis, was obtained using FEV1 and FVC divided by height squared. In conclusion, within-subject variability in three successful spirometric recordings was small, but dependent on height and BMI of the subjects as well as technician performance. The observed heterogeneity in between-subject variation in FEV1 and FVC levels disappeared when each variable was divided by height squared. Novel multiple linear regression equations for FEV1/height2 and FVC/height2 were developed to be used in evaluating the effects from occupational airborne exposures in Nordic men aged 30-46 years.

Adult↗

[The effect of trigeminal zone irritation on parameters of forced vital capacity in humans].

In 44 healthy males aged 18-21 years, the authors studied the effect of irritation of the trigeminal zone by ammonia vapors and by immersion of the face into water on parameters of forced vital capacity. Inhalation of ammonia immediately induced impairment of all the studied parameters of forced expiration. In the later time intervals (up to the 10th minute after inhalation) the air flow remained reduced over the whole forced expiration (FVC/FET), mainly at the expense of decreased air flow at the end of forced expiration (FEF75-85%). Inhalation of ammonia also resulted in abolition of the psychically induced higher heart rate and in its normalization. Immersion of the face into cold water caused reduction in the values of FVC, FEV1, FVC/FET, and FEF0-25%. After voluntary apnea in the air there was only a small reduction of FEF0-25%. In the light of these findings, the authors consider irritation of cold receptors of the face to be the main cause of the changes in functional parameters of the lungs during immersion reflex.

Adolescent↗

Forced vital capacity (FVC) as an indicator of survival and disease progression in an ALS clinic population.

In a large cohort of 1034 patients with the diagnosis of definite or probable amyotrophic lateral sclerosis (ALS), the association of forced vital capacity (FVC) at baseline with (a) time to progression of 20 points in Appel ALS (AALS) score or (b) tracheostomy free survival was investigated. The median survival of ALS patients with baseline FVC <75% was 2.91 years, compared with 4.08 years for patients with baseline FVC >75% (p<0.001). Patients with baseline FVC <75% progressed more rapidly (taking 8.0 months to progress 20 AALS points) compared with patients with baseline FVC >75% (10.0 months, p<0.001). Moreover, FVC at first examination was identified as a significant predictor of survival and disease progression in both univariate and multivariate Cox regression models, after adjustment for age, sex, site of onset, diagnostic delay, riluzole therapy, and use of bilateral positive airway pressure and percutaneous endoscopic gastrostomy (p<0.001). We conclude that a single FVC value obtained at an initial visit may serve as a clinically meaningful predictor of survival and disease progression in ALS.

Adult↗

Postural change of forced vital capacity predicts some respiratory symptoms in ALS.

The detection of respiratory muscle weakness in ALS is necessary to plan initiation of noninvasive positive pressure ventilation and begin discussion of advanced directives. The authors measured the erect seated and supine forced vital capacity (FVC) in 38 patients with ALS and 15 controls. The supine FVC is significantly lower and the erect--supine FVC difference is significantly greater in patients with complaints of dyspnea, orthopnea, and daytime fatigue.

Adult↗

Effect of vital capacity manoeuvres on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery.

BACKGROUND: Arterial oxygenation may be compromised in morbidly obese patients undergoing bariatric surgery. The aim of this study was to evaluate the effect of a vital capacity manoeuvre (VCM), followed by ventilation with positive end-expiratory pressure (PEEP), on arterial oxygenation in morbidly obese patients undergoing open bariatric surgery. METHODS: Fifty-two morbidly obese patients (body mass index >40 kg m-2) undergoing open bariatric surgery were enrolled in this prospective and randomized study. Anaesthesia and surgical techniques were standardized. Patients were ventilated with a tidal volume of 10 mL kg-1 of ideal body weight, a mixture of oxygen and nitrous oxide (FiO2 = 40%) and respiratory rate was adjusted to maintain end-tidal carbon dioxide at a level of 30-35 mmHg. After abdominal opening, patients in Group 1 had a PEEP of 8 cm H2O applied and patients in Group 2 had a VCM followed by PEEP of 8 cm H2O. This manoeuvre was defined as lung inflation by a positive inspiratory pressure of 40 cm H2O maintained for 15 s. PEEP was maintained until extubation in the two groups. Haemodynamics, ventilatory and arterial oxygenation parameters were measured at the following times: T0 = before application of VCM and/or PEEP, T1 = 5 min after VCM and/or PEEP and T2 = before abdominal closure. RESULTS: Patients in the two groups were comparable regarding patient characteristics, surgical, haemodynamic and ventilatory parameters. In Group 1, arterial oxygen partial pressure (PaO2) and arterial haemoglobin oxygen saturation (SaO2) were significantly increased and alveolar-arterial oxygen pressure gradient (A-aDO2) decreased at T2 when compared with T0 and T1. In Group 2, PaO2 and SaO2 were significantly increased and A-aDO2 decreased at T1 and T2 when compared with T0. Arterial oxygenation parameters at T1 and T2 were significantly improved in Group 2 when compared with Group 1. CONCLUSION: The addition of VCM to PEEP improves intraoperative arterial oxygenation in morbidly obese patients undergoing open bariatric surgery.

Adult↗

Vital capacity following traumatic brain injury.

This study was designed to describe lung volume subdivisions in individuals with traumatic brain injury. Records were reviewed for 114 consecutive referrals for motor speech evaluations in a community re-entry residential rehabilitation programme. Obtained measures were vital capacity, inspiratory capacity, and expiratory reserve volume at the time of evaluation. Seventy-nine per cent of subjects evidenced at least moderate deficits in expiratory reserve volume, with 60% evidencing severe deficits. Inspiratory capacity was the least affected, with 61% of subjects evidencing values within normal limits. Possible contributors to reduced expiratory reserve volumes include expiratory muscle weakness due to physical inactivity, inability to voluntarily perform the task, or perceived effort.

Adolescent↗

Single-breath vital capacity rapid inhalation induction in children: 8% sevoflurane versus 5% halothane.

BACKGROUND: The authors compared the speed of induction of anesthesia with sevoflurane with and without nitrous oxide with the speed of halothane and nitrous oxide using a single-breath vital capacity induction. METHODS: With informed parental consent, 51 healthy unpremedicated children aged 5-12 yr were randomized to inhale a single breath of one of three gas mixtures: 8% sevoflurane in 66% nitrous oxide, 8% sevoflurane in oxygen, or 5% halothane in 66% nitrous oxide. A blinded observer recorded the times to loss of the eyelash reflex, return of conjugate gaze, the presence of airway reflex responses, involuntary movement, and hemodynamic responses. RESULTS: Forty-two children completed the study. The times (mean +/- SD) to loss of the eyelash reflex with sevoflurane/nitrous oxide, 38+/-8 s, and for sevoflurane-oxygen, 34+/-12 s, were less than that with halothane-nitrous oxide, 58+/-17 s (P < 0.01). Movement occurred less frequently during sevoflurane than during halothane anesthesia (P < 0.05). The times to return of conjugate gaze and the incidence of airway reflex responses were similar among the groups. The incidence of dysrhythmias in the sevoflurane groups was less than that in the halothane group (P < 0.01). CONCLUSIONS: Induction of anesthesia with a single breath of 8% sevoflurane with or without 66% nitrous oxide is more rapid than with 5% inspired halothane with 66% nitrous oxide in children. The incidence of movement and dysrhythmias during a single-breath induction with sevoflurane are less than they are with halothane.

Anesthesia, Inhalation↗

Rapid lung volumetry using ultrafast dynamic magnetic resonance imaging during forced vital capacity maneuver: correlation with spirometry.

INTRODUCTION: Dynamic magnetic resonance imaging (MRI) has the potential for rapid noninvasive evaluation of changes in lung volume. The aim of this study was to perform rapid lung volumetry using ultrafast dynamic MRI to capture a forced vital capacity (FVC) maneuver. MATERIALS AND METHODS: Nine healthy volunteers underwent 2-dimensional spoiled gradient echo imaging in coronal and sagittal planes during FVC maneuvers. An elliptical model of the axial cross section of the lungs was used to generate rapid volume-time curves. Spirometric indices were correlated with MR volumetry findings. RESULTS: Total lung volume calculated from static MRI correlated well with the dynamic MR scans (r = 0.83; P < 0.01). Spirometric indices (first second of forced expiration and FVC) calculated from our MR volumetry technique correlated well with conventional spirometry (P < 0.01). CONCLUSION: The technique provides a means of sampling lung volume change during the rapid subsecond movements that take place during a FVC maneuver.

Adult↗

Developmental perspective of pulse rate, blood pressures and vital capacity in Chinese children.

Physiological development in Chinese children was analysed based on a national survey sample. Close to half a million children and adolescents, aged 7-18 years, from Han and 27 minority nationalities were assessed for pulse rate, systolic and diastolic blood pressure, and forced vital capacity in these 12 age groups. The factors of age, sex, race, and region (urban/rural, north/south) were analysed. P95 hypertension screening standard was established for each age group. These results were compared with research reports from world literature.

Adolescent↗

Vital capacity, respiratory muscle strength, and pulmonary gas exchange during long-duration exposure to microgravity.

Extended exposure to microgravity (microG) is known to reduce strength in weight-bearing muscles and was also reported to reduce respiratory muscle strength. Short- duration exposure to microG reduces vital capacity (VC), a surrogate measure for respiratory muscle strength, for the first few days, with little change in O2 uptake, ventilation, or end-tidal partial pressures. Accordingly we measured VC, maximum inspiratory and expiratory pressures, and indexes of pulmonary gas exchange in 10 normal subjects (9 men, 1 woman, 39-52 yr) who lived on the International Space Station for 130-196 days in a normoxic, normobaric atmosphere. Subjects were studied four times in the standing and supine postures preflight at sea level at 1 G, approximately monthly in microG, and multiple times postflight. VC in microG was essentially unchanged compared with preflight standing [5.28 +/- 0.08 liters (mean +/- SE), n = 187; 5.24 +/- 0.09, n = 117, respectively; P = 0.03] and considerably greater than that measured supine in 1G (4.96 +/- 0.10, n = 114, P < 0.001). There was a trend for VC to decrease after the first 2 mo of microG, but there were no changes postflight. Maximum respiratory pressures in microG were generally intermediate to those standing and supine in 1G, and importantly they showed no decrease with time spent in microG. O2 uptake and CO2 production were reduced (approximately 12%) in extended microG, but inhomogeneity in the lung was not different compared with short-duration exposure to microG. The results show that VC is essentially unchanged and respiratory muscle strength is maintained during extended exposure to microG, and metabolic rate is reduced.

Adult↗

[Remarks on finding "real" sexual differential values--presented by the example of measurements of vital capacity (author's transl)].

Investigations conducted over many years have lead to the proposal to use - on the basis of classes of equal stature - the "female-male-index" (Ifm) for anthropometric, physiological and physical-athletic measured or performance values, respectively, which correlate significantly with stature. A "standard table for measurements of vital capacity by dry spirometer" is used to present this method of applying the "real" sexual differential values.

Adolescent↗