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1. unseesseesseesneesneneneeeneeensennne nen 108 View predicted values 108 Anaerobic Lactate Threshold detection 108 View the Lactate Threshold enene 108 Detect the Lactate Threshold u 108 Customise graphs for the LT viewing 108 PItungsn aka MN NN ek 109 Fit a graph with a linear regression 109 Fit a graph with a Mono exponential regression 109 Calculate the Mean Value 110 Oxygen Kinetie nuan gen ae a aa Kein 110 Run the O2 Kinetic function enneeneneennenen 110 Information about the Test 111 View the Information 111 Modify the information 111 SUMIM ALY steuern ieo ie i E E E 111 View the summary eesssensennsensensnnsennensnonn 111 Printthe data mutants 111 Print the current window 112 Chapter 17 Appendix 7 Printithe report nennen 112 View the feport Ein den dt stzeves tus cots ie reede riie 112 Data Editing cssesssssesesesesssnsasassrsessnsssenennsussessenssensesnnssuseessetsse rer 113 Editing values and input numerical values 113 Data Hering sieissanto tni a 113 Using the User fields 114 Deletingisteps nennen 114 Advanced Editing ne 114 Restore the original test 115 Overwrite the original test 115 Customise the d
2. 10 minutes with data acquisition of which the software will make an average at the end of the test automatic end of the test after the 16 minute e Selection of the RMR workspace windows placement The test is fully automatic the software will stop it and save the data at the end of the 16 minute The real time view is as shown in the following picture 128 Quark PFT User Manual Viewing the test AAA Nota The percentage of used Proteins PRO is calculated assuming 12 grams of Ureic Nitrogen in 24 hours You can modify this value selecting View Information gt Modify PFT Ergo InfoCenter BE File Test View Events ECG indow Demo Pe Sl oi UE 18 48 ETO START _STOP EVENT MARK LORD Wer gt UMO REC ORS BS vo2 ve02t BOND J test n 8 1315 US VEHRR BOND J test n 8 lolx vo2 V02 ml min VCOZ ml min VE 1 min HR bpm 386 370 370 vco2 321 287 287 R 083 O77 0 77 Rf 15 0 148 14 8 EEkc 26777 2529 0 2529 0 00 00 01 00 02 00 03 00 04 00 05 00 06 00 07 00 MB BOND 4 test m 8 lof x t Rf VE vo2 vco2 vo2 Kg R Feo2 FeCO2 HR vo2 HR Loadi Ti Ttot VD VT hh mm ss b min l min ml min ml min ml min Kg bpm ml bpm ae SE 00 00 31 15 0 10 6 386 321 5 08 0 83 16 57 3 78 72 5 3 0 0 38 0 28 ON NAN 1ao ne E1 non n a 25 r ann son a 07 nm 4e sn am m A aan PbimmHg 741 RH 56 Temp C
3. Spirometry patient s database ir AAA Note after having deleted a record patient visit or test it is recommended to reorganize the archive in order to free disk space The Patients database consists of a Patient Card a Visit Card and a Test Card in which are listed all tests performed by the patient Select Archive Navigator from the File menu or press the button by side The Archive Navigator xi Patient Card Tests to Display mo a 09 10 1995 FVC Name 1001 Last 1001 iDf1001 Birth 0170171975 Visit Card a hes D amp A Dae 071078 en S 0 amp 8 Height cm 180 Weight Kg 70 Age 120 Smoke Drug DRUG pre No Yes Ex Year fo Cig Day 0 Borderine Obstuction Diag Borderline Obstruction Description S Quality Control Diagnosis Blow out longer FET100 lt 6 sec chec Notes Patient Card It collects all the information of a patient first name last name date of birth which remain the same for each visit For each patient there is only one Patient Card which is created the first time the Patient performs a test FE Sa mn m lt T To move within the database use the following buttons Move to the first patient in the archive Move to the previous patient in the archive Move to the next patient in the archive Move to the last patient in the archive Find a patient in the archive Enter a new patient in the archive Delete current patient fro
4. m AT nz N q 0 0002 4e Te2y 2434 JEWJON 682 z wyBy INg 60r OHO 9 659 1V4 Z wdq YH 0SL 09 06 uiw 3A Ob lt IIL ssejo Asaqo We PLL Oz Le uiua 44 6 6E 0 SE 11 ssejo Aysaqo Z POL gzz sez uw w ZODA 6 tE 0 0 ssejo us qO L LOL 992 982 uiw ZOA 6 6Z 0 SZ u lemiano 8 96 G8 0 z8 0 Y 6 pz S 8l JEWJON HELL 6 LELL L L86L Aepy eoy YW g8l gt 1y lemispun 0 S6 00 01 08 60 ss ww awi s u w 2 S Ing Pad Pad ysoy Jayewieied JeJe 1106180949 8SI9J8X3 pe07 JUEJSUOT S8JoN Sez 2 5 INE 6b Zvw Ysg 081 wdg xew YH 020 dxe Sd1g 00 91 00 ss ww yy voneing 0 92 B4 14518M 180 L ds Sd19 ze sdajs Jo N 0 821 ws 1459H 662 0 ddLlS 00 00 3w Isa Op 25y 4z 9 seasBap ainjeseduiay LEGLICO EL ep IsaL W xag lez Byww ssaid auyawaleg Jaqwnu s j 000 2p09 qI SINVT eweu 7114 GNOS eweu jse7 y pawsooMoju Jew 3 h pawsoo MMM dyju ae 08SFLE690 6 XEJ Z69SLE690 6 19 Ale awoy 07000 XOA O d 4 Trs Q3NSOI Chapter 14 Resting Metabolic Rate Test 131 Performing a test using the canopy option Calibrations The principle of a ventilated bubblehood system is that a stream of air is forced to pass across the face of a subject and mixes with the air which is collected by a transparent hood placed over the subject s head A measurement system knowing the flow rate calulates the oxygen consum
5. Description Quark PFT4 unit Turbine 28mm Kit optoelectronic reader Quark PFT 2 3 4 Breathing valve PFT3 4 3 ways Calibration syringe 3 litres Permapure L 2 m Antibacterial filter Nose clips Paediatric paper mouthpieces Adult paper mouthpieces Antimoisture filter PC software Power cord Schuko 2 mt Serial cable RS 232 DB9 M F Tank tubing 6m Air valve membrane Time Lag Fuses 5x20 250V T630 mA Time Lag Fuses 5x20 250V T1 25A Registration card PTE soft mouthpieces User manual Quark PFT Conformity declaration Chapter 1 Getting started 23 Quark PFT Ergo standard packaging Code C00935 01 04 C02120 01 05 C02170 01 11 C00243 01 06 C02210 02 08 C01399 02 12 A 800 900 001 C02125 01 10 C02135 01 10 C02145 01 10 A 182 310 001 C01788 01 36 C01790 01 36 A 362 060 001 A 362 300 001 C00191 01 11 C00861 01 06 A 661 200 001 A 661 200 002 A 680 013 630 A 680 024 125 C00067 02 94 C01340 02 91 C01999 02 DC Qty 1 1 1 1 2 1 2 1 1 1 5 1 1 1 1 1 1 1 1 2 2 1 1 1 Description Quark PFT Ergo unit Turbine 28mm Kit optoelectronic reader Ergo Calibration syringe 3 litres Permapure L 2 m Cable in HR TTL Head cap for the adult masks Mask mouth nose breath adult S Mask mouth nose breath adult M Mask mouth nose breath adult L Anti moisture filter PC software Spiro PC software Ergo Power cord Schuko L 2m Serial cable RS 232 DB9 M F Tank tubing 2m HR probe Polar belt HR
6. Message interpretation Criterion Normal Spirometry FVC and FEV1 FVC gt LLN Obstructive abnormality it may be physiological Pred FEV1 gt 100 Obstructive abnormality mild Pred FEV1 lt 100 and gt 70 Obstructive abnormality moderate Pred FEV1 lt 70 and gt 60 Obstructive abnormality moderately severe Pred FEV1 lt 60 and gt 50 Obstructive abnormality severe Pred FEV1 lt 50 and gt 34 Obstructive abnormality very severe Pred FEV1 lt 34 Restrictive abnormality mild FVC lt LLN and Pred FVC gt 70 Restrictive abnormality moderate Pred FVC lt 70 and gt 60 Restrictive abnormality moderately severe Pred FVC lt 60 and gt 50 Restrictive abnormality severe Pred FVC lt 50 and gt 34 Restrictive abnormality very severe Pred FVC lt 34 Quality Control Messages Reference Spirometry in the Lung Health Study Methods and Quality Control ARRD 1991 143 1215 1223 Message Criterion Start faster VEXT gt 5 of the FVC and gt 150ml Blast out harder PEFT gt 120 msec Avoid coughing 50 drop in the flow in first second Blow out longer FET 100 lt 6 sec 156 Quark PFT User Manual Blow out more air Blow out harder Take a deeper breath Blow out faster That was a good test FVC reproducible FEV1 reproducible PEF reproducible MVV time too short flow gt 0 21 s within 20 ml of FVC dPEF lt 10 dFVC lt 200ml and 5 best FVC dFEV1 lt 200ml and 5 FEV1 No errors diff 2 m
7. Reference Standardization of Spirometry 1994 Update American J Respiratory Critical Care Medicine Vol 152 1107 1136 1995 ATS recommendations Volume range 81 BTPS Flow range 14 l sec Volume accuracy 3 or lt 50ml Flow accuracy 5 or lt 200ml sec Flowmeter resistance lt 1 5 cmH20 da 0 a 14 l sec Reproducibility the 2 largest of 3 acceptable FEV1 and FVC values should be within 5 or 150 ml The end of test no change in volume for 1 second with at least 6 seconds of collected volume Accumulation time the maximum time allowed for volume accumulation during the VC manoeuvre should be at least 30 seconds and at least 15 seconds during the FVC The spirometer should be store at least 8 FVC maneuvres FEV1 should be calculated by using the back extrapolation method to detect the start of the test extrapolated volume must not be higher then 5 FVC or 150ml The graphic resolution of the printed report must be as in the following Volume 10 mm l Flow 5 mm l sec Time 20 mm sec F V ratio 2 1 The total number of error FVC e FEVI gt 3 5 FEF25 75 gt 5 5 during the measurement of the 24 standard waveforms must be lower than 4 154 Quark PFT User Manual Predicted values ERS93 Standardized Lung Function Testing Official Statement of the European Respiratory Society The European Respiratory Journal Volume 6 Supplement 16 March 1993 Compilation of reference va
8. from the Options menu 2 Select the parameters and confirm Parameters to view Ea Select parameters to view E Q If you are using the Quark with a treadmill without serial interface it is possible to enter manually from the PC the event the phase and the marker Enter Load and Phase 1 During the test select Load from the Events menu 2 Select the phase and or type the value of the load and press OK to confirm Set the markers Select Marker from the Events menu The software allows to automatically control the ergometer according to the protocol previously selected Anyway it is allowed to change it even after the test is started Modify the load during the test 1 During the test choose Ergometric protocol from the Events menu 2 Select the row corresponding to the desired load and press OK to confirm The software allows the user to set the alarm level for the heart rate in order to monitor the patient response Enter the BPM 1 Choose BPM alarm from the Events menu 2 Set the alarm by moving the scroll bar and press OK to confirm It also allows to enable or disable the acoustic alarm by the option Acoustic alarm Chapter 13 Exercise Testing 105 Data management As soon as the test has been completed all data stored can be retrieved for a complete management Viewing data Data can be viewed in the following formats Table form Graphic form Summary Predicted numeric values of the
9. For Help press F1 21 08 2003 James BOND NUM 96 Quark PFT User Manual Airway resistance measurement option The airway resistance measurement test The measurement of the airway resistance is an important determinant for the assessment of the respiratory system Traditional methods of measurement are based on body plethysmography which although highly standardised require a certain degree of patient s co operation In many cases critical illness acute asthma geriatric and unconscious patients neonates pre school children this is not possible and different measuring methods are required Instruments based on the interrupter technique are good alternatives to body plethysmography The idea behind the interrupter technique is that alveolar pressure will rapidly equilibrate the pressure at the mouth during a transient airflow interruption Thus if we provoke an airflow interruption and measure the pressure at the mouth immediately after the interruption we are able to express the airway resistance as the ratio between the pressure at the mouth identical to alveolar one and the value of the flow before the interruption The Appendix reports bibliographic references which demonstrate a high reproducibility and correlation between the values so measured and those measured by body plethysmography The measured parameters are the following Roce ex Expiratory resistance Gocc ex Expiratory conductance Roce in Inspirator
10. The returned goods need to re enter COSMED together with the customs documents Pro forma Invoice and Customs Paper as requested by the Italian law e The shipment has to be qualified as a Temporary Export e All the goods returned to COSMED without the customs papers will not be accepted For European Community members Pro Forma invoice complete with e Number e Description of the goods e Quantity e Serial Number e Valuein e Number of parcel e Gross weight e Net weight e Reason for resent i e Resent for repair In case you should send the system for repair please contact the nearest service centre or contact COSMED at the following address COSMED S r l Via dei Piani di Monte Savello 37 P O Box 3 00040 Pavona di Albano Rome Italy tel 39 06 9315492 fax 39 06 9314580 E mail customersupport cosmed it For USA customers only please contact COSMED USA Inc 2758 North Paulina Chicago IL 60614 USA Phone 1 773 528 8113 Fax 1 773 528 8116 email usa sales cosmed it To ensure that you receive efficient technical assistance please specify as precisely as possible the nature of the problem as it is specified on the assistance information form We advise you to save the original packaging You may need it in case to ship the unit to a technical assistance centre Chapter 17 Appendix 149 Privacy Information Dear Customer we inform you that your personal data are gathe
11. 25 Mixing chamber 00 30 Ru o O MEA g SE I By Espora risorse FO Posta in arrivo m BA QPFT Chaptit co PFT Ergo W Jasc Paint Shop Pro a At the rend of the test it will be opened automatically a window with the test results I Fie Test Events View Options Window 2 18 x 035 22 AANT Far Far A vu A vR Parameter Rest Pred Pred BMI Statements Time mm ss 09 30 10 00 95 0 Underweight lt 18 5 RMR Keal day 1981 1 1731 9 114 3 Normal 18 5 24 9 0 82 0 85 96 8 Overweight 25 0 29 9 ps ml min 286 266 107 7 Obesity class 30 0 34 9 VCO2 ml min 235 226 104 2 Obesity class II 35 0 39 9 Rf b min 13 7 12 0 114 2 Obesity class Ill gt 40 VE l min 9 0 60 150 4 HR bpm 72 FAT 59 5 CHO 40 9 BMI Kg m 2 23 9 Normal Eke Keal day 3500 04 r T 3000 2500 2000 1500 1000 t hh mm ss 00 00 01 00 02 00 03 00 04 00 05 00 06 00 07 00 08 00 09 00 10 00 11 00 12 00 13 00 14 00 15 00 16 00 17 00 18 00 19 00 20 00 At the end of the test or if it is selected View RMR the main results are shown e The average time interval default 10 minutes e Average values of VO VCO R RMR RF VE HR FAT and CHO and predicted values if available e Body Mass Index BMI and interpretation e Graph of the energetic expenditure for all the data acquisition interval highlighting the selected average inte
12. CH4 21 O2 N2 balance 1 Remove the sampling line from the flowmeter 2 Select CO diffusing capacity steady state from the Test menu 4 Wait for the zeroing of the analyser is completed and plug in again the sampling line in the flowmeter 5 Connect the Patient to the mouthpiece and let her him breathing at rest until the message Carry out Vital Capacity is prompted 6 Carry out a Slow Vital Capacity if desired this is not necessary for completing the DLCO test 7 While the patient is exhaling press F2 in order to start the mixture 8 When the steady state is reached press F3 to end the test Right clicking you can generate new graphs and parameters to be displayed both during the test and at the end Chapter 9 Lung diffusing capacity 91 92 Quark PFT User Manual MIP MEP option MIP MEP test The MIP MEP test measures the maximum inspiratory expiratory pressure of the patient He She breathes normally until the start of the test perform a maximal expiration inspiration and then inspires expires with the maximum force against a valve which does not allow the air flow The measured parameters are MIP MEP Maximum inspiratory pressure Maximum expiratory pressure How to perform the test TEST 1 Disconnect the breathing valve from the front panel of the Quark 2 Connect the MIP MEP valve to the breathing valve connector on the front panel of the Quark and insert the flowmeter into the valv
13. G Borsboom ERJ 1989 2 Supp 4 184s 261s Reference Values for Residual Volume Functional Residual Capacity and Total Lung Capacity ATS workshop on Lung Volume measurements official statement of the European Respiratory Society J Stocks Ph H Quanjer ERJ 1995 8 492 506 Single Breath Oxygen Test Buist SA Ross BB Quantitative Analysis of the Alveolar Plateau in the Diagnosis of Early Airway Obstruction ARRD 108 1081 1973 Mansell A Bryan C Levison H Airway Closure in Children JAP 33 711 714 1972 Buist SA Ross BB Predicted Values for Closing Volumes Using a Modified Single Breath Test ARRD 107 744 751 1973 Rint Lombardi E Sly PD Concutelli G et al Reference values of interrupter respiratory resistance in healthy preschool white children Thorax 2001 56 691 695 Mip Mep Leo F Black Robert E Hyatt Maximal Respiratory Pressures Normal Values and Relationship to Age and Sex American Review of Respiratory Disease Volume 99 1969 Vincken W Ghezzo H amp Cosio MG 1987 Maximal static respiratory pressures in adults normal values and their relationship to determinants of respiratory function Bull Eur Physiopathol Resp 23 435 439 Automatic diagnosis algorithm Reference Lung Function Testing selection of reference values and interpretative strategies A R R D 144 1991 1202 1218 LLN Pred 0 674 SD ATS 50 percentile LLN Pred 1 647 SD ERS 95 percentile LLN Pred 0 8 80 Pred
14. The software is provided with three free fields in which the user may enter values coming from others devices such as lactate blood pressure etc To define the user fields 1 Choose User Fields from the Options menu 2 Type the desired text in the input fields and press OK To enter values in the user fields 1 Choose Edit test from the Test menu 2 Scroll horizontally until the fields USER 1 2 and 3 3 Enter the desired values and press OK to confirm Deleting steps This feature is useful whenever some steps acquired during the test are to be discarded steps acquired before the start of the test patient disconnected from the face mask 1 Choose Edit tests from the Test menu 2 Position the cursor on the step you want to delete and press the button Delete step Advanced Editing This feature allows to perform some advanced editing of the data stored in the software 1 Choose Edit test from the Test menu 2 Press the Advanced button and select from the following options Edit test Advanced x Mode Time Range C Delete steps From 00 00 02 Ki D Smoothing Ea To 00 05 16 Ki gt IV All steps Edit parameter Apply to Parameter Ti Value s Value ormul c a Correction IV All steps C Offset Formula Save settings Load settings Step moothing Cancel Option Function Delete steps deletes the steps meeting the selection criteria Smoothing applies a moving
15. To select the serial port click on the proper COM button the selected port must be different from the mouse one Units of measurements It is possible to configure the units of measurements weight and height for printing and viewing To select the units of measurement click on cm Kg or in Ib according to the desired format Using extra fields The Patient s database is organised in 3 different cards Patient card Visit Card and Test card where it is possible to store the information about patients and visits Besides the standard information it is possible to customise some fields user free fields entering and labelling measurements coming from other devices The customisable free fields are e 3 fields in the Patient Card Patient s information e 3 fields in the Visit Card information about the visits e 3 fields 2 numeric in the Test card information about Test Customise the fields In the group User free fields type the desired text in the 9 fields available 60 Quark PFT User Manual Spirometry Setting spirometry options The software allows to configure some options selecting Configure from the Option menu Spirometry Test options x Preferences Spirometry PR Automatic Interpretation LLN Calculation SRAMA aa x M Enable Automatic Interpretation IV Enable Quality Control IV Response graph in logarithmic scale F Print active window FYC in ATS format 2 pages M Reduce scal
16. VO2 1819 1409 f1 expf t 546 33 1 4056 3 834 Tau 29 4 sec 3612 3330 3168 2946 2724 2502 22804 4 4 4 1 b 4 b 4y 4 4 1 2058 7 ET 1836 ey tate 1614 1392 1170 4 948 726 on 504 a En 4 262 ud t hh mm ss 00 01 00 52 01 44 02 35 03 27 04 18 05 10 06 01 06 53 07 44 08 36 09 27 10 19 11 10 12 02 110 Quark PFT User Manual Information about the Test amp Summary AAA Tip double clicking on the Summary window the function Options Summary is activated by which you may configure the structure of the data Print the data The Test Information dialog box shows all the information concerning environmental data patient data and some data about the test View the Information Choose Information from the View menu Test information x Patient Calibration ID code 1TEST Temperature C 22 STPD 0 802 Humidity 61 BTPS insp 1 103 Temp flow C 34 BTPS exp 1 020 Hum flowm 100 Press mmHg 740 Last name BABETSIS First name GIORGOS Patient data Test Sex M FVC l 0 00 Date of test 1370972002 Age 34 FEV1 I 0 00 Time of test 16 15 Height cm 182 0 IC D 0 00 Testn 21 Weight Kg 88 0 MVY I min 0 0 N of steps 230 BSA me 20 VO2max ml 0 Duration hh mm ss 00 16 15 HRmax bpm 186 User A 0 00 LT time hh mm ss UN g day 0 0 User
17. calibration procedure Calibration has to be carried out with a calibration syringe of 3 litres volume the calibration procedure is totally managed by software A measurement system should be calibrated daily in order to ensure maximum accuracy and reliable test results If a correct maintenance is provided it s possible to check the calibration of the turbine flowmeter even at relatively long intervals i e 1 month The calibration procedure assures valid and verifiable results within a 3 accuracy The calibration syringe The 3 litres calibrated syringe is included in all the Quark PFT line with the exclusion ofthe PFT 1 model 3 litres calibration syringe P N C00600 01 11 Assembling the flowmeter for calibration 1 Connect the Opto reader to the calibration syringe through the adapter Do not use the breathing valve 2 Connect the flowmeter to the syringe with the rubber cylinder supplied in the standard packaging 1 Syringe 2 Silicone tube 3 Adaptor for calibration syringe Note If a bacterial filter is used for the tests do use it also during the turbine calibration Chapter 4 Calibration 51 Calibrating the turbine After having run the calibration program AAA f Note if you are using a sow 1 Select Reference Values from the File menu If your syringe has a different value PC we recommend to set from the default one 3 litres please enter the correct value ee 2 Select Calibration Tu
18. e Mechanical efficiency i e VO at a given work rate is consistent Although if done correctly sub maximal exercise tests provide valuable information concerning cardiorespiratory fitness they have extremely limited diagnostic capabilities and should not be used as a replacement for clinical exercise tests or other clinical treatment or management modalities Health care professionals should avoid detailed interpretation beyond the scope of the information obtained Considerations with sub maximal exercise testing Considerations for selection of protocol and equipment include any physical or clinical limitations that may preclude certain types of exercise i e age weight arthritis orthopaedic complications individual comfort level of fitness type of exercise training that will be performed and individual preference For example some individuals may perform better on a non weight bearing modality cycle versus treadmill while others may not have the required range of motion in the hip or knee to pedal and may perform better walking Deconditioned weak or elderly persons may have to start the test at a low work level and increase the workload in small increments Also field tests may not be appropriate for those who require strict supervision during testing who do not understand the concept of pacing or who cannot be expected to put forth a good effort More consistent results may be obtained by testing in a controlled environ
19. should be less than the compliance level in each frequency range Interference may occur in the vicinity of equipment marked with the following symbol o Notes 1 At 80 MHz the higher frequency range applies 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people a Field strengths from fixed transmitters such as base stations for radio cellular cordless telephones and land mobile radios amateur radio AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy To assess the electromagnetic environment due to fixed RF transmitters an electromagnetic site survey should be considered If the measured field strength in the location in which the Quark PFT is used exceeds the applicable RF compliance level above the Quark PFT should be observed to verify normal operation If abnormal performance is observed additional measures may be necessary such as reorienting or relocating the Quark PFT b Over the frequency range 150 kHz to 80 MHz field strengths should be less than 3 V m Chapter 1 Getting started 17 Recommended separation distances between portable and mobile RF communications equipment and the Quark PFT The Quark PFT is intended for use in an environment in which radiated RF disturbances are controlled The customer or the user of the Quark PFT can help
20. 1513 853 I No recovery Max 3950 29 Max 4519 84 IV Mark points Step o 0000 Step 10 0000 Option Function Grid on X Y axes show the grid lines in correspondence with x or y axes that make the graph easier for you to analyse data Autoscale maximum and minimum values of the graph will be measured automatically Ignore 0 points with 0 value measured won t be shown Not interpolated make the graph scattered Marker highlight with a symbol all steps of the test in which the marker button was pressed Squared makes the graph a square Without recovery exclude from the graph all points of the recovery phase Mark points marks each point with a symbol Min Max allows to set manually the axes values Step Set the axes scale step Switch from graph to data and vice versa When the active window is a graph or a report in data form it is possible to view very quickly the data or the graph corresponding to that test Choose Current test data if the active window is a graph or Current test graph if the active window is a data report from the View menu Chapter 13 Exercise Testing 107 Viewing predicted values Q NORMS For some parameter it is possible to compare the maximum value measured during the test with its predicted value and the LT value both in percentage and absolute View predicted values Choose Predicted from the View menu 14 1 Anaerobic Lactate Threshold detection AAA Note Dou
21. 78 Perform the test een 79 Closing Volume Test CV sccssscssscssscsssccssccsscssccescescsscesscoescoecs 80 Recommendations 4 4 80 Performa the tests assise ehem he 80 PO 1 Respiratory drive 83 PO 1 Respiratory Crive ccccccsccsscscscsssccssccssccssccssccssccsscosscoesces 84 Ati OF the TEST cescssgsriccsceveresgavera denses d lice bee E 84 Setting respiratory drive OptiOns 84 Recommendations uuesssssessennennnennennnnnen nennen 84 Perform the testsessies tiise erriei aiii aeiia 84 Lung diffusing capacity 87 CO Diffusing Capacity DLCO Test ssccsssscssssscssssccssccsssceseses 88 Setting DLCO options 20 0 cece eccesceseceeeeseeeeceeeeeeeeeceaeeaeeaeeeneeaes 88 Recommendations 89 DLCO with breath hold standard technique 89 DLCO with apnoea standard method 89 DLCO without apnoea intrabreath method 91 Multiple breath DLCO test Steady State method 91 MIP MEP option 93 MIP MEP test 000000sssssnsssssnnnnnnsssnnnnssssnnnnnnsnnnnssnnnnssnnnnnnnnsnsnnnnnnne 94 How to perform the test 94 Pulse oximetry option 95 The oximetry test vies siscsscconssscassccossssonssececsscosesssossavesssscassssesseessssestssee 96 How to perform the test 96 Airway resistance measurement option 97 The
22. 9 Appendix Preparing the disinfecting solution 142 Cleaning the turbine flowmeter 143 Precautions during the cleaning of the turbine 143 Suggested disinfection solutions nnnenee 143 Cleaning the Breathing valve 143 Masks cleaning and disinfection 144 Disassembling the different parts of the mask 144 Cleaning the mask 144 Disinfecting the mask 144 Permapure maintenance 145 INSPECUONS iarann ut 145 Replace the fuses u00unsenseenseenseennennnennnennnn nennen 145 Select the proper power supply voltage 146 147 Service Warranty ccccccccssccssccssccssccesccesccesccssccesccssscesscescoescoes 148 Warranty and limitation of liability ce 148 Return goods policy for warranty or non warranty repair 148 Repair Service Policy uuesesssesssesnseenneenneennennennnennennnennnnn 149 Privacy Information cccciccoccscccvsscensscescssccessesesesecuecccvectsosssesessecceseses 150 Personal data treatment and purposes 150 How your personal data are treated eeennen 150 The consent is optional but 150 Holder of the treatment 150 C stomerrights eeesnsdiensiennisnunesns 150 Heart Rate TTL input cccscccsccssccssccsscssccssccssccssccssccssccsscoesees 151 Converting factors configuration essssessonees
23. Cancel Gain exp fi 000 Help You might configure the following options Name identify the parameter Unit of meas unit of measurement Base line and Gain factors used to convert the acquired raw data mV into the final format according to Y mV BL Gain The value entered for gain must be multiplied by 1000 for Gain 1 enter 1000 Precision the number of decimals shown as 0 152 Quark PFT User Manual Calculations references VO and VCO Energy Expenditure and Fuel Selection in Biological Systems The Theory and Practice of Calculations Based on Indirect Calorimetry and Tracer Methods M Elia G Livesey World Rev Nutr Diet Basel Karger 1992 vol 70 pp 68 131 Nutritional Assessment in Critical Care A Training Handbook Donald C Zavala Anaerobic threshold modified V Slope O kinetics The break point or intercept of the two slopes can be selected by a computer program that defines the VO2 above which VCO2 increases faster than VO2 without hyperventilation During an incremental exercise above the Lactate Threshold the net increase in lactic acid production results in an acceleration of the rate of increase in VCO2 relative to VO2 When these variables are plotted against each other squared graph without recovery points the relationship is composed of two apparently linear components the lower of which has a slope of slightly less than 1 0 whereas the upper component has a slop
24. Psychological factors such as pre test anxiety may influence the heart rate especially at rates below 120 beats per minute and at low workloads It is not unusual for the heart rate and or blood pressure to be higher at rest than during the initial stages of exercise in these cases Having the subject repeat the first test may improve reliability particularly ifthe subject has never previously performed such a test Factors that can cause variation in the heart rate response to testing Dehydration Prolonged heavy exercise prior to testing Environmental conditions e g heat humidity ventilation Fever Use of alcohol tobacco or caffeine 2 to 3 hours prior to testing Because of these inherent inconsistencies standard procedures for each test must be strictly followed to ensure the greatest accuracy and reproducibility possible Standard testing protocol The same testing modality and protocol for repeat testing A constant pedal speed throughout cycle ergometry testing Cycle seat height properly adjusted recorded and standard for each test The time of day for repeat testing consistent All data collection procedures standardized and consistent Test conditions standard Subjects free of infection and in normal sinus rhythm Prior to the test no intense or prolonged exercise for 24 hours smoking for 2 3 hours caffeine for 3 hours or heavy meal for 3 hours Room temperature 18 20 C 64 68 F with air movement provided C
25. RMR The abbreviated Weir equation is probably the most common calculation of RMR Abbreviated Weir equation RMR 3 9 VO2 1 1 VCO2 1 44 How to perform a RMR test For best results when having a REE done there are certain conditions that need to be controlled and others that just require documenting at the time of the test During the test the individual is interfaced with a metabolic measurement system by means of a facemask A mouthpiece with a nose clip is also sometimes used but it may create overly stressful conditions to a subject patient Important considerations or conditions to improve the RMR measurement e No food for at least 12 hours and no smoke for at least 2 hours before the test e Maintain quiet surroundings when the test is in progress and normal temperature The individual should not move arms or legs during the test e Medications taken should be noted such as stimulants or depressants e The first 5 minutes of acquisition should be discarded by the computation of RMR e Steady state should be achieved which would be identified clinically by the following criteria 5 minute period when average minute VO and VCO changes by less than 10 average RQ changes by less than 5 e Stable interpretable measurements should be obtained in a 15 to 20 minute test e Renal failure patients requiring hemodialysis should not be tested during dialysis therapy 126 Quark PFT User Manual Recommendations
26. Significant drop 20 mmHg in systolic blood pressure or a failure of the systolic blood pressure to rise with an increase in exercise intensity Excessive rise in blood pressure systolic pressure gt 260 mmHg or diastolic pressure gt 115 mmHg Signs of poor perfusion tight headedness confusion ataxia pallor cyanosis nausea or cold and clammy skin Failure of heart rate to increase with increased exercise intensity Noticeable change in heart rhythm Subject requests to stop Physical or verbal manifestations of severe fatigue Failure of the testing equipment Assuming that testing is non diagnostic and is being performed without direct physician involvement or electrocardiographic monitoring 138 Quark PFT User Manual Considerations for accuracy The ability to obtain valid and reproducible results is essential to ensure that any differences between pre treatment and post treatment test results are due to exercise training rather than variations in testing procedures Some inconsistencies that are inherent may increase variability Sub maximal heart rate is influenced by time of day eating smoking and familiarization with test procedures Prediction equations for estimating VO may overestimate trained individuals and underestimate untrained individuals The efficiency of motion during walking running and cycling varies Cardiac output and VO have a test retest variability of 3 4
27. Single Breath CO diffusing capacity from the Test menu 3 Confirm or in case change the test options Breath hold time Simulated test it allows to carry out the manoeuvre without inhaling gas useful for teaching purposes Hb haemoglobin Anatomic dead space Chapter 9 Lung diffusing capacity 89 Patient i V Breath hold I Simulated test Con 4 Wait for the zeroing of the analyser is completed and plug in again the sampling line in the flowmeter 5 Connect the Patient to the mouthpiece and let her him breathing at rest until the message Carry out Vital Capacity is prompted 6 Carry out a Slow Vital Capacity if desired this is not necessary for completing the DLCO test 7 Invite the Patient to exhale up to Residual Volume and press F2 during the maximal expiration 8 Coach the Patient to inhale up to Total Lung Capacity and to hold the breath until the expiratory valve will be automatically open a quick full expiration shall follow and the test will be completed A dashed line indicates the 90 of the Best Vital Capacity if a FVC or SVC test is available in the archive otherwise it indicates the 90 of the Predicted VC in order to verify the correctness of the manoeuvre Quark PFT James BOND DLCO 4 18 09 1998 F Eile View Test Options Window Help EJEA Single breath CO diffusing capacity t t t i a 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1
28. Vt stability threshold 100 ml C 200 ml 400 ml ce Option Description Apnoea time ATS and ERS standard 10 s Effective time Ogilvie Jones amp Meade ESP Vt Stability threshold Recognition criterion of regular respiration from the beginning of the inspiration till the beginning of sampling 2 from 70 of inspiratory time to 50 of sampling gt from 50 of Inspired Volume to the beginning of sampling 88 Quark PFT User Manual Pressing the System button you can set the following options Option Description System dead space Add the volume of the viral filter eventually used O concentration O content of the used mixture ATS 21 ERS 17 Pressing the Patient button you can set the following options Option Description Physiologic dead space calculation criterion ATS 2 2 weight manual Haemoglobin calculation criterion ATS 14 6 adult men 13 4 women and children Carboxyhaemoglobin digit the percentage value Recommendations e The system must be calibrated before each test See Calibration chapter e The flowmeter must be connected properly to the breathing valve and the soft mouthpiece must be properly fixed to the corresponding adapter e Check that the DLCO cylinder is open and its output pressure is adjusted in the range 5 6 bar DLCO with breath hold standard technique The Patient carry out a maximal inspiration of a mixture containing a low concentration of CO 0 3 and a trace
29. a diagnosis ID code and a string of text The report of the visits can be done either by typing the desired text in the field Diagnosis of the Visit Card or more quickly retrieving from the diagnosis database the desired one If you want to insert modify or delete a diagnosis from the database select Database Diagnosis from the File menu Chapter 5 Database Management 57 Exercise testing Enter a new patient di Find a patient Edit patient data Delete a patient patient s database The exercise testing software uses a different interface for presenting patient information The patient database allows to e Enter a new patient e Find patient data e Edit patient data e Delete patient data Select Patients from the File menu 1 Press New to show the Patient dialog box 2 Enter data of a new patient and press OK button to confirm Patients in archive CI a Patient Progr 5 ID code 3 Last name GAS ECG First name INCREMENTAL Modify E Sex M Delete OK Enter a search string into the Find field and press Find to view the data concerning a subject already in the database You can search for Last name ID code or Progressive Or Press List to view the list of patients in the database Press Next or Previous to view the data corresponding to the next or to the last patient Press OK to confirm The Next and Previous buttons allow to m
30. a patent ne A rs 58 Edit patient datas c ccssssscceasssscedashs ccdeaiesseccues oocceass sesedeghs desert 58 Delete 4 Patient ae seen ae de 58 Archive Maintenance cccccsccccscccscsccccsccccesccccsccccsccccesccseecssees 59 Reorganise the archive 59 Delete the archive csesesennsensnnsnnsnnensnnnennnnnennennn 59 4 Quark PFT User Manual Spirometry Backup and restore uuneeesssssnnseenneenneennennneennennennne ns 59 BACKUP min sk ek hehe 59 Restore nisse 59 Spirometry SettingS cccccccccsccssccssccssccssccssccssccssccssccssccesccescoesees 60 Graphs renina a E R ESE 60 Serial POM aussen 60 Units of measurements 60 Using extra fields u nnenseenseeesneeenenenennneennnne nennen 60 Customise the fields 60 61 Setting spirometry Options cccccccsccssccssccssccssccssccssccsccssccsssceees 62 SPIO Etr aon oaeo case sesdeasacesdbes E E a a E 62 Automatic Interpretation 62 Quality control eseenseenseerseensnensnennnennnnnnennne nennen 62 Parameters manager 63 Predicted values manager ne 63 Predictedsset nn este ie are 63 Set the current predicted 64 Formula definition 64 PA Se setup ns 65 Spirometry tests ccccsccccsccescrssccssccssccesccesccssccesccesccesccssccescsescoesees 66 Forced Vital Capacity pre sss
31. attempt to use Such combustible substances in contact with oxygen are explosive 6 Be certain that the materials of the pressure regulators are chemically compatible with the intended gas service before installation Inspect the regulator for the proper 12 Quark PFT User Manual 10 11 12 13 O OD h gt connection and note the ranges of the pressure gauges Also examine the physical condition of the regulator including threads and fittings Remove any dust or dirt from the regulator or cylinder valve with a clean cloth Do not install a regulator on a cylinder valve containing oxygen if grease or oil is present on either Such substances in contact with oxygen are explosive Cleaning residue particulates and other contaminates including pieces of torn or broken components in the breathing circuit pose a safety risk to the patient during testing procedures Aspiration of contaminates can potentially be life threatening Use disposable anti bacterial filters or disinfect each part in contact with the patient before each test You must follow all the cleaning procedures in System Maintenance and you must thoroughly inspect the components after cleaning and before each patient test This device is not suitable for use in presence of flammable anaesthetics It is not an AP nor an APG device according to the EN 60 601 1 definitions Keep the device away from heat and flame source flammable or inflammable liquids or g
32. average to the selected parameter Edit parameter edits a parameter according to the selected criteria Edit parameter Specifications Value replaces the value of the selected parameter with a new one Correction applies a percentage correction to the value of the selected parameter Offset adds an offset to the value of the selected parameter Formula replaces the value of the selected parameter with a mathematical function Time range Specifications From To specifies the time range All steps applies the editing from the beginning to the end of the test 114 Quark PFT User Manual Apply to Specifications Parameter specifies the reference parameter gt gt lt lt lt gt higher than higher or equal equal to lower than lower or equal different Value Formula specifies the value mathematical expression compared with the value of the specified parameter All steps do not use any selection criteria Restore the original test To cancel all the editing in the Edit Test dialog box press the Restore button confirm your choice by pressing yes Overwrite the original test To save all the editing replacing the original test with the modified one in the Edit Test dialog box press the Overwrite button confirm your choice by pressing yes Customise the desktop Smart edit Customise the display colours 1 Select Colors from Options menu 2 Select the item to be modified 3 Press Chang
33. be reach a value between 5 and 6 atmospheres bar provided with a calibration certificate indicating the gas F 7 composition er Notice The gas cylinder must be replaced when the primary pressure gauge falls below 10 bar Chapter 3 Installation 39 Connecting cables and tubing The assembling procedure will be shown in the following illustrations Q T COSMED MT SRE ge Heart Rate Probe connector Flowmeter connector Calibration plug Power switch Sampling tube connector arm TC gt Breathing valve connector o DLCO mix gas connector Cal gas 16 O 5 CO connector O gas connector RS232 Serial Port for PC connection Ground snap connector Power cable connector Switch 110V 220V ARWTOrxrx nr 40 Quark PFT User Manual Cables and Tubing s installation sequence g q e Connect the power cable of the Quark PFT to the trolley e Connect the power cable of the PC and the printer to the trolley e Connect the RS232 cable from the Quark PFT PC RS232 to the PC COMI or COM2 If the PC does not have a RS232 port please use the USB RS232 adapter A 388 410 001 available as an accessory e Cut the tube as needed Tubes connecting cylinders to Quark should be as short as possible e Connect the DLCO cylinder to the Quark PFT DLCO and adjust its pressure between 5 and 6 ba
34. buttons view the Rocc graph view an average ofthe measured parameters view all the performed steps Pr suite vito LA CASA ROCC 8 12 05 2004 Eile View Test Options Window Help Roce kPaitlis N nennen ns pen ee y 0 800 AEE A T E 1 1e 0 400 D200 xt 333 o t t t t 1 2 3 4 5 B Occlusion n Parameter UM Description Pred TEST 8 Pred Rocc_in kPail s Airways Resistance occlusion inspiratory 0 200 0 252 126 1 Gocc_in sykPa Airways Conductance occlusion inspiratory 5 08 3 97 79 3 Flow_occ mils Trigger Flow 530 Palv kPa Alveolar Pressure 0 157 For Help press F1 12 05 2004 Vito LA CASA NUM x 9 Press Alt F3 or the button by side to stop the acquisition discarding the results ABORT Chapter 12 Airway resistance measurement option 99 100 Quark PFT User Manual Recommendations for the exercise testing The evaluation of the cardiorespiratory function The physical training requires the interaction of physiological mechanisms that allow the cardiovascular and respiratory systems to supply the increasing demand of energy due to the contraction of the muscles During the training the systems are both engaged an adequate answer to the effort is the measure of theirs health state The increase of the metabolic rate during the exercise needs an appropriate increase of oxygen in the muscles At the same time the CO musc
35. cause malfunctions due to overheating of components we strongly suggest to keep the unit in a clean environment and well ventilated as possible Quark PFT and accessories can have place on the trolley as shown in the following illustration Quark unit Printer Calibration cylinder Keyboard Mouse pad Table arm Breathing valve PC Trolley 10 Bag len ON Er D D Zee 38 Quark PFT User Manual Setting up the system Before starting operating with the system make sure to meet the environmental and operational conditions reported in Chapter 1 Installing the Calibration Gas Cylinders In order to calibrate the sensors you need to have available calibration cylinders with the following gas concentrations Cylinder Recommended Gas mixture Test Calibration O 16 CO 5 N Bal Washout CV P0 1 Ergo MIP MEP DLCO CO 0 3 CH4 0 3 O2 21 N2 Bal DLCO Oxygen O 100 Washout CV Gas pressure adjustment procedure The gas regulator has an adjustable second stage that must be adjusted only when used for the first time This is necessary to protect the internal demand valve from the high pressure surge that can be generated when the cylinder is opened 1 Make sure that the regulator is turned off before opening the cylinder valve 2 Open the cylinder valve by turning the valve counter clockwise AAA 3 Adjust the regulator pressure by turning the adjustment knob clockwise in order to Notice The cylinders must
36. confirm the information input on the dialog box or press the Esc key to cancel changes Use of the mouse e To move the cursor among fields move the mouse on the desired field and left click e Click on the OK button with the Left button of the mouse to confirm the information input on the dialog box or click on Cancel button to cancel changes Some windows are provided with scroll bars that help to see data exceeding the window space available e To move the scroll bar row by row click the scroll arrows at the end of the scroll bars e To move the scroll bar page by page click on the grey area at both sides of the scroll fields COSMED Quark Help is a complete on line reference tool that you can use at any time Help is especially useful when you need information quickly or when the Quark user manual is not available Help contains a description of each command and dialog box and explains many procedures for accomplishing common tasks To get the Help on line press the F1 key To know the software version and the serial number of the software select About Quark PFT from Help menu Chapter 3 Installation 45 46 Quark PFT User Manual Calibration Calibrating Sensors The software allows to automatically calibrate zero gain and delay of gas sensors Even if the program doesn t force you to carry out the calibration we strongly recommend to execute it before each test Running the Calibration program Eh Start
37. en Best FYC a gE D2575 pre Date DFEY1 poss Date time DFEV1 pre ERY DFEY1 pred EYC DFYC pre FEF25 75 DPEF FET100 DPEF pre FEV1 IC KE FEY1 FYCZ Te FEVI VC Ti FRC VEXT FRC TLC FYC hae All tests FYC Post I Show description F Show Pre I Show SD V Show Pred E OK Cancel Apply Help The program allows to calculate a huge number of parameters it is advisable in order to simplify the analysis of the results to view to print and to sort the desired parameters only Select the menu item Options Parameters View Move the parameters to view into the Selected parameters list Print Move the parameters to print into the Selected parameters list Sort Drag the parameter up or down with the mouse Customise Add modify and delete custom parameters If it is necessary to restore the default parameters press the button in the left corner of the window to initialise the parameters database Predicted values manager Predicteds x Predicteds set Formula definition NORMS Description Set current predicteds ERS 93 Name of the predicteds New Male fo Oy Female peck Age Mc Barcelona I Modity predicteds Cancel Amw Hein The program contains a preset of predicted equations but the user is allowed to customise its own predicted sets Select Predicteds from Options menu The window is divided into two forms Predicteds set and
38. format of the file in the dialog Save as If the ASCII format is selected the Text button in the dialog box Save as allows you to configure the separators for character based files With the xpo Cosmed file format it is possible to import data from another Quark archive Press OK to confirm 4 Select the folder for the export and type the file name Press OK to confirm A status bar will show the file creation Chapter 6 Spirometry 75 76 Quark PFT User Manual Lung volumes tests N washout In the PFT lab the measurement of Lung Volumes usually refers to the measurement of Total Lung Capacity TLC residual volume RV functional residual capacity FRC and Vital Capacity VC These measurements are essential to assess lung function they are important for the diagnosis of restrictive disorders FRC is most commonly determined with one of three basic techniques 1 Multiple breath open circuit Nitrogen washout 2 Body Plethysmography 3 Multiple breath closed circuit Helium washout COSMED Quark PFT uses the nitrogen wash out technique to measure Lung volumes This method involves removing or washing out the N2 gas present in a patient s lung by having the patient breathe 100 O2 for several minutes usually 7 minutes or until the final concentration of N2 is below 1 5 2 5 Since the whole expired nitrogen come from the initial lung volume a simple equation allows to get FRC value The main parameters me
39. from Test Event 3 As soon as 5 or 6 complete breaths have been acquired press F3 to stop the acquisition p p Event 02 C02 Graph OI x 0214 COZ 25 00 si I 1 1 I i I 1 1 I 1 i i i i 1 i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i i 12 00 i i i i i i ei i 1 1 1 L 1 y 4 L am w Te AN dE i 1 1 1 1 i 1 3 00 h i i i i i f i i i i i i i i i i i i i i i i i i i i i 1 I 1 I i I 1 I 1 I i i i i i l i l i i 6 00 15 00 i i i i i i i i i i I 1 I 1 1 I 1 1 I i i i i i i i i i Fi 1 if 1 1y I iy T 1 3 00 1 1 1 i i 1 I 1 I i l 1 t 10 00 t hh mm ss oo 02 04 06 08 10 t hh mm ss 00 00 53 O2 Saturation optional The O2 Saturation event is useful to check the quality of SpO2 signal acquired by the on board Oxymeter if available during the test 122 Quark PFT User Manual Spirogram O2 Saturation during the test 1 2 3 Start with normal Exercise test and begin the memorisation of breath values F2 Select O2 Saturation from Test Event As soon as 5 or 6 complete pulses have been acquired press F3 to stop the acquisition The spirogram event allows to display and store the volume time plot EN F V LOOPS F Event Spirogram Vil t hh mm ss 00 00 06 Spirogram during the test 1 Start with normal Exercise test and begin the memorisation of breath values F2 2 During a steady state select Spiro
40. holder as shown in the picture Chapter 16 System maintenance 145 3 le Note Be careful to use proper fuses 680 013 630 Time Lag Fuses 5x20 250V T 630 mA for 220 240V supply A 680 024 125 Time Lag Fuses 5x20 250V T 1 25A for 100 120V supply Select the proper power supply voltage The power supply voltage can be changed in the following way 1 Open the power supply cover using a screwdriver 2 Rotate the voltage selector in order to read the desired value 146 Quark PFT User Manual Warranty and limitation of liability COSMED provides a one 1 year limited warranty from the date of the original sale of COSMED products All COSMED products are guaranteed to be free from defect upon shipment COSMED s liability for products covered by this warranty is limited exclusively to replacement repair or issuance of a credit for the cost of a defective product at the sole discretion of COSMED COSMED shall not be liable under the foregoing warranty unless 1 COSMED is promptly notified in writing by Buyer upon discovery of defect ii the defective product is returned to COSMED transportation charges prepaid by Buyer iii the defective product is received by COSMED no later than four weeks after the last day of the one 1 year limited warranty period and iv COSMED s examination of the defective product establishes to COSMED s exclusive satisfaction that such defect was not caused by misuse negle
41. in 6 sec FEV as a percentage of FEV6 FEV6 as a percentage of FVC Best Forced Expiratory Vital Capacity Best Forced Expiratory Volume in 1 sec Best Peak Expiratory Flow Expiratory Flow when 75 of the FVC remains to be exhaled Expiratory Flow when 50 of the FVC remains to be exhaled Expiratory Flow when 25 of the FVC remains to be exhaled Mid exp flow between 25 75 FVC Forced expiratory time Forced Expiratory Volume in 2 sec Forced Expiratory Volume in 3 sec FEV2 as a percentage of FVC FEV3 as a percentage of FVC Tiffenau index Mid exp flow between 50 75 FVC Mid exp flow between 75 85 FVC Mid exp flow between 0 2 1 1 21 Inspiratory Forced Vital Capacity Forced mid inspiratory flow Forced Inspiratory Volume in 1 sec Peak Inspiratory Flow Extrapolated Volume back extrapolation Time to PEF 10 90 VC IVC Slow Vital Capacity and Ventilatory pattern Symbol EVC IVC ERV IRV IC VE Vt Rf Ti Te 32 Quark PFT User Manual UM 1 min 1 min sec sec Parameter Expiratory Vital Capacity Inspiratory Vital Capacity Expiratory Reserve Volume Inspiratory Reserve Volume Inspiratory Capacity Expiratory Minute Ventilation Tidal Volume Respiratory Frequency Duration of Inspiration Duration of Expiration Ttot Ti Ttot Vt ti sec Duration of Total breathing cycle Ti Ttot ratio l sec Vt tiratio MVV Maximum Voluntary Ventilation Symbol MVV MVt MRf MVVt UM Parameter l min Maximum Volunta
42. of activities to carry out a bronchoprovocation test are 1 Typing and storing a bronchoprovocation protocol in the database usually only once 2 Selection of protocol among the list of the ones already present in the database before carrying out the FVC post tests the selection of manual protocol allows to execute the test fully manually 3 Performing the Post tests Enter a new Bronchial provocation protocol in the archive 1 Select Bronchoprov protocols database from the File menu 2 Type the Protocol name the Bronchoprovocator name and the unit of measurement in the proper input fields 3 If the bronchoprovocator has a cumulative effect select the cumulative check button 4 Enter the quantities for each step and press the button E 72 Quark PFT User Manual Viewing results di All the visualisation functions refer to the test carried out by the Current Patient whose name is indicated on the left side of the status bar To view tests results 1 Select the Patients from the File menu 2 Select the patient corresponding to the test you want to view 3 Select in the list box of the tests up to 5 tests of the kind FVC VC IVC or MVV and press OK To switch between graph and or data use the following buttons on the toolbar view Flow Volume graph F5 view Volume Time graph F6 view data of the test F7 view bronchial provocation response If you need more than one visualisation meantim
43. provides information about the transfer of gas between the alveoli and the pulmonary capillary blood The two major gases involved in lung diffusion O and CO must move through two barriers the alveolar capillary membrane and the blood plasma red blood cell barrier The rate of diffusion across these primarily liquid barriers is limited by the surface area for diffusion the distance the gas molecules must travel the solubility coefficient of the gases in the liquid the partial pressure difference gradient between air and blood and the density of each gas Measurements of the diffusing capacity is usually performed using Carbon Monoxide CO because it has a great affinity for Haemoglobin 210 times that of O it is soluble in blood and its concentration in venous blood is insignificant The main techniques are 1 Single Breath with Apnoea ATS ERS standard 2 Single Breath without Apnoea requires a fast response CO analyser 3 Multiple Breath in Steady State Setting DLCO options 1 Select Settings from Options menu 2 Select Single Breath CO diffusing capacity 3 Set the desired value in all the fields described in the next table Tast options x Preferences Spirometry Multi breath N2 Wash out Single breath CO diffusing capacity Respiratory drive Patient F TLC DLCO correction for obstruction severity IV Breath hold Time Effective time 10 sec Jones and Meade x 0 7 Ti 0 5 S ample
44. sec for 5 sec Power frequency 3 A m 3 A m Power frequency magnetic 50 60 Hz magnetic fields should be at levels field characteristic of a typical IEC 61000 4 8 location in a typical commercial or hospital environment Note Ur is the a c mains voltage prior to application of the test level 16 Quark PFT User Manual Guidance and manufacturer s declaration electromagnetic immunity The Quark PFT is intended for use in the electromagnetic environment specified below The customer or the user ofthe Quark PFT should assure that it is used in such an environment Immunity test Test level Compliance level Electromagnetic environment guidance Conducted RF IEC 61000 4 6 Radiated RF IEC 61000 4 3 3 Veff 150 kHz to 80 MHz 3 V m 80 MHz to 2 5 GHz 3V 3 V m Portable and mobile RF communications equipment should be used no closer to any part of the Quark PFT including cables than the recommended separation distance calculated from the equation applicable to the frequency of the transmitter Recommended separation distance d 1 17 4 P d 1 17 4 P 80 MHz to 800 MHz d 2 33 Y P 800 MHz to 2 5 GHz where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer and d is the recommended separation distance in metres m Field strengths from fixed RF transmitters as determined by an electromagnetic site survey
45. the face and the mask It has to be used for mask applications on hard to seal faces and where leaks are not tolerated 42 Quark PFT User Manual Will not irritate the skin Contains no adhesives Has no odour Will not dry out Single patient use Headcap Mask Inspiratory valve Turbine Optoelectronic reader Sampling adapter Sampling plug AAA Notice Avoid the exposure to the sun Do not put the seal into the water Connecting PC Apply the seal to the mask Apply seal to clean residue free mask only and follow the instructions below 4 Remove the plastic tray from the bag Peel off clear film and retain for later use While holding tray align the nose area of mask to nose area of Ultimate SealTM gel Press together and roll mask down over the surface of the gel seal attaching it to the mask and releasing it from the tray If needed adjust the position of the seal aligning it with the outer perimeter of the mask sealing surface The mask is now ready to be placed on the subject s face To remove seal on mask The Ultimate Seal have been conceived for a single patient use only it can not be cleaned or sterilised If mask requires cleaning for a new patient application then pull off and dispose of the Ultimate SealTM To keep the seal clean between use keep it attached to the mask and place the clear film against the Ultimate SealTM gel on the mask When the seal becomes disc
46. transmitter watertight Time Lag Fuses 5x20 250V T630 mA Time Lag Fuses 5x20 250V T1 25A Registration card User manual Quark PFT Conformity declaration Quark PFT2 ergo Standard packaging Code C00936 01 04 C02120 01 05 C02171 02 11 C01590 01 05 A 800 900 001 C00243 01 06 C00191 02 11 C02210 02 08 C01399 02 12 C02125 01 10 C02135 01 10 C02145 01 10 C00861 01 06 A 661 200 001 A 661 200 002 C00269 01 20 C00137 01 20 C00136 01 20 A 182 300 005 A 182 310 001 A 362 060 001 24 Quark PFT User Manual 8 0 n aN ll o1s5 S5 S Description Quark PFT2 ergo unit Turbine 28mm Kit optoelectronic reader Quark PFT 2 3 4 Breathing valve PFT2 Head cap for the adult masks Calibration Syringe 3L Tank tubing 4m Permapure L2m Cable in HR TTL Mask mouth nose breath adult S Mask mouth nose breath adult M Mask mouth nose breath adult L HR probe HR elastic belt HR polar transmitter PTE soft mouthpiece Paediatric paper mouthpieces Adult paper mouthpieces Antibacterial filter Anti moisture filter Power cord Schuko 2m A 362 300 001 A 662 100 001 A 680 013 630 A 680 024 125 A 830 300 001 C01788 01 36 C01790 01 36 C01999 01 DC C00067 02 94 C01340 02 91 1 2 2 2 1 1 1 1 1 1 RS232 cable DB9 M F Nose clips Time lag fuses 5x20 250V T630mA Time lag fuses 5x20 250V T1 25A Air valve membrane PC software Spiro PC software Ergo Conformity declaration Registration c
47. warm up time before starting the calibration procedure ERGO Calibration This calibration must be repeated at least daily A new calibration before any ergospirometry P0 1 or MIP MEP test is strongly recommended 1 Remove the sampling line from the flowmeter 2 Ensure that the O CO cylinder is properly connected to the rear panel of the Quark PFT and check that the pressure of the gas is in the range 5 6 bar 3 Check if the reference values for the calibration gas specified in File Reference values correspond to the certified composition of the mixture 4 Connect the sampling line to the CAL port placed on the front panel of the Quark PFT 5 Select Calibration Gas ERGO and wait until the procedure is completed The software performs automatically the calibration procedure After 90 seconds the graph will be displayed In this way the user can check the calibration procedure both graphically and numerically At the end of the procedure the software displays the new calibration factors vs the old ones FRC Calibration This calibration must be repeated at least daily A new calibration before any FRC or CV test is strongly recommended 1 Remove the sampling line from the flowmeter 2 Ensure that the O cylinder is properly connected to the rear panel of the Quark PFT and check that the pressure of the gas is in the range 5 6 bar 3 Ensure that the O CO cylinder is properly connected to the rear
48. 0 54 5 05 10 Methacholine 1 16 4 56 11 Methacholine 2 41 4 28 12 Methacholine 4 91 3 80 CATS l One page no ATS FN Preview e Selecting the option One page no ATS the report will contain on one page the F V and V t graphs of the best test overlapped on the FVC Post the patient data the notes the diagnosis and the test results e Otherwise the report will contain two pages the first with the patient data the graphs and the diagnosis and the second one with the measured parameters according to the ATS recommendations e The 3 page will contain the bronchoprovocation response Select the desired options FVC graph Prints the F V and V t curves for the best FVC test One page no ATS Prints data and graphs on the first page Response Prints the bronchoprovocator response FVC post Prints data and graphs for the Post FVC test the test can be selected among the test performed in the current visit Multi breath N Prints the best FRC test of the current visit wash out Single breath O Prints the best CV test ofthe current visit Single breath CO Prints the best DLCO with apnoea test of the current visit diffusing capacity Single breath CO Prints the best DLCO without apnoea test ofthe current visit no breath hold CO diffusing capacity Prints the best DLCO Steady State test of the current visit Steady State Respiratory drive Prints the best PO 1 test of the current visit Preview Views a report preview on t
49. 45 52 11 3 0 875 9 9 335 297 29 33 4 41 0 88 16 91 3 65 65 5 1 0 15 50 on ue le cet aoe em om a ES EPI T PIETA a an s Creating graphs The software is provided with powerful functions for creating charts You can add custom graphs to create exactly what you need View data in graph form Choose Graph from the View menu Select the tests to visualise from the list and press OK Choose the parameters you require on the X Y1 and eventually for Y2 select if necessary some of the following options by pressing the more button and press OK to confirm It is possible to access quickly 5 common graphs from the View Graph dialog box 106 Quark PFT User Manual AAA Note Double click in the graph window to open the edit test lolx VCOZ ml min VO2 VCO2 t BOND J test n 2 VOZ ml min 3249 3004 2758 2513 2268 2023 1778 1533 1288 1043 797 552 tihh mm ss 00 30 01 57 03 24 04 51 06 19 07 46 09 13 10 40 12 08 13 35 15 02 16 29 Right clicking the graph can be exported in bmp file format Customise the graphs 1 With a graph on the screen choose Customise graph from the View menu 2 Onthe Customise graph dialog box select options to obtain the wished graph Customize Graphs x IV Autoscale From 00 00 15 f E To 00 14 45 gt Options vo2 Vco2 T Ignore 0 Grid I Points only Bake V Autoscale V Autoscale f Squared Min 1628 692 Hin
50. 5 2 883 138 1 3367 3978 45 36 50 25 1 32 17 99 4 37 196 18 7 17 20 5 36 Average 34 4 1 904 70 1 2074 2146 30 31 30 96 0 97 16 77 3 90 160 12 4 15 76 4 88 Trend 46 3 2 659 123 2 3158 3704 37 32 47 13 1 17 17 50 3 80 187 16 8 16 80 4371 Phase n 3 Recovery Start 00 07 07 End 00 10 43 Speed 0 Load2 0 Load3 0 Min 25 2 1 170 34 0 477 834 33 28 7 13 1 16 16 95 3 02 130 3 3 16 09 3 82 Max 43 2 2 799 118 0 3143 3647 74 41 46 92 1 67 18 87 4 43 190 16 5 18 21 5 42 Average 34 6 1 660 66 3 1366 1910 51 25 20 42 1 45 16 11 3 57 156 8 3 17 41 4 45 Trend 30 6 1 268 38 8 770 968 47 37 11 50 1 25 16 10 3 29 132 5 8 17 50 4 12 Kiel M It is possible to print graphs and data by means of two functions Print report and Print current window The last one is active only if the active window is a graph or a data report Chapter 13 Exercise Testing 111 View the report Print the current window 1 Be sure that the current active window is the graph or the report you desire to print 2 Select Print current window from File menu 3 Press OK to print or Setup to customise the print Print the report 1 Select the report to be printed from File menu 2 Press OK to print or Setup to customise the print 3 To only view the report without printing it press Shift during the selection This function allows to show a preview of a selected report 1 Select Report from the View menu 2 Select the test and the report to visualise and press O
51. 7 18 19 20868 Volume Time DLCO Info vyt r Breath hold Jones and Meade k i H 1 Washout I L Saipe sessebsses esse OPER EPRPEIEERERIEEUPELPELEISPEPLUEDEN ELTIELEFERTEEREEULEFFELFLEFELEFERTEFER 0 BestEyQ ot feasting sn 5 RES meal ts 1 2 3 12 13 14 15 16 17 18 19 20165 For Help press F1 18 08 2003 James BOND NUM Double click with the left mouse button in order to modify the test options wash out volume sampling volume calculation of the real apnoea time Checking the box ATS95 Criteria it is possible to set automatically 1 litre for wash out and sampling values according to the ATS95 criteria M Edit James BOND DLCO 4 18 09 1998 ofx A Select SVC System Patient Default Fowler 3 Equations Single breath CO diffusing capacity 0 35S HA _ Breath hold Jones and Meade je SS pi ua r HeT 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20t s J I Jones and Meade F4 J 0 7 Ti 0 5 Sample Cancel 90 Quark PFT User Manual DLCO without apnoea intrabreath method 1 Remove the sampling line from the flowmeter 2 Select Single Breath CO diffusing capacity from the Test menu 3 Confirm or in case change the test options Breath hold time deselect the check box Simulated test it allows to carry out the manoeuvre without inhali
52. 9 261 28 32 3 94 0 87 16 73 3 77 63 4 7 0 15 27 00 01 07 9 1 0 722 6 5 237 203 27 32 3 11 0 86 16 65 3 78 63 3 7 O 15 16 00 01 14 8 9 0 721 6 4 234 199 27 32 3 09 0 84 16 64 3 77 63 3 7 0 15 25 00 01 20 10 0 0 728 7 2 263 227 27 32 3 46 0 86 16 63 3 60 64 4 1 O 14 97 00 01 25 11 4 0 796 9 1 349 288 26 31 4 59 0 82 16 44 3 83 65 5 3 0 15 12 00 01 30 10 5 0 947 10 0 376 316 26 31 4 95 0 64 16 51 3 85 66 5 7 0 15 15 00 01 36 10 8 0 888 9 6 339 294 28 32 4 46 0 86 16 72 3 74 65 5 2 0 15 25 00 01 42 10 8 0 917 9 9 352 309 28 32 4 63 0 87 16 73 3 77 64 5 5 0 15 35 00 01 47 10 9 0 846 9 2 323 283 28 32 4 25 0 87 16 77 3 74 64 5 0 0 15 29 00 01 53 10 9 0 848 9 2 315 274 29 33 4 15 0 87 16 86 3 61 64 4 9 0 15 63 00 01 58 10 7 0 881 9 4 329 292 28 32 4 32 0 89 16 78 3 77 64 5 1 0 15 33 00 02 04 11 0 0 761 8 4 289 249 29 33 3 80 0 86 16 86 3 61 65 4 4 D 15 52 00 02 09 10 5 0 817 8 6 286 261 30 33 3 77 0 91 16 95 3 69 64 4 4 0 15 62 00 02 15 11 2 0 876 9 8 320 283 30 34 4 21 0 88 17 06 3 50 65 4 9 0 15 65 00 02 20 11 1 0 907 10 1 337 286 29 35 4 44 0 84 16 97 3 46 66 5 1 0 15 69 00 02 25 10 9 0 795 8 6 275 246 31 35 3 62 0 89 17 14 3 46 65 4 2 0 15 68 00 02 31 11 5 0 795 9 1 312 269 29 34 4 10 0 86 16 89 3 57 65 4 8 O 15 58 00 02 36 10 7 0 829 6 9 303 269 29 33 3 99 0 88 16 87 3 67 65 4 6 0 15 50 00 02 42 10 9 0 736 6 0 269 234 30 34 3 54 0 86 16 96 3 53 64 4 2 Oo 15 57 00 02 47 10 7 0 821 6 8 299 260 29 34 3 94 0 86 16 89 3 59 65 4 6 0 15
53. B 0 00 VD mij 60 User C 0 00 Notes Comments il Modify Calibration ET Ti i Modify the information 1 Press the Modify button on the Information dialog box 2 Change the values you want to modify and press OK to confirm The software allows to assess the energy expenditure and metabolism substratum In order to measure FAT and CHO type the UN Ureic Nitrogen value into the field All the nutritional parameter will be recalculate considering the UN value The summary feature allows to summarise test results according to the workload and phase during the test View the summary 1 Choose Summary from the View menu 2 The summary ofthe current test active window will be displayed BB TREADMIL T test n 3 Summary Oo x Rf VT VE vo2 vcoz VE VO2 VE VCOZ VO2 Kg R Feo2 Feco2 HR vo2 HR FetO2 Fetco2 b min 1 l min ml min ml min ml min Kg bpm ml bpm Phase n 1 Rest Start 00 00 00 End 00 01 08 Speed 0 Load2 0 Load3 0 Min 14 6 0 586 8 6 212 157 28 35 3 16 0 73 16 51 2 49 88 2 2 15 09 4 12 Max 21 0 0 971 20 3 619 489 39 52 9 24 0 82 17 68 3 58 107 6 6 15 90 4 76 Average 16 8 0 747 12 7 349 272 33 43 5 22 0 77 17 23 2 95 94 3 6 15 60 4 29 Trend 19 8 0 853 16 9 542 429 28 36 8 09 0 79 16 65 3 47 106 5 1 15 21 4 65 Phase n 2 Exercise Start 00 01 10 End 00 07 05 Speed 4 Load2 0 Load3 0 Min 47 8 0 811 16 7 540 420 23 28 8 06 0 72 15 75 3 54 110 4 7 14 34 4 37 Max 51
54. Cosmed does not assume the liability for interpretation mistakes of this documentation 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 express permission of COSMED Srl COSMED Software can be installed only in one device Excel is a registered trademark of Microsoft Corporation DBIII is a registered trademark of Bordland International Inc Lotus 123 is a registered trademark of Lotus Development Corporation Quark PFT User manual XI Edition 03 2005 Copyright 1998 COSMED Copyright 2003 COSMED COSMED Srl Italy http www cosmed it Part N C01340 02 91 Table of contents Getting started 11 Important notices cscccccccrescrsscccsccesccesccesccesccesccesscesccesscescoessoes 12 Intended Use ae 12 WaAIINES ee eeeceecceceeseeseeeecesecaeeeecesecaeeecesecsaeeeeesecaeeaeeaeerenaeeas 12 Contraindication cccccsccccscccscsccccsccccesccccsccccescccesccccesecscscceeeeee 14 Contraindications for the Spirometer tests 14 Absolute contraindications uueeeeeesneeeneeenenennenee nn 14 Relative contraindications uuneeeeneeennnennne 14 Contraindications for Bronchial provocation tests 14 Absolute contraindications uueeeeseneeeneeeneeenennenne nen 14 Relative contraindications uueeeenennnenneeenne 14 Contr
55. Ergo software must be the same of the Quark PFT spiro 1 2 PC port configuration The first time the software is used it is necessary to configure the communication port with the PC USB COM1 COM2 For further details see the chapter Database management 44 Quark PFT User Manual In the Windows Program Manager open the Program Group in which the software was installed Click the Quark PFT icon Software main features Display Tool bar Dialog windows Scroll bars On line help Software version The program may contain several windows The active window is highlighted with a different colour of the caption Some functions of the program are active window sensitive Print right key of the mouse Many of the functions that may be selected from the menu can be activated more rapidly by clicking with the mouse on the corresponding icon in the tool bar Positioning the mouse cursor on one of the buttons of the toolbar if the option Hints is enabled the description of the corresponding function is shown in a label Show hide the toolbar Select Toolbar from Options menu in order to show or hide the toolbar The typical operating environment of Microsoft Windows is the Dialog box This window is provided with a series of fields in which input the information Use of the keyboard e To move the cursor among fields press the Tab key until you reach the desired field e Press the Enter key to
56. Formula definition Predicteds set This form allows the user to manage the set of predicteds The following information define a set Chapter 6 Spirometry 63 Name identifies the set and cannot be duplicated Description free field Age the adult predicteds start since this age To enter a new set of predicteds click on the New button The field Name must be filled and must be unique To stop without saving click on the Cancel button To save the set click on the Save button To delete a set of predicteds click on the Delete button If a set is deleted also the associated formulae are deleted It is possible to generate a new set of predicteds with the same attributes and the same formulae of the selected one To do this click on the Copy button and specify a new Name To import a set of predicteds click on the Import button and select a file of Predicteds files type To export a set of predicteds click on the Export button In the list Set current predicteds choose the current predicteds for printing and viewing Set the current predicted Quark PFT allows to calculate the predicted values according to the following configurable sets Adults Paediatrics ERS 93 Zapletal Knudson83 Knudson83 ITS white ITS white ITS black ITS black LAM LAM MC Barcelona MC Barcelona Nhanes III Nhanes III Select the desired choice in the group Predicted Formula definition Predicteds x Predicteds set Formula defini
57. K to confirm Visualizzazione Report Elenco dei test in archivio Naas Elenco 20 02 97 00 14 13 Paziente attuale 000002 13 03 97 00 15 00 BOND J 000003 11704797 00 10 43 TREADMIL T 000004 14704797 00 05 16 CARDIAC OUTPUT C z 000005 16 04 97 00 07 14 F LOOPS F m Report 000006 26 01 00 00 14 45 GAS ECG G Tutti i test Wasserman C Const4plot C ST trends C ERS 98 OK Annulla VOZ ml min 3534 2862 2189 1516 844 171 00 00 01 45 03 30 05 15 07 00 08 45 10 30 12 15 14 00 15 45 112 Quark PFT User Manual Data Editing AAA Nota In Data view double click in the window to enter in Data Editing The software allows the user to edit the data acquired during the test in the following Ways e deleting one or more steps e editing row data e input new parameters e data filtering averaging or smoothing e advanced data elaboration After data elaboration it is always possible to restore the original data file by pressing the Restore button If you want to save permanently all the changes press Overwrite being aware this function replaces the original test definitely Editing values and input numerical values 1 Choose Edit test from the Test menu 2 Select the cell containing the value you want to replace with others values and press OK to confirm the editing The software will recompute all the parameters Both the tables and the graphs wil
58. LT viewing The software allows to customise two of the three graphs for the LT visualisation 1 Choose Lactate Threshold from the Options menu 2 Choose the parameters you want to be shown on the LT window and press OK to confirm your choices 108 Quark PFT User Manual Fittings The purpose of the fitting function is to find the function that fits as better as possible the measured data The software allows to fit data according to 3 different functions Model Function Algorithm Available for Linear Y A X B Least squares Any vs any X graph Mono Exp Y A B exp t to tau Levemberg Marquardt Any Y vs Time Graph Mean value This function is available only if the active window is a single Y graph i e VO vs time or VO vs Load Fittings Selection Type TE ls 00 00 03 a IV Add x2 00 16 15 OK cancer Fit a graph with a linear regression 1 Make active the graph window any Y vs any X graph 2 Right click and select Fitting 3 Choose Linear in the type combo box 4 Select the first point X1 moving the mouse on the desired place in the graph pressing the Left key or using the and keys 5 Select the second point X2 moving the mouse on the desired place in the graph pressing the Right key or using the and keys 6 Press OK to confirm Fit a graph with a Mono exponential regression Insert initial factors for the formula Y B A 1 exp
59. Once you create the new predicted you can see it in the predicted window Predicted values x B gt Name Delete New List Find Copy Import Unit of meas iT O O Calculation a Male paediatric tegere r Male adult Decimals y His Female paediatric Males limit age E je Female adult Females limit age Related to no parameter OK Export Close 2 116 Quark PFT User Manual Exporting data With this function you can export the tests data and parameters in different file formats xpo Cosmed proprietary file format txt ASCID xls Microsoft Excel wk1 Lotus 123 Export a test 1 Choose Export Tests from the Test menu 2 Select the test to export from the list box and press OK to confirm 3 Select the file output format from the list box click on xpo txt xls or wkl If you selected ASCII format by clicking on Text button you can then select the Thousands sep and Column sep according to the program you want to use With the xpo Cosmed format you can import export the tests performed on another Quark equipment 4 Select the folder type the file name and press OK to confirm Export test n 1 21x File name Folders test 25 xpo c cosmed k4b2_en aS a u c yj cosmed k4b2_en LI drivers J test Save file as type Drives AAA Cosmed format _xpo 7 c hard disk c Text Note The DDE function is availa
60. Resting metabolic rate test using the face mask 1 Since the ventilation is very low normally lt 10 litres min the turbine calibration has to be performed with very slow manoeuvres each complete manoeuvre in about 10 15 seconds to obtain the best accuracy Use the following correction for the dead space VD 50 ml for the small mask 60 ml for the medium mask 70 ml for the large mask Resting metabolic rate test using the canopy option 1 Verify before and during the test that the FeCO falls into the range 0 5 0 8 and adjust the flow rate of the pump If the FeCO is too low increase the flow if it is too high decrease the flow In fact if the FeCO is too low the measurement could be not reliable while an high FeCO could be dangerous for the patient In order to perform a correct ERGO calibration and to obtein more reliable data from the test it is recommended to use a calibration cylinder with the following concectrations 1 CO 20 Oy balance N gt If you use this cylinder please remember to modify the reference values as explained in the chapter Calibration Chapter 14 Resting Metabolic Rate Test 127 Performing a test using the face mask Calibrations Before the test it is necessary to perform an ergo calibration see Calibration chapter and it is advisable to perform also a turbine calibration see Recommendations in this chapter How to prepare a patient The patient interfaces wi
61. Serial cable RS 232 DB9 M F Time Lag Fuses 5x20 250V T630 mA Time Lag Fuses 5x20 250V T1 25A Registration card User manual Quark PFT Conformity declaration Quark PFT3 standard packaging Code C00933 01 04 C02120 01 05 C02171 02 11 C01730 01 05 C00243 01 06 C02210 02 08 A 182 300 004 A 830 300 001 662 100 001 C00137 01 20 C00136 01 20 A 182 310 001 C00269 01 20 C01788 01 36 C00191 01 11 A 362 060 001 A 362 300 001 A 680 013 630 A 680 024 125 C00067 01 94 C01340 02 91 C01999 02 DC 1 1 1 1 2 2 1 1 1 Description Quark PFT 3 unit Turbine 28mm Kit optoelectronic reader Quark PFT2 3 4 Breathing valve PFT3 4 3 ways Calibration syringe 3 litres Permapure L 2 m Antibacterial filter Air valve membrane Nose clips Paediatric paper mouthpieces Adult paper mouthpieces Antimoisture filter PTE soft mouthpieces PC software Tank tubing 2m Power cord Schuko L 2 mt Serial cable RS 232 DB9 M F Time Lag Fuses 5x20 250V T630 mA Time Lag Fuses 5x20 250V T630 mA Registration card User manual Quark PFT Conformity declaration Quark PFT4 standard packaging Code C00934 01 04 C02120 01 05 C02171 02 11 C01730 01 05 C00243 01 06 C02210 02 08 A 182 300 004 662 100 001 C00137 01 20 C00136 01 20 A 182 310 001 C01788 01 36 362 060 001 362 300 001 C00191 03 11 A 830 300 001 A 680 013 630 A 680 024 125 C00067 02 94 C00269 01 20 C01340 02 91 C01999 02 DC NI N e m m m N
62. Warranty registrationn ccccccsccssscssscssscssscssscsssccsscssscsccssscesccescoes 26 Register the product via software 26 How to contact COSMED 26 Complain feedback and suggestions ene 26 Options Accessories sccsscssscssscresccesccesccesccssccesscesccesccescoescoescees 27 PC configuration required scccssscssssccssssccssscccsssccsssccsssscosescees 28 Technical features sssossssssnnnnnsssnsnnnnnnssnnnnnnssnnnnnnssnnnnnnnssnnnnnnnnnne 29 Flowmeteraa anuessnssenstanspuinniniteen 29 Oxygen Sensor O nn 29 2 Quark PFT User Manual Carbon Dioxide Sensor CO eenenenenn 29 Carbon Monoxide sensor CO 29 Methane sensor CH 29 Humidity absorber 29 Power Supply nes 29 Environmental Sensors 29 Dimension and Weight 29 AUX INpUtS nueennsnensennsensensennsensnnsnnnennn nennen san 29 Measurements 31 Pulmonary function tests and measured parameters cessee 32 Spiromeltry Tests aaa 32 FVC Forced Vital Capacity eneenene 32 VC IVC Slow Vital Capacity and Ventilatory pattern 32 MVV Maximum Voluntary Ventilation 33 Bronchoprovocation Response 33 Multi breath Nitrogen wash out 33 Closing Volume test 33 CO diffusion Test 33 Respiratory Drive PO 1 Test 34 MIPMEP ess
63. a Yt stability threshold C 100 ml 200 ml Option Description Vt Stability threshold Recognition criterion of regular respiration Recommendations e Connect the P0 1 valve on the breathing valve connector on the front panel of the Quark system e Verify that the cylinder driving the P0 1 valve O CO is open Perform the test lt 1 Select Respiratory Drive from the Test menu and wait for the green led is prompted on the right side of the screen 2 Breath at rest until the message Press F2 is prompted 3 Wait for the Patient establish a regular breathing pattern and press F2 whenever you want to close the inspiratory valve for measuring the P0 1 parameter 4 Repeat the above mentioned manoeuvre several time both in room air or with enhanced CO inspiratory gas amp 5 Press F3 to end the test 84 Quark PFT User Manual 6 To visualise the V t graph and the main parameters press the follow buttons El view P0 1 graph view Volume Time graph z view breath by breath data 7 Press the Abort button to stop the acquisition discarding the results Chapter 8 P0 1 Respiratory drive 85 86 Quark PFT User Manual capacity CO Diffusing Capacity DLCO Test The process of diffusion is defined as the flow of particles from an area of higher concentration to an area of lower concentration The measurement of diffusion as performed in pulmonary function laboratories
64. a new directory Press OK to confirm 3 In the dialog box it will appear an estimate of the number of floppy disks you need in order to back up the archives Press OK Backup v 5 4 x Restore v 5 4 x Statistics Backup to 60 fles Restore from 2 Mb ee Description Browse Cancel x Cancel Restore 1 Select Restore archive from the File menu 2 On the Restore dialog box specify the drive source and press OK a dialog box will appear indicating all data of the backup processed Chapter 5 Database Management 59 Spirometry Settings Quark PFT software allows to configure some options selecting Configure from the Option menu Preferences Sprometry Graphs Curve n J Serial Port Curve n 2 C COM 1 Curve n 3 COM Curve n 4 Unit of meas Curve n 5 Cm Kg F Grids IV Show InfoTest C Inch Lbs User Free Fields Patient Card Visit Card Test Card User Text User Text User Text User Text User Text User Numeric User Text user Text User Numeric Cancel Help Graphs All the graphs visualised and or printed can be customised in colours and appearance 1 Select the desired colours of the curves 5 curves max can be overlapped on the same graph 2 Enable or disable the Grid option 3 Enable or disable the Show Info Test option Serial port You must select the serial port RS 232 that will be used to connect the Quark PFT with the PC
65. age of test PRE DFVC pre Change of FVC as a percentage of test PRE DPEF pre Change of PEF as a percentage oftest PRE Some authors states that the above mentioned parameters are too dependent from the FVC Pre hence latest reference ERS93 A comparison of six different ways of expressing the bronchodilating response in asthma and COPD reproducibility and dependence of pre bronchodilator FEV1 E Dompeling C P van Schayck et Al ERJ 1992 5 975 981 recommend the following parameters DFEV1 pred Change of FVC as a percentage of predicted value DFEV1 poss Change of FEV1 as a percentage of possible value Methacholine and Histamine Bronchial provocation Tests The most common indication for performing methacholine and histamine bronchial challenges is to diagnose hyperresponsive airways Some patients demonstrate normal baseline pulmonary function despite complaints of tightness wheezing cough and a little or not response to bronchoconstrictor Other patients demonstrate spirometric improvement after use of bronchoconstrictor have diurnal variation in peak flows In this groups aerosolised bronchial challenges are used to confirm a diagnosis of Asthma We can summarise the use of the test as follows 1 Diagnose asthma 2 Confirm a diagnosis of asthma 3 Document the severity of hyperresponsivness 4 Follow changes in hyperresponsivness When patients with hyperresponsive airways inhale certain pharmacologic agents i e Met
66. aindications for Exercise testing 14 Environmental condition of use essessssnnnnsssnnnnnsssnnnnnsnsnnnnnnnsnnnnnnne 15 EMG 02 2505054500084es50sesssskesonunskesatssesssnnnsnnssensenesssnnssnensedennsssnskenteneeeen 16 Safety and conformity sssssessnnensnnunnnnnensnnnnnnsnennnensnsnnsnsnnnnnncnse 19 Safety cies eres ode sancdectie rsd beens eet etes etes este eeee sert ds etes 19 EMG anni ni 19 Quality Assurance uunceneenseeeeeseeennnnennnennnnnn nennen 19 Medical Device Directive CE mark 19 Keyn tes ccsosssssescssisssssseeneessoszesensssuneenssnsesnessenesssesnrnersesseeereereeenee 20 Typographic keynotes nenne 20 Graphic keynotes ueeseesseesseesenensnensnnennnnnnnennnennnen nennen 20 Systems Overview nssssssssnessnnnsnensnnnsnnnsnnnsnnnsnnnsnnnsnnnsnnnsnnnsnnnsnnnsnnnsee 21 Tests Products table 21 Before st rling 5 5 00050s53 00s000800000 005800 HR rs n essen rss 22 Checking the packing contents een 22 Quark PFT1 standard packaging e 22 Quark PFT2 standard packaging nee 22 Quark PFT3 standard packaging e 23 Quark PFT4 standard packaging nee 23 Quark PFT Ergo standard packaging 24 Quark PFT2 ergo Standard packaging 24 Quark PFT4 ergo Standard packaging 25
67. airway resistance measurement test 98 Preparing the Rocc module and connecting to the unit 98 Performing the test 98 Exercise testing 101 Recommendations for the exercise testing ss 102 The evaluation of the cardiorespiratory function 102 Precautions sencan dena Ha 102 6 Quark PFT User Manual Laboratories een 102 Ending the test au anna 102 Preparing the patient 102 Before testing ana 102 Patient assent un gentnkenken 103 Ending the test nennen 103 Start Testing innerer 104 Start LOSE niet 104 Abort the test without saving data 104 End the test saving data 104 View data in real time 104 View graphs in real time 105 Parameters tO VIEW cccccccccsseesseessecsseceseceseceseeeseeeseeeseeesaeesaees 105 Manual protocol 105 Enter Load and Phase 105 Set the MArK TS 5 ere innen 105 Automatic protocol 105 Modify the load during the test 105 Set the BPM alarm 105 Enter the BPM asien aan 105 Data management sssssssssssssnsensensensensensnnnnnnnnnsnnsensensensnnsensnnsnne 106 Viewing data ramener enteee 106 View data in table form 106 Creating STAPhS nn en ne neue 106 View data in graph form 106 Customise the graphs ceneeenenenennennnennennne nee 107 Switch from graph to data and vice versa 107 Viewing predicted values
68. aliva is entered in the tube replace it immediately because it lost its functions e Periodically grease the o ring on the connector in order to simplify the flowmeter connection e Replace it every 100 test 6 month The equipment requires easy inspections to be carried out in order to assure a proper electrical and mechanical safety level in the years These inspections are highly recommended after a rough use of the equipment or after a period of storage in unfavourable environmental conditions Referring to the electrical safety it is important to check the conditions of insulation materials of cables plugs and any other visible part by means of simple inspection when the equipment is switched off and adapters or electrical feeders are disconnected from the supply mains Mechanical parts to check are the turbine and breathing circuits Follow these instructions e extract the turbine from the optoelectronic reader e verify by inspection that the turbine axis fits correctly its seats and the blade is strongly fastened on the axis itself it can be useful to shake slightly the turbine in order to note any anomalous movement Check if there are any torn or broken components in the breathing circuits remember that they can create safety risk to patients during tests The fuses can be replaced easily in the following way 1 Open the power supply cover using a screwdriver as shown in the picture 2 Extract the fuse
69. ances e do not use abrasive powders or glass cleaners containing alcohol or ammonia on the plexiglas components of the equipment e donot steam autoclave any parts of the equipment unless it is clearly specified e do not immerse the optoelectronic reader Preparing the disinfecting solution The following recommendations are retrieved from APIC Association for Professionals in Infection Control and Epidemiology Inc APIC Guidelines for Selection and Use of Disinfectants William A Rutala PhD MPH CIC American Journal of Infection Control vol 24 N 4 pp 313 342 August 1996 http www apic org pdf qddisinf pdf As disinfecting solution it is suggested e Sodium hypochlorite 0 5 5000 ppm prepared fresh for use within 24 hours e Sodium hypochlorite 1 10000 ppm prepared fresh for use within 30 days The first solution can be easily prepared by adding 1 part household bleach sodium hypochlorite 5 25 to 9 parts water the second one by adding 1 part household bleach to 4 parts water 142 Quark PFT User Manual AAA Warning Do not use alcoholic solutions for the turbine otherwise there can be damages to the plastic material Cleaning the turbine flowmeter Turbine Optoelectronic reader It is necessary to disinfect periodically the turbine for sanitary measures or and for the correct device function The disinfecting procedure is easy and may be effected every time the user needs keeping a
70. and make the Patient breath as much deeply and rapidly as possible for at least 12 seconds 3 Press F3 or wait for automatic interruption 5 seconds without flow in order to visualise the V t graph together with the main parameters compared to the predicted values 4 To visualise the V t graph and the main parameters press the follow buttons view Volume Time graph DATA view data of the test 5 Press Alt F3 to stop the acquisition discarding the results 6 Repeat the test until it is correctly performed ATS recommends 3 times 7 Press Exit to visualise the test list carried out during current session together with the results of the main parameters 8 Select the test that you want to save the Best Test according to the ATS criteria is 70 Quark PFT User Manual highlighted as default and press OK Bronchial Provocation Test Bronchodilator test AAA Note Read carefully the contraindications in Chapter 1 Bronchodilators are administered routinely in the PFT laboratory to determine whether airflow obstruction is reversible Bronchodilators increase airway calibre by relaxing airway smooth muscle The test consists of comparing results between the reference FVC FVC PRE and the FVC POST performed after the administration of the drug Increasing value of 13 15 of FEV1 respect to the basal value FVC Pre is considered as a reversible condition Main parameters are the following DFEV1 pre Change of FEV1 as a percent
71. ard Quark PFT User Manual Quark PFT4 ergo Standard packaging Code C00937 01 04 C02120 01 05 C02171 02 11 A 800 900 001 C00243 01 06 C00191 03 11 C02210 02 08 C01399 02 12 C02125 01 10 C02135 01 10 C02145 01 10 C00861 01 06 A 661 200 001 A 661 200 002 C00269 01 20 C00137 01 20 C00136 01 20 A 182 300 005 A 182 310 001 A 362 060 001 A 362 300 001 A 662 100 001 A 680 013 630 A 680 024 125 A 830 300 001 C01788 01 36 C01790 01 36 C01999 01 DC C00067 02 94 C01340 02 91 2 lt ee e e e ee ee Ne ee Description Quark PFT4 ergo unit Turbine 28mm Kit optoelectronic reader Quark PFT 2 3 4 Head cap for the adult masks Calibration Syringe 3L Tank tubing 6m Permapure L2m Cable in HR TTL Mask mouth nose breath adult S Mask mouth nose breath adult M Mask mouth nose breath adult L HR probe HR elastic belt HR polar transmitter PTE soft mouthpiece Paediatric paper mouthpieces Adult paper mouthpieces Antibacterial filter Anti moisture filter Power cord Schuko 2m RS232 cable DB9 M F Nose clips Time lag fuses 5x20 250V T630mA Time lag fuses 5x20 250V T1 25A Air valve membrane PC software Spiro PC software Ergo Conformity declaration Registration card Quark PFT User Manual Chapter 1 Getting started 25 Warraniy registration Before using the system please take a moment to fill in the registration form and the warranty and return them to COSMED by doing this you are eligible
72. ases and explosive atmospheres In accordance with their intended use Quark PFT is not to be handled together with other medical devices unless it is clearly declared by the manufacturer itself It is recommended to use a computer with electromagnetic compatibility CE marking and with low radiation emission displays It is necessary to make the PC connected to the Quark PFT compliant with EN 60601 1 by means ofan isolation transformer The Quark PFT needs special precautions regarding EMC and needs to be installed and put into service according to the EMC information provided in the section EMC Portable and mobile RF communications equipment can affect the Quark PFT Use only the cable and accessories supplied with the equipment The use of accessories and or cables other than those supplied may result in increased emissions or decreased immunity of the equipment The Quark PFT should not be used adjacent to or stacked with other equipment If adjacent or stacked use is necessary the Quark PFT should be observed to verify normal operation in the configuration in which it will be used Graphical symbols used in accordance to present specifications are described here below Equipment type B EN60601 1 Equipment type BF EN60601 1 Danger high temperature OFF ON Protective earth ground Alternating current Chapter 1 Getting started 13 Contraindication The physical strain to execute the respirat
73. asured during this test are FRC Functional Residual Capacity CEV Total ventilated volume during the test Wash out time Test duration RV Residual Volume TLC Total Lung Capacity RV TLC Motley index Recommendations e The system must be calibrated before each test See Calibration chapter e The flowmeter must be connected properly to the breathing valve and the soft mouthpiece must be properly fixed to the corresponding adapter e Check that the O cylinder is open and its output pressure is adjusted in the range 5 6 bar Setting N2 wash out options 1 Select Settings from Options menu 2 Select Multi breath N Wash out 3 Set the desired value in all the fields described in the next table Test options x Single breath CO diffusing capacity Respiratory drive Preferences Spirometry Hulti breath N2 Wash out is lu End test criterium FetN2 2 ri Extrapolate FRC Vv Yt stability threshold 100 ml C 200 ml 400 ml Test quality control Lower Upper Depth of breathing ml 0 m 1500 Frequency of breathing 12min 5 r 25 4 M Parameters bar Cancel Help 78 Quark PFT User Manual Option Description End of test criterion FetN value under which the wash out test is concluded automatically FRC Extrapolating Enable the extrapolation of FetN to the end of test criterion Vt stability threshold Recognition criterion of regular respiration Breathing Depth Range of respiration contr
74. average interval automatically identified by the software is not satisfying for example because the patient was speaking in the first minutes it is possible to modify the interval of the average Right click and select Edit RMR It is possible to move the start and the end lines To move the start line left click on the exact time in which you want to start the calculations for the end line right click Print The print of the current window generates a report similar to the one of the RMR test using the face mask 134 Quark PFT User Manual Sub maximal Exercise Testing Introduction Pre test screening Several physiological responses to exercise are used to evaluate cardiorespiratory fitness including oxygen consumption heart rate and blood pressure Measuring these variables during exercise particularly maximum exercise increase the chance of detecting any coronary artery disease or pulmonary disease Unfortunately maximum exercise tests are impractical because they are expensive require extensive clinical supervision and subject individuals to levels of physical stress that may be unnecessary depending on the objectives of the test Consequently maximal testing is reserved for clinical assessments athletic evaluation and research A sub maximal exercise test costs less and carries a lower risk for the individual Although less sensitive and specific for detecting disease or estimating maximal oxygen consumpti
75. ax FVC within 0 21 diff 2 max FEV1 within 0 21 diff 2 max PEF within 10 MVV time less than 12 sec Chapter 17 Appendix 157 References Spirometry ATS 94 Standardization of Spirometry 1994 Update American J Respiratory Critical Care Medicine Vol 152 1107 1136 1995 ERS 93 Standardized Lung Function Testing Official Statement of the European Respiratory Society The European Respiratory Journal Volume 6 Supplement 16 March Lung function J E Cotes Blackwell scientific publications Guidelines for Clinical Exercises Testing Laboratories I L Pina G J Balady P Hanson A J Labovitz D W Madonna J Myers American Heart Association 1995 91 912 Lung Volumes ERS ATS workshop report series Multiple breath nitrogen washout techniques including measurements with patients on ventilators C J L Newth P Enright R L Johnson ERJ 1997 10 2174 2185 Single Breath with Apnea ATS 95 Single breath Carbon Monoxide Diffusing Capacity Transfer Factor Recommendation for a Standard Technique 1995 Update Am J Respir Crit Care Med Vol 152 Vol 6 pp 2185 2198 1995 ERS 93 Standardized Lung Function Testing Official Statement of the European Respiratory Society The European Respiratory Journal Volume 6 Supplement 16 March 1993 Standardization of measurement of transfer factor diffusing capacity Single Breath without Apnea Rest and Exercise Cardiac Ou
76. ayed graphically and extrapolated to the VO at the age predicted maximal heart rate HR 220 age A variety of protocols for different exercise modalities i e treadmill stationary cycle and step increments can be used as long as the VO requirements of each selected workload can be estimated with accuracy The objectives of cardiorespiratory fitness assessments in the apparently healthy population are as follows e Determine the level of cardiorespiratory fitness and establish fitness program goals and objectives e Develop a safe effective exercise prescription for the improvement of cardiorespiratory fitness e Document improvements in cardiorespiratory fitness as a result of exercise training or other interventions e Motivate individuals to initiate an exercise program or comply with an established program e Provide information concerning health status A few assumptions regarding testing are necessary to ensure the highest degree of accuracy when using sub maximal exercise testing to estimate VOomax e Selected workloads are reproducible A steady state heart rate is obtained during each stage of the test Usually workload durations of 3 minutes or more are used to ensure steady state e The maximal heart rate for a given age is uniform HR 220 age e Heart rate and VO have a linear relation over a wide range of values thus the slope of HR VO regression can be extrapolated to an assumed maximum heart rate
77. ble click in the window to open the corresponding dialog box The software allows to detect the Lactate Threshold Anaerobic Threshold according to the Modified V slope method reference The LT can be detected both manually and automatically View the Lactate Threshold Choose Lactate Threshold from the View menu Detect the Lactate Threshold 1 Choose Calculate LT from the Test menu 2 For calculating it automatically on the Lactate Threshold dialog box click on the Auto detect button 3 For adjusting manually the point you want to detect move the scroll bar on the dialog box by pressing the arrow buttons Data and graph of the LT will be automatically redrawn 4 Press Ok button to save your choices Lactate Threshold x VCOZ ml min Ferozik Fetco2 3991 3592 3193 794 1197 798 Wi 1 1 399 1 4 i Core ne V 02 ml min 0 798 1596 2395 3193 3992 VB VOZ VE VCOZ2 Parameter Values LT Max Max 34 53 t hh mm ss 00 05 30 00 11 00 50 0 48 i 4e Load Watt 30 450 20 0 42 43 Real Load Watt 0 0 0 0 72 Revolution RPM 0 0 0 0 sol i s z VO2 ml min 1217 3032 40 1 324 4 32 VO2 Kg ml min Kg 16 01 39 90 40 1 224 J 27 VCO2 ml min 1060 3991 265 21 4 Had 21 VE l min 24 7 1307 18 9 A d Le HR bpm 87 152 57 2 Rt 0 87 1 68 51 6 VO2 ml min ur ml gt 0 798 1596 2395 3193 3992 ox coment ea 2 Customise graphs for the
78. ble only if the user PC has Microsoft Excel DDE with Excel installed If Microsoft Excel is installed on your PC you can export a test simply pressing a button on the toolbar To send a test to Excel select Send to Excel from the Test menu The program will show a status bar indicating the data transmission to Excel At the end of the process a new sheet with all test data will be opened ready to be edited with the powerful functions of Microsoft Excel Chapter 13 Exercise Testing 117 Creating Test Protocols The software allows to create different exercise protocols to use during the test The load of the ergometer is automatically controlled by the software that change it acc ording to the defined protocol Create a new protocol 1 Choose Real Time gt Ergom Tests Protocols from the Options menu 2 Press New and enter a name for the protocol 3 In the field Message Time type a number that means to get a message to advise when switching to the next load 4 Enable the Drive Ergometer check box to let the software control the ergometer Select the Initial Command if the ergometer need it 5 Enabling the option Relative Increments the loads refer to the previous step Press Generate and enter the values to generate a protocol from only one load i e 30 Watt each minute for a total of 20 steps and press OK to confirm Press Add if you want to add a new step 8 To edit a step select it from the li
79. cccssscssssccsssscsssccssssccssscccssscsesscsees 67 Recommendations uneesssesnsennserseennnnnnnnnnnnnnenee nennen 67 Perform a FVC pre test 67 Lest ncouragementissssssessuses seen nement 67 Perform the FVC test with the encouragement 68 Slow Vital Capacity sccccsccssccssscssccssccssccssccsscccsccssscsccssccescoesces 69 Perform a SVC test 69 Maximum Voluntary Ventilation 70 Perform a MVV test 70 Bronchial Provocation Test 0s0ssssssnunssssonnnnnnnsnnnnnssnnnnnnnnnnne 71 Bronchodilator test 71 Methacholine and Histamine Bronchial provocation Tests 71 Perform the test a sales ee 72 Bronchial Provocation protocols Database 72 Enter a new Bronchial provocation protocol in the ane aT DOA res en E 72 Viewing FOSUNS sisesescsscccivessceteretveececesnsetesessaeseudcecdesecevecessweceuesececesense 73 Tests of the current patient 73 Delete atest naeh 73 Printing resulis s scssesessassessencssnsnsenssnnsasnsssnnsuessnnsesnsnnnssenseneesenenrense 74 Printing Reports nehraaterssennn 74 Printing the active window 75 To print the active window 75 Printing a series of reports 75 Chapter 17 Appendix 5 Electronic reports pdf 75 Export data ss n e Er EEE E EEEE EE E 75 Exporta test aan 75 Lung Volumes 77 Lung volumes tests N washout ss 78 Recommendations 4 4 78 Setting N2 wash out options
80. chest of N because not reached by the inspired O Increased values of CV can be related to lung pathologies The main parameters calculated during this test are CV Closing Volume Delta N Delta N2 between 750ml and 1250ml of expiration Recommendations e The system must be calibrated before each test See Calibration chapter e The flowmeter must be connected properly to the breathing valve and the soft mouthpiece must be properly fixed to the corresponding adapter e Check that the O cylinder is open and its output pressure is adjusted in the range 5 6 bar 1 Select Single Breath O from the Test menu and wait for the green led is prompted on the right side of the screen 2 Connect the patient to the breathing valve and invite him her to breathe normally 3 Wait for the message carry out Slow Vital Capacity is prompted on the screen of the PC and let the patient to perform a slow vital capacity 4 Wait for a normal breathing pattern is again established and press Start F2 during a maximal exhalation 5 Ask him her to inspire up to TLC level and then to expire slowly maintaining the flow rate as much constant as possible two lines corresponding to 250ml min and 500ml min can be used as a target interval On the right side of the graph it is displayed a colored column representing the instantaneous flow This column is green if the flow is within the acceptable range otherwise it is red 6 The test stops automat
81. ct improper installation unauthorised repair or alteration or accident If the product is manufactured by a third party COSMED shall make available for the Buyer s benefit only those warranties which COSMED has received from the third party manufacturer s COSMED hereby specifically disclaims any and all warranties and or liabilities arising from defect s and or damage s to and or caused by products manufactured by third party manufacturers Buyer must obtain written authorisation from COSMED prior to the repair or alteration of COSMED products s Failure of Buyer to obtain such written authorisation shall void this warranty COSMED hereby specifically disclaims any and all other warranties of any kind whether express or implied in fact or by law including but without limitation any and all warranties of merchantability and or fitness for a particular purpose COSMED shall not be liable for special indirect and or consequential damages nor for damages of any kind arising from the use of any COSMED s products whether said products are used alone or in combination with other products or substances Determination of the suitability of any of COSMED s product s furnished hereunder for the use contemplated by Buyer is the sole risk and responsibility of Buyer and COSMED has no responsibility in connection therewith Buyer assumes all risks and liabilities for loss damage or injury to persons or property of Buyer or others arising ou
82. duced with the exercise Patient assent The patient is informed that he will be submitted to a maximum effort which could be stopped at any moment and of the risks of the test execution Ending the test Test may end when the maximum value of the oxygen consumption has been reached and the patient s response established Chapter 13 Exercise Testing 103 AAA Note Selecting Simulated test the software allows to use the gas calibration in order to perform the test This is useful if the user would check the accuracy of gas measurements Q ABORT STOP Before starting exercise test type a new patient information or choose one from the list of patient in the file As soon as a patient has been entered the software is ready to start a test The name of the active patient is shown on the status bar of the program window Start a test 1 Calibrate the analysers as described in the Calibration chapter 2 Choose Execute Test from the Test menu Height cm EA Mode Gas Weight Kg 88 0 c c c l Simulated test Ergometer no one Protocol no one X Other data Le Le Le Workspace User 1 v Details Cancel ie iss Eee 3 Enter or modify the antropometric data of the patient and select the options you need to carry out the test To use a specific protocol choose it in the list box and press OK to confirm Select the ergometer you need to control 5 The sof
83. e Use a rubber mouthpiece connected to the antibacterial filter and nose clip 3 Select MIP MEP from Test menu and wait for the green led is prompted on the right side of the screen Breathe normally for some time 5 Carry out a maximal expiration for the MIP or a maximal inspiration for the MEP 6 Press F2 during the expiration inspiration 7 Inspire Expire with the maximum force against the shutter until it opens automatically 8 Repeat the same procedure for the expiratory inspiratory maneuver It is not necessary to repeat the test since both MEP and MIP can be conducted during the same acquisition 9 Press F3 or wait the end of the test so that the software displays the graphs the measured parameters and the predicteds values Quark PFT James BOND MIP MEP 20 18 08 2003 File View Test Options Window Help ANABARRA ner uT DATA P cmH20 150 BEE 16 x b Maximal Respiratory Pressures TEST 125 4 100 754 50 25 0 u r 254 19 15 20 25 30 M5 50 55 60 65 70 75 ents 50 4 754 100 4 Ke A 1254 mr 150 Parameter UM Description Pred TEST 20 Pred MIP cmH20 Max Inspiratory Pressure 104 7 79 2 75 6 MEP cmH20 Max Expiratory Pressure 138 6 115 0 For Help press F1 94 Quark PFT User Manual 18 08 2003 James BOND NUM Pulse oximetry option The ox
84. e 130 Performing a test using the canopy option ss 132 Calhbrati ns ssssassnssstnnesianene enr ceases cemeessqnsnnts 132 How to prepare the canopy and the patient 0 00 eee 132 Replacement of the power plug 132 Connecting the Canopy 132 How to prepare the patient 00nnnnonnsssoeoseseeseeseeeeeee 133 Performing the test 133 Viewingthetest u nnaienunesikskense len 134 How to modify the average interval nee 134 Print ana anni 134 Sub maximal Exercise Testing 135 Introduction sssssssssssssnsnnnssssnnnnsssnnnnnnnnsnnnnnssnnnnnnnnsnnnnnsnnnnnnnnnnnee 136 Protest Screenine eenhneenenes ke 136 Sub maximal exercise testing 137 Considerations with sub maximal exercise testing 137 Staf ANE eneren nest dace eer i EEEE E EEEE ER 138 Test termination ss 138 Considerations for ACCULACY csssscccssccsssccsssscccsscccesscccssscsesseoees 139 Performing the test ccsscccosssocsecoscssssccsesssacsssesseccsesssocsssesssccsessassssees 140 An example of testing protocol eeeneeneenneen 140 System maintenance 141 System maintenance essesssosesssosecssosecesosecseosecseosessessesssosesseosesoe 142 Cleaning and disinfection unsseeeseenneenneeenneeeneeenne nennen 142 Chapter 17 Appendix
85. e MOUSE sus eme ot 45 Seroll Bars een aha 45 Ondine Hel p ssi cats een ehe 45 Software VETSION v c cccesssccsessseccsssessdcsnteesecasntoscedsnaceccasvacaseceneetses 45 Calibration 47 Calibrating Sensors cccssccsscscsccssccesccesccesccesccssccesccesccescoescoescees 48 Running the Calibration program 48 Log Nee EE A a 48 Setting reference values 48 To set the reference values cceccecsseessecsteceteceteeeseenes 48 Calibrating analysers cccscescceseceeeesceeeeeseeeeeeseecnseeeseeeseees 49 ERGO Calibration ss 49 FRC Calibration ss 49 DLCO Calibration nennen 49 Print the calibration report 50 Edit the calibration factors 50 Oz delay check ansehen 50 Turbine calibration ss sssssssssssssssssssssssssssssssssse 51 The calibration Syringe sceeeceececeeeeeeeceeeeeeeeeereeaeens 51 Assembling the flowmeter for calibration 51 Calibrating the turbine 52 Checking the system signals ss ssssssessssssesssessessse 53 The control panel 53 Using the control panel 53 Database Management 55 Spirometry patient s database ses 56 Patient C rd un sansleninenanspe 56 Visit Caid eerie niinen neui rechne erde Tee 56 Test Card nn nannten 57 Import export a Tests card 57 Diagnosis Database 57 Exercise testing patient s database sssssssseseseseseee 58 Enter a new patient 58 Find
86. e and select the desired colour This function is useful to correct data from artefacts the noise affecting the measured data can be reduced in 2 different ways Graphical noise suppression using the mouse Threshold noise suppression applying a filter to the measured data SmartSmooth Parameter Noise X no cor max Corr Ti x gs 1 Value Execute Bale End Fix Cancel ip Apply the graphical noise suppression 1 Make active a graph or a data window corresponding to the test that you want to modify 2 Press the right key of the mouse and select Smart Edit 3 Select the parameter that you want to modify 4 Point the mouse on the position where the graph presents the artefacts click the Right key and keeping pressed the key drag the point on the desired place 5 If you want to cancel the edit press the Left key of the mouse 6 Repeat the above mentioned procedure for the all parameters and press OK Apply the threshold noise suppression 1 Make active a graph or data window corresponding to the test that you want to modify 2 Press the Right key of the mouse and select Smart Edit 3 Select the parameter that you want to modify 4 Set a Noise Threshold as a percentage of the parameter value above which any peak will be considered an artefact 5 Press Execute and eventually Undo if you are not satisfied 6 Press OK to confirm Chapter 13 Exercise Testing 115 Customi
87. e on small curves ca Automatic Interpretation Quark PFT has the function of interpreting each test performed by a patient visualising an automatic diagnosis The algorithm has been calculated basing on Lung Function Testing selection of reference values and interpretative strategies A R R D 144 1991 1202 1218 The automatic diagnosis is calculated at the end of the FVC Test if e the automatic diagnosis option is enabled e the patient s anthropometric data allow the calculation of the LLN Lower Limit of Normal range e at least one FVC test has been performed To enable disable the automatic diagnosis 1 Click on Enable Automatic Interpretation checkbox to enable or disable the calculation and the visualisation of the automatic interpretation 2 Select the LLN Lower Limit of Normal Range criteria among the ATS LLN Pred 0 674 SD ERS LLN Pred 1 647 SD or 80 Pred LLN Pred 0 8 specifications Quality control Quark PFT allows a quality test control The calculation has been carried out referring to Spirometry in the Lung Health Study Methods and Quality Control A R R D 1991 143 1215 1223 The messages concerning the quality control are shown at the end of the test To enable disable the quality control click on Enable Quality Control checkbox 62 Quark PFT User Manual Parameters manager View Print Sort Customize Not selected parameters Selected parameters UE
88. e steeper than 1 0 The intercept of these two slopes is the LT or AT point measured by gas exchange The increase in VCO2 in excess of that derived from aerobic metabolism must be generated from the buffering of lactic acid This is an obligatory gas exchange phenomenon seen in all subjects who exercise to work levels above their LT This technique is referred to as the V Slope method References OVS Original V Slope method A new method for detecting anaerobic threshold by gas exchange Beaver Wasswrman Whipp JAP 1986 60 2020 2027 MVS Modified V Slope method Metabolic acidosis during exercise in patients with chronic obstructive pulmonary disease Sue Wasserman CHEST 1988 94 93 1 938 Delayed Kinetics of VO2 in the Transition from prior Exercise Evidence for O2 Transport Limitation of VO2 Kinetics A Review R L Hughson and M A Morrissey Int J Sports Med 4 1983 31 39 ISO 8996 Ergonomics Determination of metabolic heat production 1990 In the following picture it is shown how the O debit and deficit values are computed Y A B expl t ta Tau 02 Kinetics YSA4B expl t t1 Tau vl At 2 A VC k B VOZ B o tl start work t1 stop work t2 end test O2debt VO2 worktau 2 02 deficit an X x N Le VO2 work VO2 work VO2 l min VO2 rest VO2 rest a 50 to 100 150 tt 200 250 300 time sec Chapter 17 Appendix 153 ATS 94 recommendations
89. e use the New Window function from the Window menu If you need to display a list of visits e Select Visits list from the File menu e Type the name of the Company and or the time interval desired or simply confirm for the complete list Tests of the current patient If a current patient has been selected you can quickly view his tests selecting Test current patient from the View menu Delete a test 1 Select Patients from the File menu or press the button by side 2 Select the test that you want to eliminate from the list of the tests referred to the Current Patient and press Delete Chapter 6 Spirometry 73 Printing results Printing Reports 4 You can print out in three different ways e printing the Report e printing the Active Window e printing a series of reports To print a report of the current visit select Print report from File menu The software will choose automatically the best performed test The standard Report is composed by 1 2 or 3 pages depending if you wish to printout the FVC data and the graphs together on the first page or if you wish to printout the bronchoprovocation response I Multi breath N2 Wash out i T Single breath 02 cancel Response Single breath CO diffusing capacity __ Cancel l Single breath CO no breath hold Help lv Ci diffi 1 teady Sta F FYC POST tests Test Drug Dose FEY1 Methacholine 8 Methacholine 0 23 5 13 9 Methacholine
90. ected to your PC and the selected serial port COM1 COM corresponds to the one effectively use 2 The name shown on the status bar corresponds to the patient who is to carrying out the tests 3 The today s visit card exists 66 Quark PFT User Manual Forced Vital Capacity pre FVC is a reference test to verify obstructive airflow limitations and restrictive disorders lung volume limitations To achieve good test results it is fundamental a good manoeuvre quality control messages real time plots Recommendations The main parameters measured during FVC tests are FVC Forced Vital Capacity FEVI Forced Expiratory Volume in 1 second FEVI FVC FEVI as a percentage of FVC PEF Peak Expiratory Flow FEF25 75 Forced mid Expiratory Flow The two representative plots are the Flow Volume and Volume Time loops By comparing FVC FEV1 and FEV1 FVC values the software allows an automatic interpretation concerning the levels of obstructive and or restrictive disorders The flowmeter has to be disconnected from the breathing valve The patient should wear the nose clips The turbine has been recently calibrated ATS recommends a daily calibration The paper mouthpiece or the antibacterial filter is properly connected to the flowmeter through the corresponding adapter For hygienic reasons we strongly recommend the use of a bacterial filter Ifa kid must perform the test it is recommended to enable the encourag
91. ement function which shows exactly the manoeuvre ofthe FVC test Perform a FVC pre test Test encouragement 1 Select Forced Vital Capacity pre from the Test menu and wait for the green led is prompted on the right side of the screen Explain the manoeuvre to the patient and press the F2 key Wait some seconds and perform the test After having performed the test press F3 or wait for the automatic end 5 seconds without flow so that the software displays the F V and V t graphs the main parameters and the predicteds values In order to visualise the F V and V t graph and the main parameters press the following buttons view Flow Volume graph n SI view Volume Time graph DATA view data of the test Press Alt F3 to stop the acquisition discarding the results Repeat the test until it is correctly performed ATS recommends 3 times Press Exit to visualise the test list carried out during current session together with the results ofthe main parameters Select the test that you want to save the Best Test according to the ATS criteria is highlighted as default and press OK During FVC manoeuvre you might experience some lack of collaboration with kids or with other patients In this case you may find a good help in using the encouragement software tool Chapter 6 Spirometry 67 Perform the FVC test with the encouragement 1 Select Encouragement from View menu 2 Perform the test as explained in the
92. en 34 Cardio pulmonary Exercise Testing CPET 34 Breath by Breath exercise testing 34 Indirect Calorimetry 35 Lactate Threshold V Slope 35 O2 KINCS erreneren ien E 35 Installation 37 Unpacking the system sesssosesssosesssosecssosecssosesssosesssosesssosessssesseo 38 Setting up the system esssecssecsseccsscosecosecosecosscosscosseosecosseessessseeso 39 Installing the Calibration Gas Cylinders 39 Gas pressure adjustment procedure 39 Connecting cables and tubing ss 40 Cables and Tubing s installation sequence 41 Assemble the breathing valve 4 Optoelectronic reader 41 Assemble the turbine sssssssssssssssesssssssssssssssssnessssse 42 Assemble the mask and the flowmeter 42 Using the Ultimate Seal 42 Apply the seal to the mask 43 To remove seal on mask 43 Connecting PC antenne 43 Software installation 44 Installing the software enenenenennensnnsennsennnn 44 RUM the software ernennen sun 44 PC port configuration cesessesesennsensensensennnn seen 44 Chapter 17 Appendix 3 Display erener Teen re 45 Tool Hatiin s nm 45 Show hide the toolbar 45 Dialog windows 45 Use of the keyboard 45 Use OF th
93. ent during exercise testing ses 122 Flow Volume 100ps 4 122 Flow Volume loop during the test 122 O2 CO2 vs Time iii iii 122 O2 CO2 vs Time during the test 122 O2 Saturation optional 122 O2 Saturation during the test 123 SPIEOSFAN zu vadesaudsvSecetiaiatecabaedcodsaes 123 Spirogram during the test 123 8 Quark PFT User Manual View the events after the test 123 Raw data er eine dire 123 Save Raw data 123 Resting Metabolic Rate Test 125 Metabolism 220 0 0000000000000000000000nnnnnnnnnnnnnnnnnnnsnnnnnnnnsnnnnnnnnsnnnnnnn 126 Total Metabolic Rate 126 Resting Metabolic Rate RMR 126 Importance to measure RMR 126 Measurement of the rest metabolic rate with indirect CALLIN CW 5 8e dd coat E E RE ER RRE 126 How to perform a RMR test 126 Recommendations sssssssssssssssnnnnnnnnsnnnnnssssnnnnnnssnnnnnsssnnnnnnnnne 127 Resting metabolic rate test using the face mask 127 Resting metabolic rate test using the canopy option 127 Performing a test using the face mask 128 Galibrations rne ersehnte 128 How to prepare a patient 128 barb the 1 11 A A O titre este 128 Viewing the Stan siatacesaestuccasteavteavscesodegbsceteass 129 How to modify the average interval enee 130 PriNt nieret E E ctr eenhocttdraie metre te
94. escription Calibration cylinder 5 CO2 16 O2 balance N2 DLCO cylinder 0 3 CO 0 3 amp CH4 21 O2 balance N2 DLCO st state cylinder 0 3 CO 0 3 CH4 21 O2 balance N2 O2 cylinder Trolley for Quark PFT Trolley with arm for Quark PFT Pressure regulator for cal DLCO cylinder Pressure regulator for O2 cylinder Spirovis system for MIP and MEP measurement Mask mouth nose breath ID28 adult XL Mask mouth nose breath ID28 paediatric L Mask mouth nose breath ID28 paediatric S Paediatric Headcap Chapter 1 Getting started 27 PC configuration required 28 Quark PFT User Manual Pentium II 350 MHz Windows 98 XP 64 Mb RAM CD drive VGA SVGA monitor Serial Port RS 232 available 2 serial ports in case of Ergometer control An USB port can replace one RS232 serial port if using the USB RS232 adaptor Cosmed code A 388 410 001 Any Mouse and Printer compatible with the MS Windows operative system PC conform to European Directive 89 336 EMC Technical features Flowmeter Type Bidirectional digital turbine 28 mm Flow Range 0 03 20 L sec Accuracy 2 Resistance lt 0 7 cmH O s L 12 L s Ventilation Range 0 300 litres x min Oxygen Sensor O Type Galvanic Fuel Cell Paramagnetic option Response time lt 120 ms lt 120 ms Range 0 100 O2 0 100 O2 Accuracy 0 05 O 0 03 O Carbon Dioxide Sensor CO Type NDIR Response time lt 120 ms Range 0 15 Acc
95. esktop 115 Customise the display colours 115 Smart editerio iinei ERN ES 115 Apply the graphical noise suppression 115 Apply the threshold noise suppression 115 Customise the parameters 116 Create a new parameter 116 Create a new predicted parameter nnneeee 116 Exporting data ss ciesssestaedantachceghs ceneadencesenincetaadesacess vives 117 Exporta TEST une deste vont easements 117 DDE with Excel 117 Creating Test Protocols ssssssssseesesesesessssse 118 Create a new protocol 118 Software configuration essseessnnensnnunsnnnnnnnnnnsnnnnnsnnnnsnsnnnsunnssnee 119 Data vie Wing nement R determinee 119 Select the parameters to view 119 Select the parameters to view during the test 119 Sort the parameters 119 Steady State sense E EE EEEE EEE RE 119 Customise the Steady State detection criteria 119 Printout reports cccccccscccsccccccssccssccssccssccssccssccsccsccesccssccscoesees 120 Set up the printout eenseenseeseesnensnenenensnnnsnnnnnnnnnnnnn 120 Select parameters to be printed 120 Customise the printout header 120 Electronic reports pdf cccescceecceseceeeeeseeseeseessees 121 Print the current window cescceseeseeeeeeeceseeseeeeceaeeaeeeneeaeenee 121 Print the customised report 121 Events managem
96. est that the measured FeCO is within the 0 5 0 8 range Otherwise adjust it by means of the Flow adjustment handle Warning If the green led turns off during the test the red led flashes and the alarm beeps abort the test because the pump does not work or the mains does not power the system In the last case the pump works only because of the backup battery The test is fully automatic the software will stop it and save the data at the end Chapter 14 Resting Metabolic Rate Test 133 Viewing the test Atthe end ofthe test it will be opened automatically a window with the test results At the end of the test or if it is selected View RMR the main results are shown e The average time interval default 10 minutes AAA y Average values of VO VCOz R RMR VE HR FAT and CHO and predicted Note The percentage of use Proteins PRO is calculated values if available assuming 12 grams of Ureic Body Mass Index BMI and interpretation Nitrogen in 24 hours You can modify this value selecting e Graph of the energetic expenditure for all the data acquisition interval highlighting View Information gt the selected average interval Modify In order to verify the goodness of the test check that the FeO and FeCO values are within the acceptability ranges 20 2 20 8 and 0 5 0 8 respectively and the heart rate is the rest heart rate of the patient How to modify the average interval If the
97. f t Tau J IE Constraint B 0 93 IV Constraint Tau 40 0 Constraint Max attempts fo Cancel fe Make active the graph window any Y vs any X graph Right click and select Fitting Choose Mono exponential in the type combo box 1 2 3 4 Select the first point X1 moving the mouse on the desired place in the graph pressing the Left key or using the and keys 5 Select the second point X2 moving the mouse on the desired place in the graph pressing the Right key or using the and keys 6 Enter if necessary the initial values of A B and TAU these are the values from which the iterative algorithm starts in order to reach the best values the closer are the initial coefficients to the best ones the higher is the possibility to reach the best fit 7 Press OK to confirm Chapter 13 Exercise Testing 109 Calculate the Mean Value 1 Make active the graph window any Y vs any X graph 2 Right click and select Fitting 3 Choose Mean value in the type combo box 4 Select the first point X1 moving the mouse on the desired place in the graph pressing the Left key or using the and keys 5 Select the second point X2 moving the mouse on the desired place in the graph pressing the Right key or using the and keys 6 Press OK to confirm Note The results of the O2 Fittings function are not stored therefore in order to keep the information print the page us
98. formation page An example of testing protocol An example of protocol is reported here The YMCA cycle ergometry protocol is defined as follows 1 step workload 150 kgm min 2 step if the HR at the end of the 1 step is lt 80 80 89 90 100 gt 100 set the workload at kgm min 750 600 450 300 3 step if the HR at the end of the 2 step is lt 80 80 89 90 100 gt 100 set the workload at kgm min 900 750 600 450 4 step if the HR at the end of the 3 step is lt 80 80 89 90 100 gt 100 set the workload at kgm min 1050 900 750 600 140 Quark PFT User Manual System maintenance All service operations which are not specified in this user manual should be performed by qualified personnel in accordance with the service handbook to be required to the manufacturer Rubber mouthpieces face masks breathing valve and the other parts are not shipped sterile They should be disinfected before using according to the following instructions All materials used in the construction of the Quark PFT are non toxic and pose no safety risk to the patient or operator Prior to the device cleaning disinfection and inspection it is necessary to switch off the device and to disconnect adapters from the supply mains In order to guarantee the highest accuracy of measurements we recommend you to disinfect the turbine periodically Use disposable anti bacterial filters or disinfect each part in contact with the patient before each
99. g and disinfection The face masks should be cleaned and sterilised after each test Disassembling the different parts of the mask 1 Remove the valves from their place 2 Remove the adapter for the optoelectronic reader Cleaning the mask 1 Clean the mask with hot water and a soap solution to remove the impurities 2 Rinse the mask with energy in running hot water Warning Do not use synthetic or petroleum based products for the masks cleaning Disinfecting the mask It s possible disinfecting the mask following these procedures e Standard autoclaving method Rapid cycles of autoclave lasting 10 minutes at 132 C 270 F 144 Quark PFT User Manual Heavy cycles of autoclave lasting 30 minutes at 121 C 250 F Pre vacuum cycles of autoclave lasting 30 minutes at 121 C 250 F e Hetilene oxide method ETO The hetilene oxide doesn t deteriorate the face masks Sterilisation by this method is not advised unless sufficient data is available regarding the time required for complete out gassing of residual ETO If you use this method follow carefully the instruction provided by the maker of the sterilising product e Pasteurisation The disinfecting with hot water is a sterilising method that may be used with the silicone masks Permapure maintenance Inspections Replace the fuses e Do not bend squash or deform it e Do not keep it in open air if not used especially in crowded or smoky places e If s
100. gram form Test Event 3 Acquire volume time plot until the window is filled and press F3 to stop the acquisition View the events after the test Raw data 1 Select Data from the View menu 2 Select the test during which spirogram event has been carried out in the list box and press OK 3 Select View from the Events menu choose the desired event and press OK 4 Select Print Current Window from the File menu to print the F V curve page It is possible to edit the F V loops event in the following way 5 Select Edit from the Event menu to change the F V loop at rest the list contains all the FVC test carried out by the same Patient with the Spirometry software and press OK It s a particular feature with which the user can check and save some parameters CO output O concentration and volumes in Ascii file format in a archive apart at a sampling rate of 25 Hz Save Raw data 1 During the test choose Event from Events menu 2 Select Raw Data from the list 3 On the save data box give a name to the file and select the destination folder 4 To stop saving Raw data press the stop icon or press F3 on the keyboard Chapter 13 Exercise Testing 123 124 Quark PFT User Manual Metabolism can be understood as the conversion by the human body between food and accumulated fat into energy The energy is used by the body to maintain constant temperature to move and to make all the organ functi
101. hacholine or histamine the airways respond by constricting Test consists of executing repeated FVC following the pharmacologic agents inhalation according to an established protocol The fall of the FEV1 parameter is used to calculate the bronchial hyperresponsivness The most important parameter is the PD20 that is amount of drug mg ml that causes a reduction of 20 of the FEV1 respect the basal value without drug Main parameters are P10 Dose that causes a 10 fall of FEV1 P15 Dose that causes a 15 fall of FEV1 P20 Dose that causes a 20 fall of FEV1 The representative plot is the Dose response curve showing the percentage variation of FEV1 versus the Drug dose in logarithmic scale The program assumes as the baseline test the best FVC pre carried out during the today s visit You can change the reference pre test editing the Post test The name of the drug its quantity and its unit of measurement can be typed immediately before any FVC post manoeuvre manual protocol or can be stored in a database of bronchoprovocation File Bronchial Provocation protocols Database Chapter 6 Spirometry 71 Perform the test Q ABORT During 1st step only select Protocol from the Test menu and choose the name of the bronchoprovocation protocol that you are going to use manual protocol if you want to type the information about the agent before any manoeuvre 1 Select FVC post from the Test menu 2 Select a
102. hange and eventually cancel the fields as he prefers Configures the print margins from the borders of the paper The unit of measure is decided in Units of measurements Configures information at the bottom of the page Defines the automatic name to be asssigned to the pdf file if the report will be printed in this format Page setup x Header Data Margins Footer Printed file name Format uazizt Available fields b date of birth Zi ID d date of test Zl last name Zf first name s sex cone He In the example it has been set to create a filename composed by lt date of the test gt followed by lt last name gt and lt first name gt Chapter 6 Spirometry 65 Spirometry tests Once completed the phases of the introduction of the patient s data and the visit data it is possible to carry out the spirometric tests AAA Quark PFT allows to perform the following tests Note Read carefully the contraindications in Chapter 1 ey Test FVC pre Forced Vital Capacity FVC post Forced Vital Capacity after bronchial stimulation SVC Slow Vital Capacity MVV Maximum Voluntary Ventilation FRC Nitrogen Wash out CV Closing Volume DLCO CO Diffusing capacity PO 1 Respiratory Drive Note The FVC SVC and MVV tests must be performed with the flowmeter disconnected from the breathing valve Before performing any test make sure that 1 Quark PFT is properly conn
103. hapter 15 Sub maximal Exercise Testing 139 Performing the test In this chapter it is supposed that the user is able to e perform an exercise test e create exercise protocols e view edit and print tests If this is not the case please read the Exercise testing chapter To perform a sub maximal test follow these instructions 1 Create a proper protocol procedural guidelines for several sub maximal testing protocols are provided in ACSM s Guidelines for Exercise Testing and Prescription 6 Edition Philadelphia Williams amp Wilkins 2000 22 29 2 Start an exercise test 3 Perform the test as it were a maximal exercise test ending it when the heart rate reaches the 85 of the Hrmax or it happens an event listed in the section Test termination 4 Display a VO Kg vs HR plot 5 Right click on the graph and select VO submax from the pop up menu PFT Ergo VO2 Kg HR SISINNI E test n 4 T lofx IN File Test Events View Options Window lelx re 2 ei zul ay PY 5 ANE a V02 Kg ml min Kg 45 00 40 00 35 00 V 30 00 wes yon 25 00 ah je De 20 00 epee M ge LS 15 00 hed 10 004 5 00 0 00 60 70 80 30 100 110 120 130 140 150 160 170 180 190 200 SISINNI EMANUELA If the predicted HR max calculated as 220 age is not suitable for the patient tested it is possible to edit the HR max value from the View In
104. hapter 2 Measurements 33 DLco corr DLco VA Dm Ve FaCO FACH4 ta FiCO FiCH4 wash out vol Vsample vol ml min mmHg ml min mmHg ml min mmHg ml sec CO Diffusion Capacity corrected for Hb COHb PB Krogh factor Membrane Diffusion capacity Capillary Volume Alveolar concentration of CO Alveolar concentration of CH4 Apnoea time Inspiratory concentration of CO Expiratory concentration of CH4 Rejection Volume Sampling volume IVC DLCO 1 TVC calculated during test DLCO TLC DLCO 1 Total Lung Capacity Respiratory Drive P0 1 Test Symbol UM Parameter PO 1 cmH20 Respiratory drive FiCO2 Inspiratory CO2 PFT2 and PFT4 only RF l min Respiratory Frequency Vt l Tidal Volume MIP MEP Symbol UM Parameter MIP cm HO Maximum inspiratory pressure MEP cm HO Maximum expiratory pressure Cardio pulmonary Exercise Testing CPET The Ergo option makes the Quark PFT a complete Cardiopulmonary Exercise Testing system able to measure the following parameters Breath by Breath exercise testing Symbol VO2 VCO2 Vt FetO2 FetCO2 R VE HR Qt AT VE SV RF FeO2 FeCO2 VE VO2 VE VCO2 VO2 HR VO2 Kg 34 Quark PFT User Manual UM ml min ml min ml beat ml min Kg Parameter Oxygen Uptake Carbon Dioxide production Tidal Volume End Tidal O2 End Tidal CO2 Respiratory Quotient Ventilation Heart Rate Cardiac output Anaerobic Threshold Ventilation Stroke v
105. he screen 74 Quark PFT User Manual Printing the active window This printout function is only enabled when the active window title bar highlighted is one of the following objects e Any kind of Graph e Numeric data e List of visit To print the active window 1 Ensure that the active window is one of the preceding objects 2 Select Print Active window from File menu Printing a series of reports Sometimes it is useful to printout automatically a series of reports all tests carried out with the employees all tests carried out in the today s session To print out proceed as follows 1 Select Visit List from the File menu 2 Set the criteria of the visits to be added in the list from to 3 Select Print Report from the File menu Electronic reports pdf Export data If an Adobe PDF writer Printer Driver is installed and set as the default printer it is possible to store the printout report automatically in any location of the HD or eventually LAN paths according to a customizable filename format It is possible to define the created filename format selecting File Page Set up see Page set up With this function you can export the test data in 4 different formats e txt ASCII e xIs Microsoft Excel e wkl Lotus 123 e xpo Cosmed Export a test 1 Select Export tests from the File menu 2 Select the test to export from the list box and press OK 3 Type the name and the
106. his conditions and will allow a reliable interpretation of the test For this reason every ergometric test must be preceded from a precise training of the patient Before testing The physician applying the exam must be provided with a written request including a brief description of the diagnosis confirmed or suspected the request s reason and the patient therapy carried out showing the dose and time of the drug assumption To standardise the response to the test and reduce the patient s anxiety it s suggested to provide him either written before the exam or oral at the same time of the test information At the scheduling time detailed instructions should be delivered to the patient consisting in smoke and food abstinence three hours before an ergometric test or eight hours before a scintigraphic test Test are usually executed supporting the therapeutic outline in progress but sometimes it could be necessary to stop some drugs such as b block or calcium antagonist which could impair the effort response reducing the diagnostic accuracy of the exam The patient must wear comfortable suit and gymnastic shoes and two hours before test stop any kind of drugs eat light and avoid coffee and smoke 102 Quark PFT User Manual It s very important acquire information on the patient s clinical past before performing the test Keep attention in particular way to the use of drugs tobacco to the physical fitness and symptoms pro
107. ial Challenge Tests Nitrogen Wash out Closing Volume Lung Diffusing Capacity PO 1 Exercise Testing Indirect Calorimetry PFTI Spirometry FVC SVC MMV and bronchial challenge tests PFT2 adds Functional Residual Capacity testing via Nitrogen Washout and Closing Volume techniques PFT3 combines Spirometry plus Lung Diffusing Capacity testing by adding CO and CH analysers PFT4 integrates PFT2 and PFT3 features to become the Complete Pulmonary Function Testing instrument ERGO Option The PFT 2 and PFT 4 can be enhanced with the Pulmonary Gas Exchange module allowing breath by breath analysis indirect calorimetry and RS232 ergometer control PFT3 can be upgraded to PFT4 or PFT4 ERGO PFT PFT2 PFT3 PFT 4 PFTErgoPFT2ergoPFT4ergo option option option e option e option option option option option Oxymetry option option option option option option option Ergometer Control e e Integration with Quark C12 T12 ECG option option option option option option MIP MEP option option option option option option Rocc option option option option option option option Canopy option option option Chapter 1 Getting started 21 Before starting Before operating the Quark PFT system we strongly recommend to check the equipment and register you as a customer Checking the packing contents Make sure that the package contains the items listed below In case of mi
108. ically 7 In order to visualise the graph and the main parameters press the follow buttons View CV graph 80 Quark PFT User Manual EE view Volume Time graph DATA view data of the test At the end of the test you can edit the test e Display the test to be modified e Right click with the mouse and select Edit to change the test properties wash out volume sample volume effective breath hold time calculation Chapter 7 Lung volumes 81 82 Quark PFT User Manual PO 1 Respiratory drive Aim of the test The test named P0 1 or Respiratory Drive consists of evaluating the reduction of pressure caused by the patient s inhalation In order to evaluate the P0 1 the subjects breaths in a mouthpiece provided with a shutter and a pressure detector by determining a shut down of the respiratory ways for 100 msec at the beginning of the inhalation its possible to measure the reduction of pressure The shut down is so short that the patient keeps breathing normally without realising it Many other measurement can be carried out making the patient inhale increasing concentration of CO and verifying the results Setting respiratory drive options 1 Select Settings from Options menu 2 Select Respiratory drive 3 Set the desired value in all the fields described in the next table Test options x Preferences Spirometry Multi breath N2 Wash out Single breath CO diffusing capacity Respiratory drive Test dat
109. imetry test The oximetry test measures the haemoglobin saturation i e the percentage of the blood haemoglobin bearing oxygen The test can be performed at rest or during after a light exercise phase cycling jogging This test is not intended for measuring the oximetry during exercise tests For this use see chapter Exercise testing The test is completely automatic The measured parameters are SpO Haemoglobin saturation HR Heart rate How to perform the test 1 Connect the pulse oximeter to auxiliary RS232 port on the back of the Quark PFT 2 Connect the probe to finger or ear of the Patient different probes are available 3 Select Oximetry from the Test menu and wait for the green led is prompted on the right side of the screen 4 In the first part of the test the HR and SpO values together with a plethysmographic graph are displayed The graph monitors the quality of the signal Quark PIT PAOLO BRIGNOU Ra Tew Test Cry LL tot ven Wind SET HR Spo2 68 96 UBS tet 1 a id onca Sem contr pao D Ks Wait for an acceptable quality of the real time trace and press F2 or the Start button to start the data acquisition 6 Every 5 seconds the HR and SpO values are stored 7 After the test press F3 so that the software displays the graphs and the measured parameters Bile Yer Test Options Window Hel iO Fe ES fi ED Sp02 HR Time Into 00 40 00 45
110. ing File print Active Window Oxygen Kinetic This function is available only if the active window is a VO2 vs time graph and it has a sense only with Constant Load Exercise Tests The aim of this function is to find the dynamic response of the rising and falling edges of the VO2 together with the Oxygen Deficit and Oxygen Debt m Init Fact O2def Init Fact O2debt Selection Ir Al 1657 rc A2 1657 u 00 03 50 E i Cancel pi 735 Pe pe 2393 we 2 o0 1 30 en mm 40 0 Mas attempts 100 Iaul LE A Tau2 pc Max attempts 100 a Run the O2 Kinetic function 1 Make active a VO vs Time graph window 2 Press the right key of the mouse and select O2 Kinetic 3 Select the beginning of the exercise phase t1 moving the mouse on the desired place in the graph pressing the Left key or using the and keys 4 Select the beginning of the exercise phase t2 moving the mouse on the desired place in the graph pressing the Right key or using the and keys 5 Enter if necessary the initial values for A B and Tau these are the values from which the iterative algorithm starts in order to reach the best values the closer are the initial coefficients to the best ones the higher is the possibility to reach the best fit and press OK You can lock data checking the relative field V02 t BRUGNOLS M test n 4 olx V02 ml min 4499 452 1453 1 exp t 178 29 4 re WO
111. isualise the V t graph together with the main parameters compared to the predicted values 4 To visualise the V t graph and the main parameters press the follow buttons ai view Volume Time graph DATA view data of the test 5 Press Alt F3 to stop the acquisition discarding the results 6 Repeat the test until it is correctly performed ATS recommends 3 times 7 Press Exit to visualise the test list carried out during current session together with the results of the main parameters 8 Select the test that you want to save the Best Test according to the ATS criteria is highlighted by default and press OK The reference for the ERV calculation is displayed on the V T graph Chapter 6 Spirometry 69 Maximum Voluntary Ventilation Test for assessing the maximum ventilatory capacity In the past it was commonly performed during routine PF tests however its clinical use declined over the years Today MVV test is most commonly performed as part of the exercise tolerance tests where it is used as an index of maximum ventilatory capacity Test consists in breathing in and out deeply and rapidly for 12 15 seconds The expired volume during this short period is then extrapolated The most important measured parameter is the following MVV Maximum Voluntary Ventilation Perform a MVV test 1 Select Maximum Voluntary Ventilation from the test menu and wait for the green led is prompted on the right side of the screen 2 Press F2
112. l be automatically updated Phase Time ni Te IV VT O2exp et 00 00 03 2 35 0 69 0 912 154 4 m A 00 00 06 2 22 0 93 1 133 192 0 C3 00 00 11 2 49 0 90 1 121 190 5 C4 00 00 15 2 40 0 86 1 018 172 8 17 Marker il 00 00 19 2 54 0 87 1 020 172 3 00 00 23 2 57 0 90 1 041 176 3 ok 00 00 27 2 61 0 84 0 935 159 0 Cancel 00 00 30 2 43 0 82 0 919 156 5 Preview 00 00 34 2 46 0 84 0 947 161 6 Filtering 00 00 38 2 29 0 83 0 960 164 5 Delete step 00 00 41 2 25 0 80 0 936 160 7 Advanced 00 00 45 2 25 0 78 0 956 163 6 Restore 00 00 49 2 27 0 77 0 921 157 4 gt Overwrite 2 Test n 21 Stepn 17230 Duration 00 16 15 Bee Data filtering Select Filter Type Filter C Discard invalid steps Averaging 00 24 ETI OK Poin E B Cancel C Smoothing ihe Choose Edit test from the Test menu 2 Press the button Filtering and choose the option Discard invalid steps to automatically eliminate all the invalid steps 3 Press the button Filtering and choose the option Averaging and type the desired value for points Ave smooth to perform an averaging of the all acquired steps This feature reduces the size of the original test 4 Press the button Filtering select the option Smoothing and type the desired value for points This feature doesn t reduce the size of the original test although it smoothes the fluctuation of data Chapter 13 Exercise Testing 113 Using the User fields
113. les production must be removed in order to avoid the lactic acid making To satisfy the increase in the gas exchange necessary to the muscles during the exercise is requested the intervention of many physiological mechanisms This process involves lungs the pulmonary circulation the heart and the peripheral circulation Precautions The physician has the responsibility that the patient subjects to the test is a suitable person able to execute an effort test Laboratory The room in which the test is performed must be big enough to contain the whole necessary equipment allowing an easier accessibility to the patient in case of emergency In the room should be placed a thermometer and a hygrometer the heart frequency and the perceived values of the effort rise as much as the ambient temperature increases and the variability of the cardiovascular response grows for humidity values higher of 60 Generally it is considered 22 C the temperature adequate for the test execution even for short efforts values till 26 C can be considered acceptable in presence of an efficient air ventilation Ending the test The patient should be monitored with ECG for at least 8 minutes in resting conditions or until he returns to the pre exercise conditions Preparing the patient To enhance the value of a diagnostic test it s very important patient collaboration In most cases a well informed patient will make a better effort in relation to
114. lues for lung function measurements in children Ph H Quanjer J Stocks G Polgar M Wise J Karlberg G Borsboom ERJ 1989 2 Supp 4 184s 261s KNUDSON 83 Changes in the Normal Maximal Expiratory Flow Volume Curve with Growth and Anging J Knudson D Lebowitz J Holdberg B Burrows ARRD 1983 127 725 734 ITS Intermountain Thoracic Society Clinical Pulmonary Function Testing second edition 1984 pp 101 144 LAM A survey of ventilatory capacity in Chinese subjects in Hong Kong Lam Kwok Kwong Pang Shing et Al Annals of Human Biology 1982 vol 9 No 5 459 472 Multieentrico de Barcelona Spirometric reference values from a Mediterranean population J Roca J Sanchis A Agusti Vidal F Segarra D Navajas R Rodriguez Roisin P Casan S Sans Bull Eur Physiopathol Respir 1986 22 217 224 Nhanes III Spirometric reference values from a sample of the general US population John L Hankinson John R Odencrantz and Kathleen B Fedan Am J Respir Critr Care Med 1999 159 1798 187 Pneumobil Brazil Valores extraidos do Programa Pneumobil Brasil para a Tese de Doutoramento do Dr Carlos Alberto de Castro Pereira Boehringer Gutierrez Chile Gutierrez et Al Reference values for Chile population Knudson Morris and Bass The maximal Expiratory Flow Volume curve Knudson et al ARRD Vol 123 p 659 664 1981 Spirometric Standard for healthy non smoking adults ARRD Vol 10 3 p 57 67 1971 Pereira Bra
115. lume loops during exercise at different workloads and overlapping them on the rest maximal flow volume loop of a Forced Vital Capacity test The majors information that you can get from this manoeuvres are the flow reserve flow distance from the peak flow of the F V loop during exercise to the corresponding flow on the superimposed F V loop at rest and the volume reserve volume distance from the maximum volume of the F V loop during exercise to the corresponding volume on the superimposed F V loop at rest The manoeuvre consists in the following phases e Acquiring some Flow Volume loops during the exercise e Making the patient inspire completely up to TLC level this is necessary to place the loop correctly into the rest F V loop of the forced Vital Capacity test e Overlapping the F V loop acquired during exercise and the F V loop performed at rest Flow Volume loop during the test 1 Start with normal Exercise test and begin the memorisation of breath values F2 2 During a steady state select F V loops form Test Event 3 As soon as 2 or 3 complete loops have been acquired ask the patient to inspire completely up to TLC level and press F3 to stop the acquisition The O2 CO2 event is useful to check the real time readings of the O2 and CO2 signals during the test O2 CO2 vs Time during the test 1 Start with normal Exercise test and begin the memorisation of breath values F2 2 During a steady state select O2 CO2 vs Time
116. m the archive a 2 D A EE amp Edit the current patient card Visit Card It collects all information relative to the visit diagnosis visit description and to the patient information subject to change between one visit and another height weight smoke Each patient can be related to several Visit Cards provided they have been created in different days Before carrying out any spirometric test it is necessary to create a new Visit Card or to open the today s Visit Card To move within the database use the following buttons Move to the first visit in the archive Move to the previous visit in the archive Move to the next visit in the archive Move to the last visit in the archive i Le 4 I Find a visit in the archive 56 Quark PFT User Manual Enter a new visit card in the archive Delete current visit card from the archive Edit the current visit card Test Card It contains all the information about the test To move within the database use the following buttons Delete current test from the archive Edit the current test Import export a Tests card BO This function allows to import export a test card with the respective visit and patient card 1 Select the patient 2 Choose the test and press the key by side All data will be imported exported in the XPO file format Cosmed proprietary Diagnosis Database The program allows to manage a diagnosis database whose records are composed by
117. ment such as a laboratory setting Creativity when selecting protocols may allow adaptations of commonly used protocols to accommodate athletes competing in specific sports Regardless of the type of exercise and protocol selected the same type of exercise and protocol should be used for repeat testing if between test comparisons are important Chapter 15 Sub maximal Exercise Testing 137 Staffing Test termination Staff members should be able to do the following Establish rapport with the subject and make him or her feel comfortable Recognize normal acute and chronic responses to exercise Recognize abnormal signs and symptoms during exercise Provide basic life support measures competently Adhere to established procedures and protocols pn N m Clearly explain test results to the individual Sub maximal tests should be terminated according to ACSM or other accepted guidelines see table in the following In the event of an abnormal response the test should be terminated the medical director of the facility and the individual s primary care physician notified and all specified follow up procedures performed In the event of mechanical or electrical failure that may compromise the accuracy of the test results or monitoring capabilities the test should be terminated until the problem is corrected General Indications for Stopping an Exercise Test in Apparently Healthy Adults Onset of angina or angina like symptoms
118. n e Non sterile device e Device not suitable in the presence of flammable anaesthetics e Continuous functioning equipment EMC The system meets the EMC Directive 89 336 EN 60601 1 2 EN 55011 Class B emission IEC 1000 4 2 IEC 1000 4 3 IEC 1000 4 4 Quality Assurance UNI EN ISO 9001 2000 Registration n 387 A Cermet Medical Device Directive CE mark MDD 93 42 EEC Notified Body 0476 Class Ila Chapter 1 Getting started 19 Here are the keynotes used to make the manual easier to read Typographic keynotes These are the typographic keynotes used in the manual Style Description Bold indicates a control or a key to be pressed Ttalic indicates a messages shown by the firmware Graphic keynotes These are the graphic keynotes used in the manual Illustration Description shows the button to click in the software to activate the related feature 20 Quark PFT User Manual Systems Overview Quark PFT is a stationary and modular system designed for Pulmonary Function Testing This system has been designed to meet the most accredited criteria and recommendations of the latest scientific publications The system incorporates plug and play circuitry allowing the customisation of features and instant upgrades Quark PFT comes in the following configurations Tests Products table Test Forced Vital Capacity Slow Vital Capacity Respiratory Pattern Maximum Voluntary Ventilation Bronch
119. n existing protocol or click on manual protocol and wait the green leds turned on 3 Press F2 or the button by side to start the test Press F3 or the button by side to achieve the test 5 In order to visualise the V t graph and the main parameters press the follow buttons view Flow Volume graph DATA view data of the test view bronchial provocation response Press Alt F3 to stop the acquisition discarding the results na Repeat the test until it is correctly performed ATS recommends 3 times 8 Press Exit to visualise the test list carried out during current session together with the results of the main parameters 9 Select the test that you want to save the Best Test according to the ATS criteria is highlighted as default and press OK Bronchial Provocation protocols Database The response to a bronchoprovocator is usually assessed in terms of change in the FEV1 vital capacity or airways resistance on the basis of serial measurements FVC manoeuvres in which the results of the initial test constitute the reference values The international literature proposes several standardised protocols in order to address the methodological issues of the various available techniques The possibility to store a bronchoprovocation protocol in a database is useful to simplify and automate the sequence of operations that the Physician need to execute during the bronchoprovocation tests The typical sequence
120. ng gas useful for teaching purposes Hb haemoglobin Anatomic dead space Test DLCO x Patient l Simulated test Cancel 4 Wait for the zeroing of the analyser is completed and plug in again the sampling line in the flowmeter 5 Connect the Patient to the mouthpiece and let her him breathing at rest until the message Carry out Vital Capacity is prompted 6 Carry out a Slow Vital Capacity if desired this is not necessary for completing the DLCO test 7 Invite the Patient to exhale up to Residual Volume and press F2 during the maximal expiration 8 Coach the Patient to inhale up to Total Lung Capacity and to expire slowly maintaining the flow rates within the two target lines shown on the real time window until the Vital Capacity has been exhaled A dashed line indicates the 90 of the Best Vital Capacity if a FVC or SVC test is available in the archive otherwise it indicates the 90 of the Predicted VC in order to verify the correctness of the manoeuvre Double click with the left mouse button in order to modify the test options wash out volume sampling volume calculation of the real apnoea time Multiple breath DLCO test Steady State method In this test the patient breathes regularly during the whole test about 8 min graphs and results will be displayed breath by breath Normally during the first 2 minutes the patient inhales ambient air then such a mixture 0 1 CO 0 1
121. ng purposes according to the desired order 1 Select Sorting parameters from the Options menu 2 Move the parameters in the order you want by pressing and holding the left mouse button 3 Press OK to maintain the current configuration The program has an algorithm to tag sets of steps as Steady State The algorithm considers belonging to the Steady State the only consecutive steps that meet the following conditions e The value of VO2 VE and R do not vary from their mean values more than Threshold e The number of consecutive steps that met the preceding criteria are at least Minimum number of steps Steady State x m Minimum n of steps YO2 threshold 2 VE threshold 2 Cancel a u ea Pesto 3 o 2 Restore R threshold Customise the Steady State detection criteria 1 Choose Steady State from the Options menu 2 Type the desired values for Minimum number of steps VO threshold VE threshold and R threshold The steps which satisfy these conditions will be highlighted with a yellow bar Chapter 13 Exercise Testing 119 Printout reports The software allows the user to printout data and graphics according to 4 customisable reports Further it allows the user to customise a printout header that will be printed in each page Set up the printout 1 Choose Reports from the Options menu 2 Define the desired features of the report and confirm Enabling the option Gra
122. nment Immunity test Test level Compliance level Electromagnetic environment guidance Electrostatic 6 kV contact 6 kV contact Floors should be wood discharge ESD 8 kV air 8 kV air concrete or ceramic tile If IEC 61000 4 2 floors are covered with synthetic material the relative humidity should be at least 30 Electrical fast 2 kV for power 2 kV for power Mains power quality should transient burst supply lines supply lines be that of a typical IEC 61000 4 4 1 kV for 1 kV for commercial or hospital input output lines input output lines environment Surge 1 KV differential 1kV differential Mains power quality should IEC 61000 4 5 mode mode be that of a typical 2 kV common 2 kV common commercial or hospital mode mode environment Voltage dips short lt 5 Ur lt 5 Ur Mains power quality should interruptions and gt 95 dipin Ur gt 95 dipin Ur be that of a typical voltage variations on for 0 5 cycles for 0 5 cycles commercial or hospital power supply input 40 U 40 Ur environment If the user of the lines 60 dip in Ur for 60 dip in Ur for Quark PFT requires continued IEC 61000 4 11 5 cycles 5 cycles operation during power mains 70 Ur 70 Ur interruptions it 18 30 dip in Ur for 30 dip in Ur for recommended that the Quark 25 cycles 25 cycles PFT be p nn from ce lt 5 Ur lt 5 Ur a e power supply 95 dip in Ur 95 dip in Ur for 5
123. ol bar during FRC tidal volume Breathing Frequency Range of respiration control bar during FRC respiratory frequency Pressing the System button you can set the following options Option Description System dead space Add the volume of the viral filter eventually used O2 cylinder impurities Refer to the used O2 cylinder analysis certification Perform the test 1 Select Multi Breath N wash out from the Test menu and wait for the green led is TEST prompted on the right side of the screen 2 Connect the patient to the breathing valve and invite him her to breathe normally 3 Wait for the message carry out slow vital capacity is prompted on the screen of the PC and let the patient to perform a slow vital capacity 4 Wait for a normal breathing pattern is again established and press Start F2 to begin the wash out with oxygen 4 a 5 Wait for the final Nitrogen concentration FetN reaches a value lower than 2 5 STOP and press Stop F3 to conclude the test 6 In order to visualise the graph and the main parameters press the follow buttons mal view FRC graph view Volume Time graph DATA view data of the test view breath by breath data At the end of the test you can edit the test e Display the test to be modified e Right click with the mouse and select Edit to change the test properties wash out volume sample volume effective breath hold time calculation Chapter 7 Lung v
124. oloured or opaque approximately two weeks dispose of the current seal and replace it with a new one Before operating the system make sure the unit is connected to the PC as described in the following illustration H DOVAC Shiite 2 FUSE T6IOMA cum eCo e 0 i oO i RHITA zei SENSOR TISVAC Otiz 2 FUSE TISA e 6 ia Male plug to Quark Al Female plug to PC esse 5 4 3 gt itt _ e AV Poa Pier has w Chapter 3 Installation 43 Software installation The software is made of two programs one for the spirometry and the other one for the ergometry only for PFTergo PFT2ergo and PFT4 ergo The two programs share the same archive and use the same program for the system calibration even if they are used for performing completely different tests Installing the software 1 AAA Notice The software is copy protected Install the software from the original disk Run the software a Be amp D Select Run from Windows Start menu Insert the disk in the proper drive In the Command line type lt name of the drive gt install Click on OK or press ENTER key The program will load up a dialog box and ask for a directory where to be installed When the installation is over the program will advise you with a message indicating that the installation has been successfully completed click on End Note the directory for the
125. olume Respiratory Frequency Averaged expiratory concentration of O2 e CO ventilatory equivalent for O2 ventilatory equivalent for CO2 Oxygen pulse VO2 per Kg Ti Te Ti Ttot Vd Vt PaCO2 P a et CO2 sec mmHg mmHg Indirect Calorimetry Symbol EE EE BSA EE Kg FAT CHO PRO FAT CHO PRO npRQ Lactate Threshold V Slope Symbol VO LT R LT Time LT VCO VE HR O2 Kinetics Parameter O deficit O debt UM Kcal day Kcal day m Kcal day Kg Kcal day Kcal day Kcal day UM lm hh mm ss ml min l min bpm time breaths Vd Vt ratio arterial PCO2 estimated Delta PaCO2 PetCO2 Parameter Energy Expenditure Energy Expenditure Body surface area Energy Expenditure pro Kg Fats Carbohydrate Protein Fat Carbohydrate Protein Respiratory quotient not protein Description Lactate Anaerobic Threshold STPD Respiratory Quotient LT Time LT CO2 output LT STPD Ventilation LT BTPS Heart Rate LT UM Calculation Vm VO2 work tau Vm VO2 work tau Chapter 2 Measurements 35 36 Quark PFT User Manual Unpacking the system On receipt of your system you should immediately inspect your package for shipping damages in case damage is suspected please contact the reseller immediately Your system has to be installed by COSMED or by an authorised reseller Excessive amount of dust and miscellaneous clutter around the instrument can eventually
126. olumes 79 Closing Volume Test CV Perform the test TEST The Patient perform one single inspiration of 100 O2 following a maximal expiration RV level and then expires smoothly through a breathing system able to measure both the instantaneous N concentration and expired flow The expired nitrogen is plotted on a N Volume graph from which test results are obtained The graph presents 4 different phases Phase I The gas expired during Phase I represents the oxygen coming from the dead volume of the measurement system and the upper airways not interested by any distribution phenomenon Phase II Shows the N rising belonging to the spaces connecting the upper airways and the alveolar volume where the initial N has be diluted with the inspired oxygen In this phase the Anatomic Dead Space is calculated Fowler method Phase II It is called Alveolar Plateau It shows the average N concentration resulting from the dilution of the air originally contained in the Residual Volume with the inspired Oxygen The slope of this plateau about 1 5 for normal subjects is an useful index for assessing distribution disorders Patients affected by severe emphysema can reach 10 values Phase IV The end of Phase III corresponds to the beginning of the so called Closing Volume which represents the last section of the Vital Capacity before the Residual Volume The quick increase of the N2 belongs to the emptying of the latest alveoli ri
127. on Federal law restricts this device to sale by or on the order of a physician This equipment has been conceived with the aim of providing an auxiliary instrument allowing e the formulation of lung pathology diagnosis e important studies concerning human physiology e the collection of important information in sport medicine No responsibility attaches COSMED Srl for any accident happened after a wrong use of the device such as e use by non qualified people e non respect of the device intended use e non respect of the hereunder reported precautions and instructions The device the program algorithms and the presentation of measured data have been developed according to the specifications of ATS American Thoracic Society and ERS European Respiratory Society Other international references have been followed when these were not available All bibliography references are reported in Appendix The present handbook has been developed with respect of the European Medical Device Directive requirements which sort Quark PFT within Class II a It is recommended to read carefully the following precautions before putting the device into operation The precautions reported below are of fundamental importance to assure the safety of all COSMED equipment users 1 This user manual is to be considered as a part of the medical device and should always be kept on hand 2 Safety measure accuracy and precision can be assured only e
128. on Measure of metabolism is calories cal Total Metabolic Rate The total metabolic rate are the total calories that the human body needs in order to actuate the daily functional activities Resting Metabolic Rate RMR Resting Metabolic Rate represents the calories that the vital organs need to properly operate at rest heart brain lungs liver kidneys etc RMR represents between 60 and 75 of the human s total metabolism Importance to measure RMR A knowledge of the RMR is very helpful in order to understand the nutritional needs and to properly manage it Measurement of the rest metabolic rate with indirect calorimetry Energy expenditure can be measured directly by putting a person in a calorimeter and measuring the amount of heat produced by the body mass This is expensive and very impractical in the clinical setting Energy expenditure can be measured indirectly with a metabolic cart by analysis of respired gases usually expired to derive volume of air passing through the lungs the amount of oxygen extracted from it i e oxygen uptake VO and the amount of carbon dioxide as a by product of metabolism expelled to atmosphere CO output VCO With these measurements the resting energy expenditure RMR and respiratory quotient RQ can be calculated The RQ represents the ratio of carbon dioxide exhaled to the amount of oxygen consumed by the individual RQ is useful in interpreting the results of the
129. on correctly performed sub maximal tests can provide a valid estimate of cardiorespiratory fitness Pre test health screening is essential for risk stratification and for determining the type of test that should be performed and the need for an exercise test prior to exercise training A thorough pretest health screening includes the following e Complete medical history e Medical contraindications to exercise e Symptoms suggesting cardiac or pulmonary disease e Angina or other forms of discomfort at rest or during exercise e Unusual shortness of breath at rest or during exercise e Dizziness or light headedness e Orthopaedic complications that may prevent adequate effort or compromise the validity of test results e Other unusual signs or symptoms that may preclude testing e Risk factors for coronary heart disease e History of major cardiorespiratory events e Current medications e Activity patterns e Nutritional habits e Reading and signing an informed consent form 136 Quark PFT User Manual Sub maximal exercise testing Heart rate varies linearly with VO to the point of maximum exertion thus VOomax may be estimated using the relation between heart rate and VO without subjecting the individual to maximum levels of physical stress During sub maximal exercise testing predetermined workloads are used to elicit a steady state of exertion plateau of heart rate and VO The steady state heart rate at each work level is displ
130. ontraindications e Bronchial obstruction caused by the respiratory manoeuvre e Moderate or serious bronchial obstruction For ex FEV1 lt 1 51 in men and FEV1 in women lt than 1 21 e Recent infection in the superior air tracts e During the asthmatic re acuting e Hypertension e Pregnancy e A pharmacology treatment epilepsy Contraindications for Exercise testing Read carefully the exercise testing chapter 14 Quark PFT User Manual Environmental condition of use COSMED units have been conceived for operating in medically utilised rooms without potential explosion hazards The units should not be installed in vicinity of x ray equipment motors or transformers with high installed power rating since electric or magnetic interferences may falsify the result of measurements or make them impossible Due to this the vicinity of power lines is to be avoided as well Cosmed equipment are not AP not APG devices according to EN 60601 1 they are not suitable for use in presence of flammable anaesthetic mixtures with air oxygen or nitrogen protoxide If not otherwise stated in the shipping documents Cosmed equipment have been conceived for operating under normal environmental temperatures and conditions IEC 601 1 1988 EN 60 601 1 1990 e Temperature range 10 C 50 F and 40 C 104 F e Relative humidity range 20 to 80 e Atmospheric Pressure range 700 to 1060 mBar e Avoid to use it in presence of noxious fumes o
131. ory manoeuvre is contraindicated in case of some symptoms or pathology The following list is not complete and must be considered as a piece of mere information Contraindications for the Spirometer tests Absolute contraindications For FVC VC and MVV tests e Post operating state from thoracic surgery For FVC tests e Severe instability of the airways such as a destructive bronchial emphysema e Bronchial non specific marked hypersensitivity e Serious problems for the gas exchange total or partial respiratory insufficiency Relative contraindications For FVC tests e spontaneous post pneumothorax state e arterial venous aneurysm e strong arterial hypertension e pregnancy with complications at the 3 month For MVV test e hyperventilation syndrome Contraindications for Bronchial provocation tests The bronchial provocation tests must be executed according to the doctor s discretion There are not data that reveal specific contraindication for the bronchial provocation test through inhalation The modern standard processes have been revealing secure in several clinical studies However it is recommendable to respect the following contraindications Absolute contraindications e Serious bronchial obstruction FEV1 in adults e Recent myocardium infarct e Recent vascular cerebral accident e Known arterial aneurysm e Incapacity for understanding the provocation test procedures and its implications Relative c
132. ove to the next or the previous patient in the database Select the patient 2 Press Modify in order to edit the patient s data 3 Edit the desired values and press OK to confirm Select the patient to be deleted 2 Press Delete 58 Quark PFT User Manual Archive maintenance The software allows to manage files selecting Archive from the File menu It is advisable to perform the archive reorganisation every month in order to free space on the hard disk and or to correct possible errors present within the database It is possible also that your have no more hard disk space So you have to delete all the data In this case it is useful to perform the initialising Reorganise the archive 1 Select Reorganize archive from the File menu 2 Wait for the end of the operation before performing any other function Delete the archive 1 Select Initialize Archive from the File menu 2 Wait for the end of the operation before performing any other function Delete a test To delete an ergometry test select Test Delete test To delete a spirometry test press the proper button in the Test Card Backup and restore It is strongly recommended to backup files a warning message will be displayed monthly This function allows the user to restore the data if the PC or the HD will not work anymore Backup 1 Select Backup archive from the File menu 2 Selecting the destination path with the Browse key or press New to create
133. own logo and close the image editor to save changes 4 Press OK to save the Printout header 120 Quark PFT User Manual Electronic reports pdf If an Adobe PDF writer Printer Driver is installed and set as the default printer it is possible to store the printout report automatically in any location of the HD or eventually LAN paths according to a customizable filename format It is possible to define the created filename format selecting Options Printout header and then Name format Printed file name xi Format Available fields b date of birth Zi ID 2d date of test Zl last name Zf first name Zn test Zh time of test s sex Cancel Print the current window The print current window function is enabled when the active window is a graph or a data report 1 Select Print current window from File menu 2 Press OK to print or Setup to customise the print Print the customised report This function is enabled only after having customised a report 1 Select the customised report from File menu 2 Setthe sheet format and press OK Chapter 13 Exercise Testing 121 Events management during exercise testing Flow Volume loops EVENT O2 CO2 vs Time This test is useful during exercise to detect abnormalities in the mechanics of ventilation in patients with pulmonary ventilatory limitations to exercise The test consists in acquiring some flow vo
134. panel of the Quark PFT and check that the pressure of the gas is in the range 5 6 bar 4 Check if the reference values for the calibration gas specified in File Reference values correspond to the certified composition of the mixture 5 Connect the sampling line to the CAL port placed on the front panel of the Quark PFT 6 Select Calibration Gas FRC and wait until the procedure is completed DLCO Calibration This calibration must be repeated at least daily A new calibration before any DLCO test is strongly recommended 1 Remove the sampling line from the flowmeter Chapter 4 Calibration 49 2 Ensure that the DLCO cylinder is properly connected to the rear panel of the Quark PFT and check that the pressure of the gas is in the range 5 6 bar 3 Check if the reference values for the calibration gas specified in File Reference values correspond to the certified composition of the mixture 4 Connect the sampling line to the CAL port placed on the front panel of the Quark PFT 5 Select Calibration Gas DLCO and wait until the procedure is completed Print the calibration report In the Calibration program choose Print from the File menu Edit the calibration factors The last sensors calibration factors can be either edited or viewed To do this choose Gas Results from the File menu To view or edit the last Turbine calibration factor choose Turbine results from the File menu Note To resto
135. phs in one page all the graphs selected in the report will be printed in one page 3 Type the name you want apply to the report and press OK to save changes Reports Configuration Report n Ss Printed pages C4 Test data FN Predicted values M Lactate threshold Test summary Parameters Comments Graphs Print Y1 Axis Y2 Axis X Axis NIV yE x Loadi M t More N20 fur vo2uR It x More N3M yo2 vco2 ieee i More war More ner More NZI yr x no graph BZ VE More NSM fr mo graph Net x More NIM Pet02 x Petco2 fe x More NT A H r N 127 Tpi t Hore Cancel Restore i Select parameters to be printed Quark allows to print a large number of parameters it is advisable in order to simplify the analysis of the results to printout desired parameters only 1 In the report configuration window select Parameters 2 Select the parameters you require to be printed in the data printout The number of parameters which can be printed depends upon the size of the paper in use see Printer Layout and from the orientation of the sheet 3 Press OK to confirm the selected configuration Customise the printout header 1 Choose Printout header from the Options menu 2 On the Report Header dialog box type the text of the header 3 To insert an image click the Logo button An image editor will be opened draw the
136. prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment transmitters and the Quark PFT as recommended below according to the maximum output power of the communications equipment Rated maximum Separation distance according to frequency of transmitter output power of m transmitter W 150 kHz to 80 MHz 80 MHzto800 MHz 800 MHz to 2 5 GHz d 1 174 P d 1 17VP d 2 33 V P 0 01 0 12 0 12 0 23 0 1 0 37 0 37 0 74 1 1 17 1 17 2 33 10 3 70 3 70 7 38 100 11 70 11 70 23 33 For transmitters rated at a maximum output power not listed above the recommended separation distance d in metres m can be determined using the equation applicable to the frequency of the transmitter where P is the maximum output power rating of the transmitter in watts W according to the transmitter manufacturer Notes 1 At 80 MHz and 800 MHz the separation distance for the higher frequency range applies 2 These guidelines may not apply in all situations Electromagnetic propagation is affected by absorption and reflection from structures objects and people 18 Quark PFT User Manual Safety and conformity Safety IEC 601 1 1988 EN 60 601 1 1990 Find reported below the complete classification of the device e Class I type B device e Protection against water penetration IP00 ordinary equipment unprotected against water penetratio
137. previous paragraph N Kit for Windows DINE 15 Real Time Test FVC 1 Verve 34 7 Fe Serax BS KT 1 3 4 s 7 ewn 14 34 ad s 3 s4 24 74 For Help press FI 77 2001 DINE S NUM 68 Quark PFT User Manual Slow Vital Capacity Important test for assessing COPD chronic obstructive pulmonary disease patients affected by this disease might present a the Slow Vital Capacity could be higher than Perform a SVC test TEST the Forced one FVC The main parameters measured during SVC tests are EVC Expiratory Slow Vital Capacity IVC Inspiratory Slow Vital Capacity ERV Expiratory Reserve Volume IRV Inspiratory Reserve Volume If the inspiratory expiratory maximal manoeuvre is preceded by a some breaths at tidal volume the software allows to measure the Respiratory Pattern represented by the following parameters VE Ventilation per minute Vt Tidal volume Rf Respiratory frequency Ttot Breath time Ti Ttot Inspiratory time Ttot Vt Ti Vt Ti 1 Select Slow Vital Capacity from the Test menu and wait for the green led is prompted on the right side of the screen 2 Press F2 and instruct the Patient to breath normally until the message carry out is prompted then ask to perform a Slow Vital Capacity deep inhalation maximal slow expiration and deep inhalation again 3 Press F3 or wait for automatic interruption 5 seconds without flow in order to v
138. ption and the CO production and starting from these values the energy expenditure Before the test it is necessary to perform an ergo calibration see Calibration chapter and it is advisable to perform also a turbine calibration see Recommendations in this chapter How to prepare the canopy and the patient Replacement of the power plug If the power plug does not fit into the mains socket replace it with the one in the packaging In order to replace the plug 1 Extract the plug from the battery charger 2 Insert the proper plug in the battery charger Fl LULU Py CUTE aa wi IND at Connecting the Canopy 1 Connect the Canopy unit to the mains by means of the medical grade AC DC adapter provided 2 Insert the bubblehood adapter into the bubblehood from the outside and fix it screwing the ring from the inside being careful to insert it in the proper hole as shown in the following picture Connect the bubblehood to the wrinkled tube interposing a bacterial filter 3 4 Connect the wrinkled tube to the unit through the Flow in connector 5 Connect the optoelectronic reader of the Quark to the Flow out connector of the Canopy unit through the spirometry adapter 6 Fix the vail to the bubblehood through the velcro strips 132 Quark PFT User Manual Performing the test How to prepare the patient 1 a Switch on the Canopy unit If there are no problems the
139. r e Connect the O cylinder to the Quark PFT O and adjust its pressure between 5 and 6 bar e Connect the O CO calibration cylinder to the Quark PFT CAL and adjust its pressure between 5 and 6 bar e Connect the Flowmeter to the front panel of the Quark Assemble the breathing valve Pneumatic cable Demand valve Body valve Air valve membrane Air valve membrane protection Optoelectronic reader ml 7 f 7 Mouthpiece w wo NAW PWN Ee I In Optoelectronic reader Optoelectronic reader Turbine Mouthpiece adapter Flowmeter cable 0 I t t Sampling line Chapter 3 Installation 41 Assemble the turbine AAA Notice It is advisable to lubricate periodically the O rings inside the optoelectronic reader with sylicone grease for its good maintenance Assemble the mask and the flowmeter 1 Insert the turbine in the optoelectronic reader in the way indicated by the arrow in the turbine Insert the turbine plug on the front panel Connect the external anti moisture filter to the sampling plug and joint the Permapure sampling line to the filter It s strongly suggest to use the filter always and we recommend to replace it every 3 months NI ON vr D Using the Ultimate Seal The ultimate seal is a moulded of Elasto Gel a glycerine based hydrogel This product is a unique polymer gel that forms an intimate seal between
140. r dusty environment and near heat sources e Do not place near heat sources e Cardiopulmonary resuscitation emergency equipment accessible e Adequate floor space to assure access to the patient during exercise testing e Adequate ventilation in the room Chapter 1 Getting started 15 Guidance and manufacturer s declaration electromagnetic emissions The Quark PFT is intended for use in the electromagnetic environment specified below The customer or the user ofthe Quark PFT should assure that it is used in such an environment Emissions test Compliance Electromagnetic environment guidance RF emissions Group 1 The Quark PFT uses RF energy only for its internal CISPR 11 function Therefore its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment RF emissions Class B The Quark PFT is suitable for use in all establishments CISPR 11 including domestic establishments and those directly connected to the public low voltage power supply network that supplies buildings used for domestic purposes Harmonic Emission Class A IEC 61000 3 2 Voltage Fluctuations Complies Flicker Emission IEC 61000 3 3 Guidance and manufacturer s declaration electromagnetic immunity The Quark PFT is intended for use in the electromagnetic environment specified below The customer or the user ofthe Quark PFT should assure that it is used in such an enviro
141. r gas which is not metabolised CH4 Methane then he is asked to breath hold for 10 seconds the expiratory valve is kept closed and finally he is allowed to expire slowly up to the Residual Volume the expiratory valve is opened Analysing the concentrations of CO and the Tracer gas CH4 belonging to a portion of the expired volume collected volume obtained by discarding the beginning of the expiration wash out volume the test indexes are determined The wash out volume 0 75 1 L for normal subjects 0 25 0 5 L with reduced Vital Capacity the collected volume 0 5 1 L and the calculation of the breath hold time ESP JONES OGILVIE have been standardised by both ATS and ERS If fast response CO and CH analysers are used it is possible to optimise the selection of the wash out and collected volumes according to the Vital Capacity of the subject This is usually achieved operating graphically on the CO CHy graphs Repeating the DLCO test with different mixtures of inhaled gas it is possible to separates the contributes of the alveolar membrane Dm and the Capillary Blood Volume Vc The main parameters of the DLCO test are DLCO Lung Diffusing Capacity DLCOcorr Lung Diffusing Capacity corrected for Hb COHb and PB VA Alveolar Volume DLCO VA Krogh Index Dm Alveolar Membrane Ve Capillary Blood Volume DLCO with apnoea standard method 1 Remove the sampling line from the flowmeter 2 Select
142. rbine 3 When the Calibration Turbine dialog box appears with the syringe piston initially pushed all the way in move the piston in and out for 5 inspiratory strokes and 5 expiratory strokes in order to get the first values appearing on the display Then move the syringe piston for other 10 strokes IN and EX Turbine Calibration x Syringe volume 3000 ml Results Gain Ins Z Gain 07 1046 2993 0 23 1027 50 1048 2995 0 17 1028 93 1052 3010 0 33 1026 23 1052 2993 0 23 1027 1051 2984 0 53 1027 27 1051 2990 0 33 1028 20 1051 3004 0 13 1027 30 1050 3008 0 27 1027 40 1051 2996 0 13 1027 87 1051 3006 0 20 1027 CR E m ww Move the calibration syringe Help 4 At each of the 10 steps the software displays the results of the manoeuvre and the percentage error in the reading 5 Atthe end ofthis operation the software displays the new calibration factors Press OK to store the new value Turbine calibration results x Gain Exp 1000 CS Help Gain Ins 1000 BE me 52 Quark PFT User Manual Checking the system signals The control panel The Control Panel which can be activated from the Calibration Control panel menu item is a useful tool to check the main hardware functions of Quark PFT By using the controls on Control Panel you are able to do the following 1 Reading the signals acquired by the system both as voltages and processed data 2 Activating Disactivating
143. re factory setting press Default button in the dialog box Once you press the default button you must run a new calibration before testing O delay check Selecting Calibration Gas O delay check if this value is below 250ms If it is above 250ms please contact the Technical Support An high value of the O delay can be due to e Chemical sensor exhausted e Old or obstructed Permapure tube e Dust or dirt in the sampling line 50 Quark PFT User Manual Turbine calibration The system uses a turbine flowmeter It opposes a very low resistance to flow lt 0 7 cmH O Vs to 12 Vs The air passing through the helical conveyors takes a spiral motion which causes the rotation of the turbine rotor The rolling blade interrupts the infrared light beamed by the three diodes of the optoelectronic reader Every interruption represents 1 6 turn of the rotor this allows to measure the number of turn in the time There is a constant ratio between air passing through the turbine and number of turns This allows an accurate measure of flows and volume The turbine flowmeter doesn t need daily calibrations as it is not affected by pressure humidity and temperature To work properly the turbine only requires the rotor to rotate freely without any friction that might be caused by dust that can be easily avoided with an ordinary cleaning procedure see Maintenance However in order to ensure accuracy it s recommended to run periodically the
144. red and will be used by Cosmed Srl in conformity with the requirements of the Italian privacy law Decreto Legislativo 196 2003 We believe it is important for you to know how we treat your personal data Personal data treatment and purposes We request and process your personal data a to place an order register a product request a service answer a survey enter a contest correspond with us all of the above in the following service and if necessary to supply the Competent Authorities with the required information in order to define your commercial profile in order to use your commercial profile for own marketing and advertising purposes for accounting purposes including e mailing of commercial invoices for providing your information to selected business partners also abroad in order to supply the service How your personal data are treated Your personal data will be stored in electronic format and protected at the best from destruction loss even accidental not authorized accesses not allowed treatment or use not in conformity with the purposes above listed The consent is optional but If you deny the consent we regret we cannot supply the service Holder of the treatment The holder of the treatment is Cosmed Srl Via dei Piani di Monte Savello 37 Pavona di Albano Laziale RM The responsible of the personal data treatment is indicated in the documentation stored by Cosmed Srl itself Cus
145. red led on the front panel of the unit flashes for few seconds and the alarm beeps If the led does not flash and or the alarm does not beep the test cannot be performed because the backup battery is exhausted or there is no backup battery When the green led turns on the test can start If the green led does not turn on the red led flashes and the alarm beeps the test cannot be performed because the pump does not work or the mains does not power the system After these checks put the patient in a supine position Place the bubblehood with the vail on the patient s head The tube has to be placed near the patient s mouth 1 Enter in the ergometry program 2 Select a patient or add a new one File Patients 3 Select Start test from Test menu Execute Test x Height cm 180 Fe Weight Kg 80 4 C RMR Canopy Simulated test Ergometer Protocol RMR v Le Other data ih Workspace RMR Details Cancel Enter the patient s data and select the Canopy mode Confirm and start the test by pressing OK In the first part of the test the flow rate of the pump has to be adjusted by means of the Flow adjustment handle on the front panel of the Canopy unit in order to measure an FeCO between 0 5 and 0 8 FeCO values can be read on the right side ofthe PC monitor When the FeCO remains within the acceptability range press F2 to start the data acquisition Verify also during the t
146. rval In order to verify the goodness of the test check that the ventilation and respiratory frequency are similar to the predicted ones 12 breaths min for the respiratory frequency and 6 litres min for the ventilation and the heart rate is the rest heart rate of the patient Chapter 14 Resting Metabolic Rate Test 129 How to modify the average interval If the average interval automatically identified by the software is not satisfying for example because the patient was speaking in the first minutes it is possible to modify the interval ofthe average Right click and select Edit RMR It is possible to move the start and the end lines E BOND J test n 3 Jol EEkc Keal day 3500 04 3000 04 2500 0 I s k A A 2000 0 Ay x PA 4 54 ur 1500 04 gt 1000 0 4 500 0 o0 Te aan ss 00 00 01 15 02 30 03 45 05 00 06 15 07 30 08 45 10 00 11 15 12 30 13 45 15 00 16 15 17 30 18 45 To move the start line left click on the exact time in which you want to start the calculations for the end line right click Print The print of the current window generates a report similar to the one in the following page 130 Quark PFT User Manual 2 0613 14d e6ed z SL E002 20 02 00 81 STILT 0E 9T SHST OOZST ST FT OC ET Sp ZT 00 21 ST IT 0E 0T Sb 60 00 60 ST 80 0E LO SP 90 00 90 ST SO OF b0 SP EO 00 E0 ST ZO 0E TO Sb 00 00 01 wu yy 000T Hx 4 N
147. ry Ventilation 1 Tidal Volume during MVV l min Maximum Respiratory frequency sec MVV duration time Bronchoprovocation Response Symbol FallFEV1 FallVmax50 P10 P15 P20 Parameter Fall in FEV1 from baseline or post diluent Fall in Vmax50 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 Multi breath Nitrogen wash out Symbol FRC RV TLC Vtot FetN2 Wash out time VDA LCI AMDN FRC TLC CEV RV TLC UM Parameter 1 Functional Residual Capacity 1 Residual Volume 1 Total Lung Capacity 1 Total volume during the test Final Nitrogen Concentration m Duration of wash out L Anatomic dead space mm ss Lung Clearance Index mm ss Mean Dilution Number FRC TLC ratio l Cumulated Volume of inspired Oxygen RV TLC ratio Motley index Closing Volume test Symbol CV VC c v VI VII VIII m q R 2 CV VC VDf Parameter Closing Volume Expired volume during wash out Related Volume at the end of phase I Related Volume at the end of phase I Related Volume at the end of phase HI Parameters of the linear fitting on the alveolar plateau CV as a percentage of VC ml Dead volume Fowler CO diffusion Test Symbol DLco DLco 3eq UM ml min mmHg CO Diffusion Capacity ml min mmHg DLco computed with the Three Equations method Parameter C
148. s Based on Indirect Calorimetry and Tracer Methods M Elia G Livesey World Rev Nutr Diet Basel Karger 1992 vol 70 pp 68 131 Nutritional Assessment in Critical Care A Training Handbook Donald C Zavala 158 Quark PFT User Manual Sub maximal testing Cardiorespiratory Assessment of Apparently Healthy Populations Timothy R McConnell in ACSM s Resource Manual for Guidelines for Exercise Testing and Prescription 4 Edition pp 361 366 Franklin BA ed ACSM s Guidelines for Exercise Testing and Prescription 6 Edition Philadelphia Williams amp Wilkins 2000 22 29 Chapter 17 Appendix 159 160 Quark PFT User Manual
149. se the parameters The software allows the user to create customised parameters and predicted values derived from the standard parameters the ones that are calculated by default through any mathematical formula Allthe customised parameters can be used freely for viewing and printing purposes Formula Editor 1 4b Parameters ml min bel _o Formula e W Cancel Calculator Create a new parameter U02 ir aa 1 Choose Customise parameters from the Options menu YER 2 Press the New button if you want to create a new parameter or Modify if you want to modify an existing one 3 Type the desired value in the fields Name unit of meas integers decimals and summary to present the parameter in the summary and press the Formula button 4 Insert the mathematical formula by using the appropriate tools and press OK twice to confirm Create a new predicted parameter 1 Choose Customise predicted from the Options menu 2 Press the New button if you want to create a new parameter or Modify if you intend to modify an existing one Type the desired value in the fields Name unit of meas integers decimals Select the group of the predicted values from the options boxes Select the reference parameter in the Compared to list box No PY Press the buttons in the calculation group and insert the mathematical formulas for men and women adults and paediatrics Press OK twice to confirm
150. snnnnsnnnennnnnsnnnnsnsncnnne 152 Calculations references 20s000000000sssssnnnnnsnonnnnnnnnnnnnnnssnnnnnnnnnne 153 VOS and Vienna anne 153 Anaerobic threshold modified V Slope 153 References 153 O Kinetics u a een et 153 ATS 94 recommendations srss00s0sssnnnssnssonnnsnnsonsnnsnnnnnsnnnonnnee 154 ATS recommendations 154 Predicted values uosssssonnssssssnnnsnnssnnnnsnnsonnnnnnnsonnnsnnnnnssnsnnnnnee 155 Automatic diagnosis algorithm neeeeenen 156 Quality Control Messages 156 References uu000000000000000000nnssnnnnnsennnnnnnnsnsnnnsnssnnnnnnnnssnnsssnnnnnnsnne 158 SPITOMELTY rs sense ele tient tte 158 Lung Volities nennen een 158 Single Breath with Apnea 158 Single Breath without Apnea eceeeeeeeeeteeneeeeees 158 RESISTANCES nana ee tee inertie tent 158 Gas Exchange References 158 Indirect Calorimetry eenseenseenseensennneenneennen nennen 158 Sub maximal testing 159 10 Quark PFT User Manual Important notices Intended use Warnings Quark PFT is an electrical medical device designed to perform pulmonary function tests It is to be used by physicians or by trained personnel on a physician responsibility Cauti
151. ssing or damaged parts please contact Cosmed technical assistance Quark PFT1 standard packaging Code C00931 01 04 C02120 01 05 C02171 01 11 A 662 100 001 C01788 01 36 C00137 01 20 C00136 01 20 A 362 060 001 A 362 300 001 A 680 013 630 A 680 024 125 C00067 02 94 C01340 02 91 C01999 02 DC 1 1 2 2 1 1 1 Description Quark PFT 1 unit Turbine 28mm Kit optoelectronic reader Quark PFT 1 Nose clips PC Software Paediatric paper mouthpieces Adult paper mouthpieces Power cord Schuko L 2m Serial cable RS 232 DB9 M F Time Lag Fuses 5x20 250V T630 mA Time Lag Fuses 5x20 250V T 1 25A Registration card User manual Quark PFT Conformity declaration Quark PFT2 standard packaging Code C00932 01 04 C02120 01 05 C02171 02 11 A 182 310 001 C01590 01 05 C00243 01 06 C02210 02 08 C00269 01 20 A 830 300 001 A 182 300 004 C00191 02 11 A 662 100 001 C00137 01 20 C00136 01 20 C01788 01 36 A 362 060 001 A 362 300 001 A 680 013 630 A 680 024 125 C00067 02 94 C01340 02 91 C01999 02 DC 22 Quark PFT User Manual Oe Oe ee ee Description Quark PFT 2 unit Turbine 28mm Kit optoelectronic reader Quark PFT2 3 4 Antimoisture filter Breathing valve PFT2 1 way Calibration syringe 3 litres Permapure L 2m PTE soft mouthpieces Air valve membrane Antibacterial filter Tank tubing 4m Nose clips Paediatric paper mouthpieces Adult paper mouthpieces PC software Power cord Schuko L 2 mt
152. st and change the relative values in the Edit boxes below the list Press the Tab button to save changes 9 To delete a step highlight the step and press Delete Steps SE Ergometer t Speed Elevation Phase Command 00 0 0 no one 01 0 0 2 no one Protocol F c 3 ie ono x Name Non 7 t mel Message Time sec 5 Delete H p 0 0 no one x Messages 0 0 no one LA de pense Generate Fu _ add nee I Relative Increments Initial command no one Final command no one x 2 118 Quark PFT User Manual Software configuration Data viewing Steady State The software can be customised as you wish Most of the feature are easily editable to be tailored according to different purposes The software allows to calculate a huge number of parameters it is advisable in order to simplify the analysis of the results view in the data window the only desired parameters Select the parameters to view 1 Choose Parameters to view Test visualisation from the Options menu 2 Select the parameters you require to view 3 Press OK to confirm the selected configuration Select the parameters to view during the test 1 Choose Parameters to view Test execution from the Options menu 2 Select the parameters you require to view 3 Press OK to confirm the selected configuration Sort the parameters It is possible to sort the parameters both for viewing and printi
153. t of the use or possession of COSMED s products The limited warranty as herein above set forth shall not be enlarged diminished modified or affected by and no obligation or liability shall arise or grow out of the renderings of technical advice or service by COSMED its agents or employees in connection with Buyer s order or use of the product s furnished hereunder Return goods policy for warranty or non warranty repair Goods shipped to COSMED for repair are subject to the following conditions 1 Goods may only be returned after your receipt of a Service Return Number SRN from COSMED S r l 2 Place your SRN report and Packing List outside the package 3 Goods returned must be shipped with freight and insurance charges prepaid Collect shipments will not be accepted 4 The following list of goods are not eligible for return unless proven defective Special order items Expendable products Goods held over 30 days from COSMED s invoice date Used goods not in original shipping containers Goods which have been altered or abused in any way 5 The following parts are not covered by warranty consumables fragile glass or plastic parts rechargeable batteries damages at the damages due to use of the device not conforming to the indication reported in this manual 148 Quark PFT User Manual Repair Service Policy Goods returned to seller for Non Warranty repair will be subject to conditions 1 2 3 4
154. test Cleaning and disinfection Cleaning and disinfecting instructions are of fundamental importance to control infections and assure patient safety In fact aspiration of residue particles and contaminated agents are life threatening In this handbook we strongly recommend you to follow the rules worked out by ATS and ERS see Lung Volume Equipment and Infection Control ERS ATS WORKSHOP REPORT SERIES European Respiratory Journal 1997 10 1928 1932 which are summarised as follows e Accessible internal as well as external surfaces of equipment exposed to expired gas should be washed and disinfected prior to testing of subsequent patients e Liquid disinfection can be used if the equipment is well cleaned first no droplets of saliva sputum remain e Disposable gloves should be worn when handling mouthpieces when cleaning equipment exposed to saliva or sputum and especially when drawing blood e Laboratory staff should wash hands prior to testing of each patient e Adopt particular precautions when testing patients with recognised high risk communicable diseases e g tuberculosis multidrug resistant staphylococcus In these cases the clinical need for such testing should justify the risks During the disinfection e do not use alcohol or other liquids containing gluteraldehyde on the exterior surfaces of the equipment Actually they can damage polycarbonates plastics and may produce unhealthy subst
155. th the equipment by means of a face mask like in the stress exercise The mask has to be tight to the face in order to avoid any air leakage Start the test 1 Enter in the ergometry program 2 Select a patient or add a new one File Patients gt 3 Select Start test from Test menu START 1D code gt Last name BOND First name JAMES Birth Date 06 03 1957 S Fr Ethnic Cor 100 Female nes m Mode Height cm 178 0 Temperature CH 25 conio Me f Ga Weight Ka 76 0 Humidity 2 50 Weight Kg 76 0 H l iig HR max bpm 181 Press mmHg 760 Be FEV1 1 0 00 Temp flowm c 34 ci UN g day 0 0 Hum flowm 100 I Simulated test YD mi 0 incremental test cycloergometer Ergometer no one Notes Protocol RMR x Other data Distance po Unit of meas D Workspace RMR E Details Load 1 Load Unit of meas Watt oK Load 2 Real Load Unit of meas Watt Cancel __ Cancel Load 3 Revolution Unit of meas RPM rd Enter the patient s data and select the RMR mode 1st picture 5 Press Other Data and enter the dead space value 50ml Small mask 60ml Medium mask and 70ml Large mask It is possible to enter the Ureic Nitrogen value NU 2 picture 6 Confirm and start the test by pressing OK Selecting RMR the system set automatically the following options e Data acquisition with a 30 seconds average e RMR protocol which is 5 minutes discarded
156. the program and choose Calibration from the Test Menu The software runs the ne Calibration software and the main menu changes accordingly Log file The program creates and updates as default the calibration log file containing the conditions and the results of all the calibrations performed by the user To access the file select File Report File from the calibration program Setting reference values Before starting calibrating make sure that the system has been configured correctly by setting the right values of gas concentration of room air i e 20 95 O and 0 03 CO of gas mixture contained in the cylinders and the volume of the calibration syringe 1 e 3 litres To set the reference values This operation must be performed only the first time The next times the system keeps stored the reference values entered in this step 1 Select Reference Values from the Calibration menu 2 Type the correct values for the O and CO room air concentration i e 2093 for 20 93 and do the same for the gas concentration of the calibration cylinder Reference values x Cylinders x100 Environment x100 oz 209 c02 52 co 30 0 coz ance Volume na Default Help 3 Type the volume of the calibration syringe i e 3000 for a 3 litres calibration syringe 4 Press OK button to confirm changes 48 Quark PFT User Manual Calibrating analysers AAA Note After turning on the unit wait 30 minutes
157. the valves components for example oxymeter the sampling pump and other installed Control panel x Samp pump Valves Tanks valves IR sources Range 02 Refresh FRC SD g Y Y C ERGO msec de a za 2 a a b 3 FRC 200 H Trimmer ta el x i er CH maf 109 189 wv CH4 Z nn 0 547 VG ee 21 19 08 02 _ Se vy CO 0 632 jy Relative humidity 2 Relative Relative humidity 2 amp yy Ambient press mmHg 742 jy Extern MIP MEP cmH2 Extern MIP MEP Extern MIP MEP cmH2 Messages off y Ambient temp C 20 0 amp Press ext RAW 2 F PO 1 cmH20 0 40 m Turbine flow ml s 0 iv Flow PNT3 flex Is 11333 m Turbine volume mi 0 F Flow PNT1 RAW ls 0 7 e Help Using the control panel Sampling Calibration O sensor flow rate valve range Apnoea valve Air valve for Signal refresh Sampling Breathing DLCO On Off infrared time pump valve air valve On off cylinders sources Y T nks Wires LL Range 02 Rehesh FRC en x Er x ERGO msec Te Ee amp D Ka Y f dkojerge e pre SER DLCO D Trimmer CH4 l 109 CO l 189 vA C02 121 1218 cp 88 F 0 547 j 02 12 1908 02 35 mV real values display Deselect all channels Analog input Select all channels Oxymeter HW zero trimmer adiystment Chapter 4 Calibration 53 54 Quark PFT User Manual
158. tion 9 Predicteds set ZAZANNN kA Description en C Use the predicteds formulae s J W or the customized formulae Hale Fema Formula Standard Deviation Young Adult Lopy sr Parameter Gave Delete Cancel Apply Hei This form allows the user to manage the formulae associated to a set of predicteds Select the set of predicteds from the list Predicteds set To insert a new parameter click on the New button The parameter formulae can be 64 Quark PFT User Manual Page set up e calculated according to the predicteds in the list Use the predicteds formulae e customised by the user with the option or the customised formulae The Delete button deletes the selected parameter The Copy button stores the selected parameter in memory The Paste button inserts a new parameter from the one copied If the name is not unique the user is asked whether to specify a new name or to replace the existing parameter Page setup Select Page Setup Header Data Margins Footer Printed file name from the File menu All the printouts carried out by the program are preceded by 3 rows of customisable header usually they contain the name and the address of the Hospital using the spirometer Patient and visit information are printed below the header These data are reported on 3 columns and 5 rows the user may configure the disposition c
159. to the customers assistance service For further information please refer to the enclosed registration and warranty form If the form is not enclosed in the packaging please contact directly COSMED Register the product via software Together with the PC software a registration software is supplied With this software it is possible to fill in an electronic form with the customer information 1 To run the software double click on the icon Registration or select Registration from menu 2 Type the requested information and click Send to send the form via e mail to COSMED How to contact COSMED For any information you may need please contact the manufacturer directly at the following address COSMED S r l Via dei Piani di Monte Savello 37 P O Box n 3 00040 Pavona di Albano Rome ITALY Voice 39 06 931 5492 Fax 39 06 931 4580 email customersupport cosmed it Internet http www cosmed it Complain feedback and suggestions If you have any complain feedback information or suggestion please inform us at complain cosmed it 26 Quark PFT User Manual Options Accessories The following options are available to enhance or to complete the Quark PFT system Code A 860 000 004 A 860 000 005 A 860 000 006 A 860 000 007 C01500 01 04 C01700 01 04 A 870 150 001 A 870 150 002 C09001 02 99 C00689 01 30 C01278 01 30 C01277 01 30 A 800 900 004 ll l l lelelelelelele lo Quantity D
160. tomer rights In accordance with art 7 ofthe Law you can a c obtain confirmation of the existence of your personal data and their communication in intelligible form obtain e updating correction or integration of your data e deletion or transformation in anonymous form of your personal data deny your consent to the treatment of your personal data These rights can be exercised directly requesting in writing to the holder of the treatment 150 Quark PFT User Manual Heart Rate TTL input The Heart Rate TTL input allows to measure the hearth rate signal from any ECG with a pulse signal 0 5 Volts available or from the POLAR belt receiver probe Referring to the connector labelled as HEART RATE on the rear panel of the Quark PFT the pin out assignment is the following pin Signal 5 TTL input 4 GND Chapter 17 Appendix 151 Converting factors configuration You can edit the parameters shown in Control Panel by selecting Control Panel from the Calibration menu in the calibration program then pressing the button by side Configuration parameters x LLU ua eee Raw data l Name 0x0002 mbient temp 0x0003 Internal temp o2 0x0005 Barometric press P 7 2 ES 020006 ART oats Unit of meas Factor Precision 0x0007 Battery voltage x o1 0x0009 Heart rate 0x000A Turbine Flow 0x000B Turbine Volume Y mV BL Gain 1000 4 Base line mY 2 Cancel Gain ins fi 004 __
161. tput and Diffusing Capacity Assessed By a Single Slow Exhalation of Methane Acetylene and Carbon Monoxide Ramage Coleman and MacIntyre CHEST 92 1 July 1987 Resistances P J Chowienczyk C P Lawson S Iane R Johnson N Wilson M Silverman G M Cochrane A flow interruption device for measurement of airway resistance European Respiratory Journal 1991 4 623 626 G Liistro D Stanescu D Rodenstein C Veriter Reassesment of interrupter tecnique for measuring flow resistance in human J Appl Physiol 67 3 933 937 1989 Gas Exchange References On line computer analysis and breath by breath graphical display of exercise function tests Beaver Wasserman Whipp JAP 34 1 128 132 1973 Measurement and analysis of gas exchange during exercise using a programmable calculator Sue Hansen Blais Wasserman JAP 49 3 1980 456 461 Principles of exercise testing and interpretation 2 edition Wasserman et Al 1994 Clinical Exercise Testing 3 edition Jones 1988 ERS task force on standardization of clinical exercise testing Clinical exercise testing with reference to lung disease indications standardization and interpretation strategies J Roca B Whipp S Anderson R Casaburi J E Cotes P Palange ERJ 1997 10 2662 2689 Indirect calorimetry Energy Expenditure and Fuel Selection in Biological Systems The Theory and Practice of Calculation
162. ttention to some precautions 1 2 3 Take out the turbine Dip it in a disinfectant solution non alcoholic based for about 20 minutes Rinse the turbine in a vessel filled of clean water shaking gently to remove the disinfectant do not clean the turbine by putting it under running water Let it dry to air After cleaning the turbine check if the turbine propeller rotates freely even with a low speed air flow Connect the turbine to the reader Precautions during the cleaning of the turbine Do not expose the turbine to high heat and do not put it under running water Do not ever dip the optoelectronic reader in any kind of solution the liquid infiltration would damage the internal circuit Do not use alcoholic solutions to clean the turbine Suggested disinfection solutions Helipur H Plus Braun Melsungen AG Gigasept FF Schulke amp Mayr GmbH Dismozon pur Bode Chemie GmbH TETA S Fresenius AG CIDEX Johnson amp Johnson Cleaning the Breathing valve The breathing valve should be cleaned everyday or at least every 10 15 tests Chapter 16 System maintenance 143 Remove the flowmeter from the breathing valve Remove the demand valve from the breathing valve Remove the valve body from the hand holder Remove the membrane valve Close the valve body with the cleaning protection plate Ne D Dip all parts in the cleaning solution and re assemble everything after the disinfection Masks cleanin
163. tware environment will change showing a new Menu bar and toolbar while the first data will be displayed in a table format File Test View Events ECG Window Demo La nA 8 era L je Le REC ORS wis 7 6 At this point the software starts showing data on the monitor but without saving them this in order to monitor the patient before starting the test To start storing data press F2 Abort the test without saving data Choose Abort from the Test menu or press Alt F3 End the test saving data 1 Choose End from the Test menu or press F3 2 Choose Yes to end the test or No to continue View data in real time The visualisation features and capabilities of the data and graphs are identical to the ones described in the Data management chapter Starting the test a small window will appear on the right corner displaying time bmp and if selected before the ergo protocol and trainer 0 104 Quark PFT User Manual Parameters to view Manual protocol we AAA LOAD Tip pressing the Shift key while choosing the marker option will allow you to enter the label for that marker i MARK Automatic protocol PRO Set the BPM alarm View graphs in real time 1 Choose Graph from the View menu 2 Follow the instructions described in data management section to edit the graphs While the test is running it is possible to choose the parameters to view 1 Select Parameters to view Test execution
164. uracy 0 03 Carbon Monoxide sensor CO Type NDIR Response time lt 200 ms Range 0 0 3 Accuracy 0 003 Methane sensor CH Type NDIR Response time lt 200 ms Range 0 0 3 Accuracy 0 003 Humidity absorber Capillary of Nafion Permapure Power Supply Voltage 100V 240V 10 50 60Hz Power consumption 100W Environmental Sensors Temperature 0 50 C Barometer 400 800 mmHg Humidity 0 100 Dimension and Weight Dimensions 17x30x45 cm Weight 8Kg Aux inputs With the auxiliary RS 232 port and the digital TTL input for external ECG signal Quark PFT offers the possibility to integrate data coming from many equipment such as ECGs and ergometers Chapter 1 Getting started 29 30 Quark PFT User Manual Pulmonary function tests and measured parameters Spirometry Tests FVC Forced Vital Capacity Symbol FVC FEVI FEV1 FVC PEF FEVO S FEV6 FEV1 FEV6 FEV6 FVC Best FVC Best FEV1 Best PEF Vmax25 Vmax50 Vmax75 FEF25 75 FET100 FEV2 FEV3 FEV2 FVC FEV3 FVC FEV1 VC FEF50 75 FEF75 85 FEF0 2 1 2 FiVC FiF25 75 FiV1 PIF VEXT PEFT UM 1 1 l sec l sec l sec l sec Vsec Vsec Vsec Vsec l sec L l sec l sec Vsec ml msec Parameter Forced Expiratory Vital Capacity Forced Expiratory Volume in 1 sec FEV1 as a percentage of FVC Peak Expiratory Flow Forced Expiratory Volume in 0 5 sec Forced Expiratory Volume
165. using the accessories described in the manual or given with the device Actually non recommended accessories can affect safety unfavourable Before using non recommended accessories it is necessary to get in touch with the manufacturer e ordinary equipment maintenance inspections disinfection and cleaning are performed in the way and with the frequency described e any modification or fixing is carried out by qualified personnel e the environmental conditions and the electrical plants where the device operates are in compliance with the specifications of the manual and the present regulations concerning electrical plants In particular grounding reliability and leakage current suppression can only be assured when the device three wire receptacle is connected to a yellow green return connected to earth ground Attempting to defeat the proper connection of the ground wire is dangerous for users and equipment 3 Before powering the system check the power cables and the plugs Damaged electrical parts must be replaced immediately by authorised personnel 4 Large gas cylinders which may be given by the manufacturer or purchased by the customer should be secured with cylinder safety chains or safety stands 5 When removing the protective cap inspect the cylinder valve for damaged threads dirt oil or grease Remove any dust or dirt with a clean cloth If oil or grease is present on the valve of a cylinder which contains oxygen do not
166. various parameters columns corresponding to each step rows graphical presentation on Y1 Y2 X charts results of the test and statistical analysis of the blocks predicted values maximum value measured View data in table form 1 Select Data from the View menu ioe 2 Select the test to visualise in the list box and press OK GEBOND J test n 2 o x t Rf VT VE voz vcoz VE VO2 VE VCO2 VO2 Kg R Feo2 FeCO2 HR vo2 HR Load Feto2 amp hh mm ss b min 1 l min ml min ml min ml min Kg bpm ml bpm Watt 00 00 00 12 2 1 151 14 1 556 505 25 27 7 32 0 90 15 86 4 35 61 9 1 D 14 79 00 00 06 10 2 1 626 16 6 595 574 27 28 7 84 0 96 16 40 4 20 65 9 1 0 15 61 00 00 10 12 7 0 610 7 7 250 236 31 32 3 30 0 94 16 94 3 70 67 3 7 0 15 88 00 00 15 12 2 0 865 10 6 344 341 30 31 4 52 0 99 16 91 3 91 66 5 2 0 15 83 AAA 00 00 21 10 8 1 043 11 3 403 372 28 30 5 30 0 92 16 62 4 01 66 6 1 0 15 54 00 00 26 eine 0 725 6 5 271 243 31 35 3 56 0 89 17 10 3 48 66 4 1 0 15 64 Note Double click in the 00 00 32 10 8 0 721 7 8 259 234 30 33 3 41 0 90 16 93 3 66 65 3 9 0 15 59 window to open the edit test 00 00 37 11 3 0 805 9 1 288 270 221 33 3 80 0 93 17 12 3 62 65 4 4 0 15 63 00 00 43 10 1 0 823 6 3 264 260 29 31 3 73 0 91 16 82 3 81 62 4 5 0 15 56 00 00 48 11 5 0 769 8 8 285 260 30 33 3 75 0 91 17 05 3 59 63 4 5 0 15 57 00 00 54 9 4 0 796 7 4 249 225 30 33 3 27 0 90 16 96 3 67 63 3 9 0 15 56 00 01 00 10 0 0 840 8 4 29
167. y resistance Goce in Inspiratory conductance Preparing the Rocc module and connecting to the unit f m d Performing the test TEST 98 Quark PFT User Man 1 Connect the three parts of the Rocc module as in the picture by side d 2 Connect the module to the Quark PFT unit through the er Flowmeter connector on the front panel 1 Occlusion valve 2 Reader 3 PNT Select Rocc from the Test menu 2 The Test option window will open By means of this window you can set the following options e Random automatic or manual occlusion e Occlusion activated on the inspiration or expiration e Value of the flow at which the occlusion is activated e Use of COSMED antibacterial filter e Parameters for the back extrapolation algorithm 3 Wait for the end of the calibration Let the patient to breathe inside the module 5 If manual occlusion is selected press F2 each time you desire to activate an occlusion 6 After each occlusion you are asked if accept or discard the result ual k Boe eee a ACIES 21 1x ROCC Deciuriee Views Pair uresmreone air kPa su 0 167 Sos 0 138 os os os Step Select xj os Roce kPa Us 0 259 IN u Pressure Pa 0 153 Les ions For Help press FI 12 05 2004 Va LA CASA NUM 7 End the test by pressing F3 or the button by side STOP 8 In order to view the graphs or the main parameters press the following
168. zil Pereira CAC Barreto SP Sim es JG Pereira FWL Gerstler JG Nakatani J Valores de Refer ncia para Espirometria em uma amostra da popula o brasileira adulta Jornal de Pneumologia 1992 18 10 22 Mallozi MC Valores de refer ncia para espirometria em criangas e adolescentes calculados a partir de uma amostra da cidade de S o Paulo Valores finais publicados em Pereira CAC Lemle A Algranti E Jansen JM Valen a LM Nery LE Mallozi M Gerbasi M Dias RM Zim W I Consenso Brasileiro sobre Espirometria Jornal de Pneumologia 1996 22 105 164 Scalambrini Costa F Scueiri CEB Silva Jr WC Pereira CAC Nakatani J Valores de refer ncia para espirometria em uma amostra da popula o brasileira adulta da raca negra J Pneumologia 1996 22 165 170 Neder JA Andreoni S Castelo Filho A Nery LE Reference values for lung function tests I Static Volumes Brazilian Journal Medical and Biological Research 1999 32 703 17 Neder JA Andreoni S Lerario MC Nery LE Reference values for lung function tests II Maximal respiratory pressures and voluntary ventilation Braz J Med Biol Res 1999 332 719 27 DLCO Standardized Lung Function Testing Official Statement of the European Respiratory Society The European Respiratory Journal Volume 6 Supplement 16 March 1993 Chapter 17 Appendix 155 Compilation of reference values for lung function measurements in children Ph H Quanjer J Stocks G Polgar M Wise J Karlberg

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