AARC GUIDELINE: STATIC LUNG VOLUMES: 2001 REVISION & UPDATE

AARC Clinical Practice Guideline

Static Lung Volumes: 2001 Revision & Update
SLV 1.0 PROCEDURE:
Measurement of static lung volumes and capacities
in adults and in children (age 5). This guideline
focuses on commonly used techniques for measuring lung volumes, including spirometry, gas-dilution determination of functional residual capacity
(FRC), and whole-body plethysmography determination of thoracic gas volume (VTG). Other methods (eg, single-breath nitrogen, single-breath helium, and roentgenologic determinations of lung volumes) are not discussed in this document, but may
be useful in certain situations.
SLV 2.0 DESCRIPTION/DEFINITIONS:
2.1 Static lung volumes are determined using
methods in which airflow velocity does not
play a role. The sum of two or more lung-volume subdivisions constitutes a lung capacity.
The subdivisions and capacities are expressed
in liters at body temperature and pressure saturated with water vapor (BTPS).
Maximal Inspiration

IC

IRV
End Inspiration

VC TV

TLC

End Expiration

FRC

ERV
Maximal Expiration

RV

Fig. 1. Subdivisions of Lung Volume

2.2 Tidal volume is the volume of air that is inhaled or exhaled with each respiratory cycle.1
(Although both VT and TV have been used to
denote this volume, TV is used in this guideline.) It varies with the conditions under which
it is measured (eg, rest, exercise, posture).

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When TV is reported, an average of at least 6

breaths should be used.2 (Fig. 1)
2.3 Inspiratory reserve volume (IRV) is the
maximal volume of air that can be inhaled from
TV end-inspiratory level.2
2.4 Expiratory reserve volume (ERV) is the
maximal volume of air that can be exhaled after
a normal tidal exhalation (ie, from functional
residual capacity, or FRC).2
2.5 Residual volume (RV) is the volume of gas
remaining in the lung at the end of a maximal
expiration.1 It may be calculated by subtracting
ERV from FRC (RV = FRC ERV) or by subtracting vital capacity (VC) from total lung capacity, or TLC (RV = TLC VC).
2.6 Inspiratory capacity (IC) is the maximal
volume of air that can be inhaled from the tidalvolume end-expiratory level (ie, FRC). It is
equal to the sum of TV and IRV.2
2.7 Vital capacity (VC) is the volume change
that occurs between maximal inspiration and
maximal expiration. The subdivisions of the
VC include TV, inspiratory reserve volume
(IRV), and expiratory reserve volume (ERV).
The largest of three technically satisfactory VC
maneuvers should be reported. The two largest
VCs should agree within 5% or 100 mL,
whichever is larger. The volume change can be
accomplished in several ways.2
2.7.1 Two-stage VC: a slow maximal inspiration from TV end-expiratory level after a normal exhaled TV, followed by quiet breathing,
followed by a slow maximal expiration from
TV (ie, end-expiratory level, or functional
residual capacity (ie, FRC). The reverse maneuver is also acceptable;
2.7.2 Forced vital capacity (FVC): the volume of
air exhaled during a forced maximal expiration
following a forced maximal inspiration. The
FIVC is the forced VC obtained during a maximal inspiration following a maximal expiration.

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AARC GUIDELINE: STATIC LUNG VOLUMES: 2001 REVISION & UPDATE

2.8 FRC is the volume of air in the lung at the

average TV end-expiratory level. It is the sum
of the ERV and RV. When subdivisions of lung
volume are reported, the method of measurement should be specified (eg, helium dilution,
nitrogen washout, body plethysmography).2
2.9 Thoracic gas volume (VTG) is the volume of
air in the thorax at any point in time and at any
level of thoracic expansion. It is usually measured by whole-body plethysmography. It may
be determined at any level of lung inflation;
however, it is most commonly determined at or
near FRC.2 As an alternative, lung volume may
be tracked continuously, and FRC determined
from VTG by addition or subtraction of volume.
2.10 Total lung capacity (TLC) is the volume of
air in the lung at the end of a maximal inspiration. It is usually calculated in one of two ways:
(1) TLC = RV + VC or (2) TLC = FRC + IC.
The method of measurement (eg, gas dilution,
body plethysmography) should be specified.2
SLV 3.0 SETTINGS:
3.1 Pulmonary function laboratories
3.2 Cardiopulmonary laboratories
3.3 Clinics and physicians offices
3.4 Patient care areas
3.5 Study and field settings
SLV 4.0 INDICATIONS:
Indications include but are not limited to the need
4.1 to diagnose restrictive disease patterns;3
4.2 to differentiate between obstructive and restrictive disease patterns,2 particularly in the
presence of a reduced VC;4
4.3 to assess response to therapeutic interventions (eg, drugs, transplantation, radiation,
chemotherapy, lobectomy, lung-volume-reduction surgery);
4. 4 to aid in the interpretation of other lung
function tests (eg, DL/VA, sGaw, RV/TLC;2
4. 5 to make preoperative assessments2 in patients with compromised lung function (known
or suspected) when the surgical procedure is
known to affect lung function;
4. 6 to provide an index of gas trapping (by
comparison of gas dilution techniques with
plethysmographic measurements).5
SLV 5.0 CONTRAINDICATIONS:
5.1 No apparent absolute contraindications

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exist; the relative contraindications for spirometry are appropriate and may include:2,6,7
5.1.1 hemoptysis of unknown origin;
5.1.2 untreated pneumothorax;
5.1.3 pneumothorax treated with a chest
tubebecause the chest tube may introduce leaks and interfere with gas-dilution
measurements;
5.1.4 unstable cardiovascular status;
5.1.5 thoracic and abdominal or cerebral
aneurysms.
5.2 With respect to whole-body plethysmography, such factors as claustrophobia, upper body
paralysis, obtrusive body casts, intravenous
(I.V.) pumps, or other conditions that immobilize or prevent the patient from fitting into or
gaining access to the body box are a concern.
In addition, the procedure may necessitate stopping I.V. therapy or supplemental oxygen.
SLV 6.0 HAZARDS/COMPLICATIONS:
6.1 Infection may be contracted from improperly cleaned tubing, mouthpieces, manifolds,
valves, and pneumotachometers.
6.2 Hypoxemia may result from interruption of
O2 therapy in the body box.
6.3 Ventilatory drive may be depressed in susceptible subjects (ie, some CO2 retainers) as a
consequence of breathing 100% oxygen during
the nitrogen washout.8 Such patients should be
carefully observed.
6.4 Hypercapnia and/or hypoxemia may occur
during helium-dilution FRC determinations as
a consequence of failure to adequately remove
CO2 or add O2 to the rebreathed gas.
SLV 7.0 LIMITATIONS OF METHODOLOGY/
VALIDATION OF RESULTS:
7.1 Patient-related limitations:
7.1.1 Slow VC is effort-dependent and requires understanding and motivation on
the subjects part. Physical and/or mental
impairment may limit patients ability to
perform.
7.1.2 Some patients may be unable to perform the necessary panting maneuver required for plethysmographic determination of FRC.
7.1.3 Some subjects are unable to maintain
mouth seal or cooperate adequately for the

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AARC GUIDELINE: STATIC LUNG VOLUMES: 2001 REVISION & UPDATE

time necessary to perform the test. Cough

is a common cause of such limitations.
7.1.4 Certain pathologic conditions in the
subject can cause a leak in a lung-volumemeasurement system (eg, perforated
eardrum, tracheostomy, transtracheal
catheter, chest tube).
7.1.5 FRC measured by gas dilution may
be underestimated in individuals with airflow limitation and air trapping.9,10 Body
plethysmography may overestimate FRC
in subjects with severe airway obstruction
or induced bronchospasm at panting frequencies greater than 1 Hz (1 cycle/second).11-13
7.1.6 Elimination of nitrogen from tissues
and blood can result in overestimation of
the FRC in healthy subjects unless appropriate corrections are made.2
7.2 Test validation encompasses those calibration and procedural elements that help assure
credible results:
7.2.1 Spirometry
7.2.1.1 Spirometers (volume-displacement devices or flow-sensing devices)
should meet the American (1994) and
European Thoracic Societies (1993)
current accepted standards.2,3 Volumedisplacement spirometers should be
leak tested when calibrated (eg,
daily).14
7.2.1.2 The VC should be measured as
close as possible in time to the FRC determination.2
7.2.2 Gas-dilution methods for FRC determination:
7.2.2.1 Open-circuit multibreath nitrogen washout method
7.2.2.1.1 Test should be continued
for 7 minutes or until N2 concentration falls below 1.0%.15 In subjects
with airflow obstruction and air
trapping, the time period for measuring FRC may need to be extended.
7.2.2.1.2 A minimum of 15 minutes
should elapse before test is repeated.16
7.2.2.1.3 Initial alveolar nitrogen
concentration of 80% can be assumed2 if patient has been breathing
room air for at least 15 minutes.

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7.2.2.2 Closed-circuit multibreath helium equilibration method

7.2.2.2.1 The helium concentration
should be measured at least every 15
seconds, and water vapor should be
removed from the fraction of gas
that is introduced into the helium analyzer.2 The reference cell of the He
katharometer should also have a
water absorber in-line, if room air is
used for zeroing.
7.2.2.2.2 A mixing fan should circulate and completely mix the air
throughout the main circuit.
7.2.2.2.3 The breathing valve and
mouthpiece (without a filter) should
add < 60 mL dead space to the system for adults and a proportionately
reduced increase for pediatric subjects and should be easy to disassemble for cleaning.
7.2.2.2.4 Gas mixing is considered
complete when the change in helium
concentration has been constant
over a 2-minute period (ie, changes
less than 0.02%) or 10 minutes has
elapsed.4 If the helium concentration
can be read directly or processed by
computer, helium equilibration can
be assumed when the change is <
0.02% in 30 seconds.2
7.2.2.2.5 The need to correct for body
absorption of helium is controversial.
7.2.2.2.6 The delay between the repeated measurements should be at
least the same as the time taken to
reach equilibrium or 5 minutes,
whichever is greater.17,18
7.2.4 Whole body plethysmography
7.2.4.1 The frequency of panting
breathing movements against the shutter should be 1 cycle/second.11-13,19
7.2.4.2 The cheeks and chin should be
firmly supported with both hands. This
should be done without supporting the
elbows or elevating the shoulders.20
7.2.4.3 Plethysmographic determination of FRC is the method of choice in
patients with airflow limitation and air
trapping.2

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AARC GUIDELINE: STATIC LUNG VOLUMES: 2001 REVISION & UPDATE

7.2.4.4 This method may be the more

practical method in subjects with short
attention spans or inability to stay on
the mouthpiece (eg, children).
7.3 Reproducibility of results is essential to validation and test quality.
7.3.1 Multiple FRC determinations by gas
dilution should be made, with at least two
trials agreeing within 10% of the mean.21
7.3.2 FRC determinations by body
plethysmography (at least 3 separate trials) should agree within 5% of the mean.22
7.3.3 IC and ERV measurements should
agree within 5% or 60 mL (of the mean)
whichever is larger. In patients who have
large variability, this should be noted.
7.3.4 The two largest VC measurements
should agree within 200 mL.3
7.4 Clear and complete reporting of results is
essential to test quality.
7.4.1 The average FRC value should always be reported (and should ideally include the variability).
7.4.2 The largest volume of either VC or
FVC should be reported
7.4.3 The largest reproducible value
should be reported for IC and ERV, as described in 7.3.3.
7.4.4 Various methods are used for calculating TLC and RV. 23 The consensus of
the Committee is that the two acceptable
methods for reporting TLC and RV from
FRC determinations made using gas dilution techniques are:
TLC = mean FRC + largest IC,
RV = TLC largest VC; or
RV = mean FRC largest ERV,
TLC = RV + largest VC.
For body plethysmographic determinations, a VC maneuver (with its IC and
ERV subdivisions) should be performed
in conjunction with each VTG maneuver
and the TLC calculated as
TLC = FRC + IC.*
*(Note: the mean IC should be close to
the largest IC)
The reported TLC should be the mean of
all acceptable maneuvers; the RV should
be calculated as:
RV = mean TLC largest VC.

534

7.5 Conditions under which testing is done can

affect results and should be controlled to the extent possible. If certain conditions cannot be
met, the written report should reflect that.
7.5.1 Lung volumes are influenced by
body position24,25 and should be made in
the sitting position. If another position is
used, it should be noted.2
7.5.2 Breathing movements should not be
restricted by clothing.
7.5.3 Diurnal variations in lung function
may cause differences and, thus, if serial
measurements are to be performed, the
time of the day that measurements are
made should be held constant.2
7.5.4 The patient should not have smoked
for at least 1 hour prior to the measurements.
7.5.5 The patient should not have had a
large meal shortly before testing.
7.5.6 Nose clips should always be worn
during testing.2
7.5.7 Measurements made at ambient
temperature and pressure saturated with
water vapor (ATPS) conditions are corrected to body temperature and pressure
saturated with water vapor (BTPS) conditions.
7.5.8 No corrections are necessary for altitude because no consistent differences in
lung volumes (TLC, VC, FRC, and RV)
due solely to altitude have been found
from sea level up to 1,800 meters.26-28
7.5.9 After the mouthpiece is in place, the
patient should be asked to breathe quietly
in order to become accustomed to the apparatus and attain a stable breathing pattern. The end-expiratory level should be
reproducible within 100 mL.
7.5.10 VC can be measured before disconnecting the patient from measuring
systems. As an alternative, the patient can
be disconnected and the VC performed
immediately afterward.
7.5.11 If expired VC is measured with a
CO2 absorber in the system, an appropriate volume correction must be made.
(1.05 M expired volume is the correction
commonly incorporated into commercial
software.)

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7.5.12 If a filter is used during FRC measurement, the filter volume must be subtracted.
7.6 Choice of reference values may affect interpretation.
7.6.1 Make a tentative selection from published reference values. The characteristics of the healthy reference population
should match the study group with respect
to age, body size, gender, and race. The
equipment, techniques, and measurement
conditions should be similar.
7.6.2 Following selection of apparently
appropriate reference values, compare
measurements obtained from a representative sample of healthy individuals (1020 subjects) over an appropriate age range
to the predicted values obtained from the
selected reference values. If an appreciable number of the sample falls outside of
the normal range, more appropriate reference values should be sought. This procedure detects only relatively gross differences between sample and reference population.29
7.6.3 Predicted values for RV, FRC, and
TLC should be derived from the same reference population.

7.7 Expression of results

7.7.1 The upper and lower limits of normal
may be derived from the standard error of
the estimates (SEE) around the regression
lines. The two-tail 95% confidence interval
can be estimated by multiplying 1.96 M
SEE. A one-tailed 95% confidence interval
can also be used for parameters in which
only an abnormal high or low limit of normal is needed; the one-tailed limit is estimated by multiplying 1.64 M SEE and
subtracting this value from the mean.22,24
These methods of estimating the limits of
normal are applicable only if the reference
data are normally distributed (Gaussian).4
7.7.2 The common practice of expressing
results as percent predicted and regarding
80% predicted as the lower limit of normal is not valid unless the standard deviation (SD) of the reference data is proportional to the mean value.30
SLV 8.0 ASSESSMENT OF NEED (See SLV 4.0
Indications.)
Technologist-driven protocols (TDP) may be useful
for assessing the need for lung-volume determination, particularly in the context of other pulmonary
function results (eg, spirometry, diffusing capacity).

Pulmonary Diagnostics Path of Workflow

Pretest

Quality
System
Essentials

Patient Assessment
Test Request
Patient Preparation
Equipment Preparation

Organization
Personnel
Equipment
Purchasing/
Inventory
Process
control
Documents/
Records
Occurence
management
Internal
assessment
Process
improvement
Service and
Satisfaction

Testing Session

Post-test

Patient Training
Test Performance
Results Review and Selection
Patient Assessment for Further Testing

Results Report
Interpretation
Clinical Consult

Information Management
Information System

Quality system essentials

apply to all operations
in the path of workflow

Fig. 2. Structure for a Quality System Model for a Pulmonary Diagnostics Service (From Reference 31, with permission)

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AARC GUIDELINE: STATIC LUNG VOLUMES: 2001 REVISION & UPDATE

SLV 9.0 ASSESSMENT OF QUALITY OF

TEST AND VALIDITY OF RESULTS:
The consensus of the committee is that all diagnostic procedures should follow the quality model described in the NCCLS GP26-A A Quality System
Model for Health Care.31 (Fig. 2) The document describes a laboratory path of workflow model that incorporates all the steps of the procedure. This process begins with patient assessment and the generation of a clinical indication for testing through the
application of the test results to patient care. The
quality system essentials defined for all health care
services provide the framework for managing the
path of workflow. A continuation of this model for
respiratory care services is further described in
NCCLS HS4-A A Quality System Model for Respiratory Care.32 In both quality models the patient is
the central focus.
9.1 General considerations include:
9.1.1 As part of any quality assurance program, indicators must be developed to
monitor areas addressed in the path of
workflow.
9.1.2 Each laboratory should standardize
procedures and demonstrate intertechnologist reliability. Test results can be considered valid only if they are derived according to and conform to established laboratory quality control, quality assurance,
and monitoring protocols.
9.1.3 Documentation of results, therapeutic intervention (or lack of) and/or clinical
decisions based on the testing should be
placed in the patients medical record.
9.1.4 The type of medications, dose, and
time taken prior to testing and the results
of the pretest assessment should be documented.
9.1.5 Report of test results should contain
a statement by the technician performing
the test regarding test quality (including
patient understanding of directions and
effort expended) and, if appropriate,
which recommendations were not
met.2,3,33
9.1.6 Test results should be interpreted by
a physician, taking into consideration the
clinical question to be answered.

536

9.1.7 Personnel who do not meet annual

competency requirements or whose competency is deemed unacceptable as documented in an occurrence report should not
be allowed to participate, until they have
received remedial instruction and have
been re-evaluated.
9.1.8 There must be evidence of active review of quality control, proficiency testing, and physician alert, or panic values,
on a level commensurate with the number
of tests performed.
9.2 Calibration measures specific to equipment
used in measuring lung volumes include:
9.2.1 Spirometers and/or other volume
transducers should be calibrated daily
using a 3-L syringe or another more sophisticated device. 3 Volume-based
spirometers should be checked for
leaks.
9.2.2 Gas dilution systems should have
their gas analyzers, (ie, He, N2, O2, CO2)
calibrated according to the manufacturers
recommendations immediately before
each test. Some analyzers may require
more frequent calibration.
9.2.3 Gas conditioning devices such as
CO 2 and water absorbers should be inspected daily.
9.2.4 Body plethysmographs (including
each transducer) should be calibrated at
least daily, according to the manufacturers recommendations. Leak checks or
calculation of time constants should be
performed in accordance with the manufacturers recommendations.
9.3 Quality control measures specific to measuring lung volumes include:
9.3.1 Lung volume analogs provide a
means of checking the absolute accuracy
and assessing precision. A 3-L syringe
with/without an additional volume container can be used to check gas dilution
systems (both open and closed circuit systems). As an alternative, a large-volume
syringe can be used to assess the linearity
of the associated gas analyzers, using a
serial dilution technique.34
9.3.2 Isothermal bottles can be constructed

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or purchased in order to check body plethysmograph function (volume accuracy).

9.3.3 Biologic controls should be used to
assess the performance of the entire lungvolume system (transducers, gas analyzers,
software). The means and standard deviations of 8-10 measurements of 2 or more
healthy subjects may be used to check the
precision of the system, as well as to troubleshoot when problems are suspected.
SLV 10.0 RESOURCES:
10.1 Equipment: Specifications should conform to recognized standards.
10.1.1 All spirometers (volumetric or
flow-based) should meet or exceed the
minimum recommendations of the American Thoracic Society.3
10.1.2 Helium analyzers (katharometers)
should be linear from 0 to 10% with a resolution less than 0.05% He and an accuracy of 0.1%. The gas flow through the
meter should be constant at 20 mL/min or
more. The 95% response time of the system (analyzer, spirometer with fan) for a
2% step change should be l 15 seconds.2
10.1.3 Plethysmographs should include:2
10.1.3.1 a patient compartment appropriate for the population to be tested;
10.1.3.2 a piston pump for box calibration and a manometer or similar device
for mouth pressure calibration. A 3liter syringe should be available for
pneumotachometer calibration;
10.1.3.3 a vent to atmosphere (constant
volume configurations);
10.1.3.4 a mouth shutter capable of
closing within 0.1 seconds;
10.1.3.5 and an intercom for patienttechnologist communication.
10.1.4 Nitrogen analyzers should have a
range of 0-100% 0.5% with 50-millisecond response time or rapidly responding
O2 and CO2 analyzers that allow calculation of the fraction of expired N2 (FeN2)
should be incorporated.
10.2 Personnel
10.2.1 Lung-volume testing should be
performed under the direction of a physi-

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cian trained in pulmonary diagnostics.35

10.2.2 Personnel should be trained (with
verifiable training and demonstrated competency) in all aspects of lung-volume determination, including equipment theory
of operation, quality control, and test outcomes relative to diagnosis and/or medical history.35
10.2.3 Attainment of either the CPFT or
RPFT credential is recommended by the
Committee.
SLV 11.0 MONITORING:
The following should be monitored during lungvolume determinations:
11.1 reproducibility of repeated efforts;
11.2 presence or absence of adverse effects of
testing on the patient during testing. (Patients
on supplemental oxygen may require periods of
time to rest on oxygen between trials.)
SLV 12.0 FREQUENCY:
The frequency of lung-volume measurements depends on the clinical status of the subject and the indications for performing the test.
SLV 13.0 INFECTION CONTROL:
13.1 The staff, supervisors, and physician-directors associated with the pulmonary laboratory should be conversant with Guideline for
Isolation Precautions in Hospitals36 and develop and implement policies and procedures for
the laboratory that comply with its recommendations for Standard Precautions and Transmission-Based Precautions.
13.2 The laboratorys manager and its medical
director should maintain communication and
cooperation with the institutions infection control service and the personnel health service to
help assure consistency and thoroughness in
complying with the institutions policies related
to immunizations, post-exposure prophylaxis,
and job- and community-related illnesses and
exposures.37
13.3 Primary considerations include adequate
handwashing,38 provision of prescribed ventilation with adequate air exchanges,39 careful handling and thorough cleaning and processing of
equipment,36 and the exercise of particular care

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AARC GUIDELINE: STATIC LUNG VOLUMES: 2001 REVISION & UPDATE

in scheduling and interfacing with the patient in

whom a diagnosis has not been established.
Considerations specific for lung-volume measurement include:
13.3.1 The use of filters is neither recommended nor discouraged. Filters may be
appropriate for use in systems that use
valves or manifolds on which deposition
of expired aerosol nuclei is likely.40
13.3.2 If filters are used in gas-dilution
procedures, their volume should be subtracted when FRC is calculated.
13.3.3 If filters are used in the plethysmograph system, the resistance of the filters
should be subtracted from the airways resistance calculation.
13.3.4 Nondisposable mouthpieces and
equipment parts that come into contact
with mucous membranes, saliva, and expirate should be cleaned and sterilized or
subjected to high-level disinfection between patients.36,41 Gloves should be worn
when handling potentially contaminated
equipment.
13.3.5 Flow sensors, valves, and tubing
not in direct contact with the patient
should be routinely disinfected according
to the hospitals infection control policy.
Any equipment surface that displays visible condensation from expired gas should
be disinfected or sterilized before it is
reused.
13.3.6 Water-sealed spirometers should
be drained weekly and allowed to dry.2
13.3.7 Closed circuit spirometers, such as
those used for He-dilution FRC determinations, should be flushed at least 5 times
over their entire volume to facilitate clearance of droplet nuclei. Open circuit system need only have the portion of the circuit through which rebreathing occurs decontaminated between patients.
SLV 14.0 AGE-SPECIFIC ISSUES:
Test instructions should be provided and techniques
described in a manner that takes into consideration
the learning ability and communications skills of
the patient being served.
14.1 Neonatal: This Guideline does not apply

538

to the neonatal population.

14.2 Pediatric: These procedures are appropriate for children who can perform spirometry of
acceptable quality and can adequately follow
directions for plethysmographic testing.
14.3. Geriatric: These procedures are appropriate for members of the geriatric population who
can perform spirometry of acceptable quality
and adequately follow directions for plethysmographic testing.
Pulmonary Function Testing Clinical Practice
Guidelines Committee (The principal author is listed first):
Gregg Ruppel MEd RRT RPFT, St Louis MO
Susan Blonshine BS RRT RPFT, Mason MI
Catherine M Foss, BS RRT RPFT, Ann Arbor MI
Carl Mottram, BA RRT RPFT, Chair, Rochester MN
Jack Wanger MS RRT RPFT, Lenexa KS
The current Pulmonary Function Clinical Practice
Guidelines Committee updated an earlier version
(Static lung volumes. Respir Care 1994;39(6):830835) and gratefully acknowledges those individuals
who provided input to that earlier version: Robert
Brown, Michael Kochansky, and Kevin Shrake.
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AARC GUIDELINE: STATIC LUNG VOLUMES: 2001 REVISION & UPDATE

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