Performing Oscillometry
Chapter 3
Chapter Outline
Patient Preparation and Comfort Interpreting Oscillometric Indices
Testing Protocols and Procedures Ensuring Quality Measurements
Effect of Volume History on Measurements Safety Considerations and Infection Control
Duration of Oscillometry Acquisition Documentation and Preliminary Assessment
Educational Aims
After Studying This Chapter You Should Be Able To:
✓ Understand the Basics of Oscillometry
✓ Prepare Patients for Oscillometry Testing
✓ Follow Testing Protocols Accurately
✓ Recognize the Impact of Volume History
✓ Optimize Acquisition Time Based on Patient Profile
✓ Interpret Oscillometry Results
✓ Maintain High-Quality Testing Standards
✓ Ensure Patient Safety and Infection Control
✓ Accurate Documentation and Reporting
Key Terms
✓Patient Anxiety ✓Preliminary Assessment
✓Guidance and Adjustments ✓Recording Results
✓Quality measurements ✓Observations and Notes
✓Infection Control ✓Adverse Reactions
Contents
Chapter Overview: Key Aspects of Oscillometry Testing
✓Focus on patient comfort, safety, and accurate documentation.
✓Clear instructions and optimal patient positioning.
✓Addressing patient anxiety through effective communication and empathy.
✓Real-time guidance for ensuring quality measurements.
✓Techniques for calibration, monitoring, and troubleshooting.
✓Infection control practices:
✓Equipment sterilization.
✓Use of disposable components.
✓Managing adverse reactions and emergency response.
✓Accurate data recording and maintaining data integrity.
✓Thorough documentation for effective and safe testing.
Clinical Settings for Oscillometry Applications
✓Oscillometry is applicable in various ✓Different devices for specific needs:
✓ Commercial devices and local bespoke
clinical settings
options
✓ Clinical lung function laboratories
✓ Hardware modifications for specialized use
✓ Field testing cases (e.g., children, ICU)
✓ Home monitoring ✓Adaptation for specific populations and
✓ Intensive care units (ICU) environments
✓Primarily used in ✓ Devices tailored for children and intensive
✓ Airways diseases care settings
✓ Paediatric lung diseases
Low-Frequency Impedance Measurement in
Adults and Infants
✓Low-frequency impedance (Zrs) can be measured in both
adults and infants.
✓ Typically requires apnoea and chest wall relaxation.
✓Newer devices and signal processing techniques:
✓ Enable measurement during spontaneous breathing.
✓In infants, apnoea is induced using the Hering–Breuer reflex:
✓ Positive airway pressure delivered via face mask.
✓Oscillometry can also be measured during quiet sleep:
✓ No apnoea required with single-frequency or higher frequency
excitations.
✓Feasibility of wave tube technique:
✓ Possible in infants as early as 1–3 days after birth.
Oscillometric Indices and Their Clinical
Relevance
✓Oscillometric indices such as Rrs, Xrs, and fres complement traditional lung function tests:
✓Spirometry
✓Lung volumes
✓Specific conductance
✓Diffusing capacity
✓Valuable in patients unable to perform spirometry:
✓Poorly cooperative or frail individuals
✓Useful alternative for bronchial challenge testing in adults
✓Particularly beneficial for paediatric patients:
✓Addresses difficulties with spirometry in young children
✓Technical considerations exist for pediatric applications
Oscillometry in Occupational Health and
Population Studies
✓Applied in occupational health screenings and large-scale
population studies
✓ Both adult and paediatric populations
✓Benefits for occupational health settings
✓ Short testing times
✓ Easy administration for subjects
✓Greater sensitivity compared to spirometry
✓ Detects airways disease from occupational exposure more effectively
✓Further research needed to expand its use in occupational
health
Home-Based Oscillometry for Asthma and
COPD Management
✓Self-administered daily oscillometry at home ✓COPD study findings:
✓Highly feasible for asthma and COPD patients ✓Early intervention based on
✓Large volumes of daily data enable oscillometric indices did not reduce
✓Analysis of day-to-day variability using time- initial hospitalizations or symptoms.
series techniques ✓Significant reduction in repeat
✓Potential clinical uses hospitalizations.
✓Asthma diagnosis ✓Substantial healthcare cost savings.
✓Monitoring therapy response
✓Clinical phenotyping
Oscillometry in Mechanical Ventilation
Optimization
✓ Potential use of oscillometry in optimizing mechanical
ventilation
✓ Applicable in the ICU and operating room.
✓ Ongoing research in this area
✓ Impedance measured using spectrally enhanced ventilation
waveforms
✓ Allows for uninterrupted ventilation in some cases.
✓ Can be implemented by modifying ventilator hardware
✓ No need for additional components.
Minimum Instructions to Be Provided to Subjects
Prior to Oscillometry Acquisition
Instruction Details
Explain duration and number Inform the patient about the duration of a single acquisition and how many replicates will
of replicates be recorded.
Describe sensations from Explain that the patient will feel a gentle "vibration" or "fluttering" in the mouth and
pressure oscillations chest. A practice run can be useful, especially for children.
Encouragement to relax and
Instruct the patient to stay relaxed and breathe as they normally would during the test.
breathe normally
Explain initial observation Inform the patient that there will be a brief observation period before oscillations begin
period to ensure normal and stable breathing.
Correct head position Advise the patient to sit upright with a slight "chin-up" position for proper posture.
Avoid swallowing Instruct the patient to avoid swallowing during the measurement.
Demonstrate teeth and lip Show the patient how to grip the mouthpiece firmly with their teeth and lips to prevent
grip on mouthpiece air leaks.
Keep tongue relaxed and
Instruct the patient to relax the tongue and keep it away from the mouthpiece opening.
clear of the mouthpiece
Support of cheeks and mouth Demonstrate cheek support with the hands, and for children, this support should be
floor provided by staff or parents.
Quick Quiz 8
Which patient positioning is recommended during oscillometry testing?
1. Lying flat
2. Standing
3. Seated upright
4. Leaning forward slightly
Duration of Oscillometry Acquisition
✓ Infants:
✓ Low-frequency oscillometry during apnoea should not exceed 5–8 seconds.
✓ In sleeping infants, acquisition times of 30 to 60 seconds can be considered to capture more
respiratory cycles.
✓ School-aged Children:
✓ 60 seconds provides better within-session and between-day reproducibility compared to shorter
acquisition times (16 s, 30 s, 8 s).
✓ Longer durations may be challenging for younger children.
✓ Adults (Healthy, Asthma, COPD):
✓ 60 seconds reduces within-session variability compared to shorter durations (16 s, 30 s).
✓ Small but significant differences in mean Rrs and Xrs were observed between durations of 16 s, 30 s,
and 60 s.
Duration of Oscillometry Acquisition
✓Recommended Minimum Acquisition Times:
✓30 seconds for high-school aged children and adults.
✓16 seconds for children under 12 years.
✓Acquisition time should vary depending on:
✓Patient population, clinical application, and disease severity.
✓Duration should be included in the laboratory report or research publication.
Effect of Volume History on Oscillometry
Measurements
✓Impact on Impedance Measurements
✓Volume history affects measurements in both airways disease patients and healthy subjects
during bronchial challenge testing.
✓Deep inspirations (e.g., inflation to TLC) have varying effects depending on the disease.
✓Effects of Deep Breaths
✓In asthmatics, deep breaths have a bronchodilator effect, potentially altering test results.
✓Non-asthmatics show airway protection with deep breaths before inhaling agonists, and
airway dilation after.
Effect of Volume History on Oscillometry
Measurements
✓ Bronchial Challenge Differences
✓ Asthmatics: Deep breaths may have reduced or variable protective effects.
✓ Non-asthmatics: Deep breaths generally prevent or reverse airway narrowing.
✓ Oscillometry, measured during tidal breathing, may detect airway hyperresponsiveness more sensitively
than spirometry.
✓ Standardisation Recommendations
✓ Perform oscillometry before tests requiring deep breaths (e.g., exhaled nitric oxide, spirometry, diffusing
capacity).
✓ Standardise the duration of withholding deep breaths before oscillometry testing.
✓ The testing order and time frame for withholding deep inspirations should be documented in reports and
publications.
Patient Preparation and Comfort
Instructions and Positioning
✓Clear Instructions
✓Proper Positioning
✓Patient Comfort
✓Accuracy of Measurements
Addressing Patient Anxiety and Questions
✓Addressing Anxiety
✓Empathy
✓Clear Information Delivery
✓Responsiveness
Conducting the Test
Real-time Guidance and Adjustments
✓Real-Time Adjustments
✓Adaptability
✓Clear Communication
✓Continuous Monitoring
Ensuring Quality Measures
✓Regular Calibration
✓Signal Monitoring
✓Troubleshooting Skills
✓Patient Interaction
Safety Considerations
Infection Control
✓Sterilization Protocols
✓Disposable Components
✓Personal Protective Equipment (PPE)
✓Hand Hygiene
✓Clean Testing Environment
Quick Quiz
Which of the following is an essential infection control practice during oscillometry
testing?
1. Wearing a hat during testing
2. Reusing mouthpieces
3. Wearing gloves and using disposable components
4. Keeping the windows open during the test
Managing Adverse Reactions
✓Emergency Response
✓Patient Monitoring
✓Communication
✓Collaboration with Emergency Services
✓Documentation
Quick Quiz
What should you do first if a patient has an adverse reaction during the oscillometry
test?
1. Ignore it and continue the test
2. Stop the test and assess the patient
3. Restart the equipment
4. Ask the patient to try again immediately
Documentation and Preliminary Assessment
Documentation and Preliminary Assessment
✓Accurate Data Entry
✓Data Integrity
✓Quality Assurance
✓Integration with Patient History
✓EHR Utilization
Initial Observations and Notes
✓Clinical Observation
✓Patient Communication
✓Symptom Documentation
✓Equipment Performance Notes
✓Contextual Information Integration
