WoundReference improves clinical decisions
 Choose the role that best describes you
Patient referral for HBO. CXR done for workup for HBO identified new Dx: Emphysema. Referred out to Pulmonologist who ordered CT Chest and PFT. Question, what should FEV1 value be pre-bronchodilator and post-bronchodilator, to safely move forward with HBO?
Jan 11, 2022 by Barbara Keller, RN, MSN, CWS
2 replies
Eugene Worth
MD, M.Ed., FABA, ABPM/UHM
Barbara, you have asked the million dollar question … for which there is no good, right, or acceptable answer in all cases. So, this is a question that depends on clinical judgment.

I approach these patients with some simple tests:
1) Can the patient talk in full sentences? (If so, then I’m more comfortable. If they must breathe every other word or so, that’s not good lung function.
2) Can the patient climb a flight of stairs without stopping?
3) Can the patient walk 100 feet without stopping? (I realize that patients with terrible diabetic foot ulcers simply cannot walk, but you get the point.)

As far as pulmonary function tests, there is no number set in stone for FEV1 or FVC … or anything else. Basically, my rule of thumb is to depend on the pulmonologist. If he/she comes back with mild or even moderate obstructive lung disease, that is responsive to bronchodilator, then take the patient whenever the pulmonologist says that he/she is maximally treated.

If I were to put someone in the chamber with moderate COPD/Emphysema, I might consider bringing the chamber from pressure to surface a little slower than usual. If you have a 5 minute decompression, then make it 10 minutes. If the CT scan showed large blebs, then I might think about not treating the patient at all. In that case, you run the risk of the bleb enlarging or rupturing with repeated treatments.

I hope this helps, but my standard answer stands for this patient … “It depends.”
Jan 11, 2022
Barbara Keller
RN, MSN, CWS
Thank you very much for your response.
Jan 12, 2022
* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.