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Incentive spirometer

Discussion in 'Fred's House of Pancakes' started by ChapmanF, Nov 5, 2024.

  1. ChapmanF

    ChapmanF Senior Member

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    A family member has been presented with an incentive spirometer, to use in training for an upcoming procedure.

    It has both a small 'indicator' for air flow rate, and a piston that rises in a cylinder marked off to 4000 ml of air volume.

    The idea is you shoot for inhaling at a pretty constant flow rate (keeping the 'indicator' near the middle of its travel), and see the total volume you have inhaled from how high the piston rises.

    [​IMG]

    What seems nifty to me about it is the graduated cylinder is nowhere near 4 liters in size! That would be like gallon-jug sized. This is sized more like a drinking glass. I might guess more on the order of 0.4 l, or a tenth of the indicated volume.

    So I'm thinking this gizmo must have some kind of clever proportioning valve that's letting 9/10 of the air you inhale come in directly, while 1/10 is drawn from the cylinder above the piston.

    I'm no fluid dynamics guy, but I'd guess it's hard to build such a proportioning valve (especially a cheap and disposable one) and have it be accurate over much of a range of flow rate. Of course, the problem here is simpler, because there's already the flow indicator and part of the game is you try to inhale at a constant rate in the middle of the range. So maybe a proportioning valve that's kinda accurate at that target rate is 'good enough'.

    Makes me wonder how far off the volume measurement might be at higher or lower flow rates than the target.

    I did a brief search this morning for "incentive spirometer patent" and found several patents on other aspects of designing the things, but still haven't found anything for "here's how we got away with a graduated cylinder that's way smaller than the actual volume being measured".

    Edit: or is the trick just that at the targeted flow rate, you're sucking with an absolute pressure near 1/10th atmospheric, and the volume is marked off for standard pressure? My gut tells me that 1/10th atmospheric would feel like a really hard suck, though, and the target rate feels like taking a pretty easy breath.
     
    #1 ChapmanF, Nov 5, 2024
    Last edited: Nov 5, 2024
  2. BiomedO1

    BiomedO1 Senior Member

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    ^ That's it. Truly not that accurate but gives them a ball-park assessment and something to write down onto the charts. Can you imagine someone putting, a smidge, about half-way or one-third in your charts? Those things are all built to an engineering specification so they all ball-park in the general area. Besides air is difficult to quantify biased on Boyle's + Charle's gas laws.

    Medical staff is looking for rate of change - are you getting better or worse? A baseline must be set. That unit is measuring a single breath, we're usually looking at LPM (liters per minute) - so normal breathing is around 8-12 BPM (breaths per minute) in an adult. So that's why that cylinder is measuring an average of 1/10. During baseline assessment (ie. hospital check-in); there's a spot in your records of how many BPM, establishing your normal.

    Hope this helps....
     
    #2 BiomedO1, Nov 5, 2024
    Last edited: Nov 5, 2024
  3. rjparker

    rjparker Tu Humilde Sirviente

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    No proportioning valve on the one I saw. There is a piston adding resistance. The device is $10.

    It is more breathing exercise with feedback. You are instructed to give it your all. Often needed after a long total anesthetic procedure.

    IMG_6625.jpeg
     
  4. ChapmanF

    ChapmanF Senior Member

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    Somehow, though, the idea is that the marks on the grad cylinder do tell you how much air you inhaled ... and when it tells me I've inhaled 3 l of air, I really do feel like I've inhaled 3 l of air, even though I can't have gotten more than 0.3 l from the cylinder above that piston.

    And the more I think about my later idea (am I just sucking it down to 1/10 pressure?), the more implausible that sounds. If I could do that, I could suck water up a three-storey straw. I don't think so. (Just think of the possibilities for hickies though.)
     
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  5. rjparker

    rjparker Tu Humilde Sirviente

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    Blood oxygen is the real metric. The $10 breathing exercise machine is for home use.

    IMG_6627.jpeg
     
    #5 rjparker, Nov 5, 2024
    Last edited: Nov 5, 2024
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  6. bwilson4web

    bwilson4web BMW i3 and Model 3

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    I've used a recording, pulse oximeter to confirm my sleep apnea diagnosis and later, the effectiveness of my CPAP machine and mask.

    Bob Wilson
     
  7. tochatihu

    tochatihu Senior Member

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    As it happens I was in hospital for something unrelated and took lung function tests. Equipment was impressively complicated including a clear plastic 'phone booth' to sit in, that (I suppose) measured body-volume changes during huffing and puffing.

    I suppose that if one really wants to know lung function it ought to be done in that way. If one wants to train for it, a more qualitative home device would be a good choice.

    ==
    Competitive free divers do amazing things to preload O2. And then nearly kill themselves. What a thing to aim at...
     
  8. ETC(SS)

    ETC(SS) The OTHER One Percenter.....

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    I'm not so sure.
    I know people with only 1 lung who are fairly active, even a Pope.
    .....and then there's the free-diver story above.
    The normal oxygen (O2) percentage in air is approximately 21% but mile-highers (both kinds) can find themselves huffing and puffing because although an elevated city's oxygen levels are similar to other areas of the continental United States... the amount of oxygen a person takes in with each breath is reduced at high altitudes due to lower air pressure.
    Works the same way with lungs.
    Any (qualified) submarine vet knows why they keep an altimeter in the control room (no....it's not for the new diving officers!) and that 'patrol headache' that you get when the O2 levels go below the targeted 19%.

    Blood gasses tell a tale AND lung function is only one of the chapters - BUT they bear watching if they're old.....full of sludge....there's only one of them....or you live where the AQI is high.
    Old lungs are like old Presidents.

    They ain't as good as some of the younger ones, and they should be tested regularly for declination.....
    OTHERWISE really, really REALLY bad stuff can happen....;)
     
  9. tochatihu

    tochatihu Senior Member

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    I am not in best health but live at 2000 meters. Vacation at 3500 meters to a scenic place, where sea-level people were using little oxygen bottles, but we were not. Acclimation is a really big thing. I suppose similar holds true for one-lungers whose remaining wetware physically gets better. Maybe bigger; that I do not know.
     
  10. BiomedO1

    BiomedO1 Senior Member

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    That booth is actually the "gold standard" for pulmonary function test (PFT). Every aspect of that environment is controlled for accurate measurement purposes. Operators can vary the O2 concentrations to measure your body response. They would need a Pulse Ox on you to do that test. As O2 levels rise, your respiration (BPM) should slow and vise-a-versa.
     
    #10 BiomedO1, Nov 8, 2024
    Last edited: Nov 9, 2024 at 11:49 AM
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  11. ETC(SS)

    ETC(SS) The OTHER One Percenter.....

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    'Zactly!'

    NOW....
    How many hospitals have those booths?
    How much is the test?

    JUST to be clear....
    O2 sensors are a GOOD thing - presuming they can reasonable measure blood gasses!

    They CAN be expected to perhaps weed out the 80-90% of people over 60 with reasonable BMIs who don't need to squeeze into a booth - PRESUMMING they can afford to do so in the first place.
     
  12. ChapmanF

    ChapmanF Senior Member

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    [​IMG]

    Toward the left, you can see three small circles stacked up: the green flow-indicating disk sitting at the bottom of its vertical channel; below that, a round air-inlet grille; below that (seen through the translucent plastic) the round mouthpiece you inhale from, on the 'back' side in this photo.

    You can see a molded passage running from the top of the flow-indicator channel, down the left side, ending at the mouthpiece, and a smaller channel to the right of the mouthpiece leading from the top of the graduated volume cylinder.

    So as you inhale, most of the air you're inhaling is coming in through the round grille and the flow meter, and a smaller fraction is coming out of the graduated cylinder and lifting the piston. The cylinder still looks to me like maybe a tenth of the marked-off volume, so you're inhaling 9/10 through the flow-meter inlet and 1/10 from the cylinder.

    The little passage from the cylinder to the mouthpiece shows eight little plastic bosses, the middle four having holes drilled through. I'm guessing that's how it's calibrated at the factory: build it to read higher than the true amount with none of the bosses drilled, attach it to a calibrated 'inhaler', then drill tiny leaks into as many of those eight bosses as it takes to get acceptable accuracy.

    I'm pretty convinced now that the volume reading's accuracy must be pretty dependent on you inhaling at the right rate to keep the green disk at the target middle position, add will be in error by larger amounts the more your inhaling rate differs from the target.

    I'm also pretty sure if you hold it so once of your fingertips 'accidentally' blocks part of that inlet grille on the back, you could astound your respiratory therapist with your stupendous lung capacity.
     

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  13. BiomedO1

    BiomedO1 Senior Member

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    We had two in my old facility and they were operating all the time - when they weren't broken. If they break, Pulmonary department manger was usually crawling up our backsides for an ETA.
    I have no idea of the cost (recharge rate); but judging from management's reactions - It was a real revenue generator.
    Those units leaked all the time, so you wouldn't be able to perform necessary tests. That in conjunction with the widening of Americans, forced the emergency PO process of two, new, wider chambers - when I was leaving. I had to sign-off on the justification and projected reduction of down-time for those newer units.
    I've found what I could only describe as grease smears on the inside doors of those units on multiple occasions. Staff was claiming the unit was leaking again - all test indicated the contrary, no problem found. When I asked the operators; 'how many of you guy pushed on the door to close it on the patient? Their response was two or three of us would push on the door until we get a positive lock signal.:(:notworthy::cry: The chamber needs to be 'air-tight' to do proper measurements. The operators not realizing this made me angry and sad for the future of our society. They had a few sharp staff members, but the majority was idiots.
     
    #13 BiomedO1, Nov 11, 2024 at 12:21 PM
    Last edited: Nov 11, 2024 at 12:28 PM
  14. ETC(SS)

    ETC(SS) The OTHER One Percenter.....

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    Not after a few flights of stairs....;)

    THAT is MY 'real metric' for 02 throughput..... :)
     
  15. ChapmanF

    ChapmanF Senior Member

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    Sure, but an incentive spirometer isn't built to measure O2 throughput, but lung capacity.

    I don't think lung capacity is the first or chief limit I hit on a few flights of stairs.
     
  16. tochatihu

    tochatihu Senior Member

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    Stair climbing is seen as a good way to improve VO2 max which is the efficiency that your body uses O2 provided by lungs. It can qualify as high intensity interval training if you ride the elevator down and then resume climbing. There are many ways of course, but in a urban stetting there are usually multistory building with elevators*.

    VO2 max can be approximated

    VO2 Max Calculator | Aerobic Capacity
    What Is Aerobic Capacity? How To Measure And Improve Your Cardio Fitness - Biostrap

    (Or by smartwatches or fitbits I guess)

    Or measured in lab with the facemask, equipment, and a physical challenge.

    I do not know that pulse oximeters are used for this. They are aimed at knowing how 'oxy' one is at rest.

    *in this country law requires elevators in residential buildings above 7 stories. So there are many many topping out at 7 :)
     
  17. ChapmanF

    ChapmanF Senior Member

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    As rjparker summarized well in #3, the incentive spirometer (the name also gives it away) really exists as a way to gamify deep breathing, so that a person recovering from a procedure doesn't forget to do it, and suffer complications.

    Other devices and techniques mentioned above are useful in their own right for improving other aspects of performance.

    I just thought it was pretty clever (and I still do) how they built a device that could measure up to a four-liter volume without being nearly four liters in size, and disposable with a $10 price point.
     
  18. tochatihu

    tochatihu Senior Member

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    "with a $10 price point" That is amazing! I could apparently buy these at wholesale in China for USD$11 to $4, for 5 to 1000 units. You have an impressive supplier.
     
  19. ETC(SS)

    ETC(SS) The OTHER One Percenter.....

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    Before I was enslaved by Steve Jobs I had a $200 smart phone and a $50 fitbit.
    I was also an active military reservist who worked in an office with 3 floors and a basement.

    No elevator.
    These used to help keep me from failing my biannual physical fitness tests in my 'over 40' years.

    Cheaper than Ozempic.
    Probably safer too.
     
  20. ChapmanF

    ChapmanF Senior Member

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    Well, I relied on #3 for the $10 figure.

    I would probably need subpoena power to ever find out what was paid for the one in #1.