SpiroPro Gebrauchsanweisung Instruction Manual Version 2.3 Art. No. 780987
User Manual SpiroPro®
We congratulate on your purchase of the SpiroPro®, the pocket-sized spirometer made by VIASYS. Thank you for the confidence you have placed in us and our product.
All rights reserved. No part of this manual may be reproduced by means of printing, photostatic duplication, microfilms or any other process, or indeed in part be edited, duplicated or distributed by means of electronic systems, without the prior written permission of VIASYS. The manual was comprised thoroughly; however, VIASYS does not assume liability for mistakes or omissions or for casual or consequential damages in connection with the information contained in this manual. Neither VIASYS nor its subsidiaries are responsible to the customer or third parties for damages, losses, costs or expenses caused by the customer or third parties due to accidents, misuse or unauthorized changes, repairs or innovations. VIASYS is not liable for damages or impairments resulting from the use of options or peripheral equipment from other manufacturers without the express permission of VIASYS.
Federal U.S.A. Law restricts this device to sale by or on the order of a physician.
For your Safety Danger
- SpiroPro® is not intended for being operated in potentially explosive rooms or flammable atmospheres. Flammable atmospheres can results from the use of flammable anesthetics, skin cleansers and skin disinfectants. - During on-line display a distance of 1.5 m between PC and patient has to be kept and a SpiroPro on-line adapter must be connected between the SpiroPro® and the lineoperated PC.
Warning - Avoid fluid getting into the device. If fluid gets into the device, it must only be operated again after being checked by an authorized service engineer.
Caution - SpiroPro® is a medical-electrical device which is subject to specific safety precautions as far as the EMC is concerned. Therefore, SpiroPro® has to be installed and operated according to the notes on EMC given in the Appendix of this instruction manual. - Portable and mobile HF telecommunication equipment may impair the function of SpiroPro®. - Magnetic and electric fields may impair the function of the device. When operating the device pay attention that all other devices operated in its vicinity correspond to the respective relevant EMC requirements. X-ray devices, tomographs, radio plants etc. can disturb other devices as they are allowed to generate higher electromagnetic interferences. - Only accessories recommended by VIASYS are allowed to be used. VIASYS is not responsible for the use of accessories of other manufacturers. - The operator must be familiar with the operation of the device. - Before using the device, the user has to convince himself/herself of a safe functioning and proper condition of the device. - Medical-technical equipment must only be used by personnel who ensure its proper use due to their training or knowledge and practical experience. - A qualified physician has to evaluate again all records generated by the computer. A computer interpretation should only be considered in connection with other clinical findings.
is SpiroPro ? Table of Contents What Delivery ®
SpiroPro® Before Measurement How to Operate your SpiroPro® The Main Menu Measurement Routine Enter and Check Ambient Conditions Patient Data Enter Patient Data Flow-Volume Measurement Perform Additional Trials Print Recorded Results Typical Flow-Volume Curves in Ill and Healthy Subjects Perform Dilation Measurement Print Dilation Results Interpretation Help Interpretation Help for Reversibility Tests On-line Display of Flow-Volume Curve Additional Measurement Programs Slow Vital Capacity SpO2 (Option) 6-Minute Walk Test Change Pneumotach Cleaning/Hygiene Volume Calibration Enter PT Code
Patient Data and Measured Data Appendix Load Delete Patient Data and Measured Data
Reorganize Data Base Print all Measurements of a Specific Day Overview of the Settings Menu Check Date and Time Enter Hospital and Practice Heading Change Contrast Auto Switch Off Memory Information Additional Settings Charge Battery Technical Data Item Numbers of Disposables and Accessories Safety Precautions for Lithium-Ion Batteries Warranty Declaration of Conformity Notes on EMC according to EN 60601-1-2 Literature
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The easy-to-exchange, high-quality pneumotach guarantees a high degree of patient safety and provides precise recording results.
Delivery SpiroPro® and accessories are delivered in a handy bag. Includes: 1 SpiroPro® spirometer 10 Pneumotachs with attached, disinfectable mouthpiece 2 Nose clips 1 Lithium-ion battery 3.6 V, rechargeable 1 Charging unit 1 Printer cable 1 Printer adapter 1 Instruction manual
SpiroPro® is a recording and diagnostic system for measurement, recording and assessment of the Flow-Volume curve and Flow-Volume parameters. The analyzed data can be immediately printed out or saved to the internal memory. The portable spirometer is small, easy to handle and allows determination of inspiratory and expiratory lung volumes (VCin, FVC, FEV1, MEF50, ...) including pre and post measurement with date and time display. An interpretation program automatically assesses the measured data. Optionally, the measurement of the oxygen saturation of the blood (SpO2) and the pulse rate are available and a 6minute walk test can be performed. The graphic LCD and the menu-guided graphical user interface comply with the latest technological developments. Just touch the appropriate icon with your finger to enter patient data or to select menu items (touch screen). Self-explanatory icons and the logical menu structure safely guide you through the procedure. Storage capacity is high: up to 550 measurements can be saved in the internal database. The rechargeable lithium-ion battery allows operation of the SpiroPro® for approximately two weeks. A charging unit, able to charge the battery within two hours, is included in the delivery. Patient data, recording results and graphs can be directly printed out on a PCL-compatible printer (for example HP DeskJet series). Of course, data transfer to a PC and vice versa is possible via the serial interface. The optional software package "SpiroPro® for Windows®" allows automatic transfer of data which are then saved on the PC.
What is SpiroPro® ?
Patient Pneumotach and mouthpiece
Releaser Move upwards to change the pneumotach.
LC display and touch screen
Supplementary pneumotach with mouthpiece
Connection for printer, SpO2 sensor, battery charger and transfer cable
Battery cover Pull upwards to open. Symbols:
Attention, follow instruction manual Equipment of Type BF
Before operation, the lithium-ion battery, which is included in the delivery, has to be inserted and charged. The battery was partially charged in the factory. Insert battery:
Pay attention to polarity!
Charge battery: Only use the charger included in the delivery. Connect charger to SpiroPro®. Connect the power plug to a 230 V power outlet. Make sure the power supply is set for local power requirements. Charging will take about 2 hours. Charger plug
How to Operate your SpiroPro® SpiroPro® has no mechanical switches. SpiroPro® can be switched on and operated via the touchsensitive screen (touch screen). To switch on the unit, touch the center of the display for about 3 seconds. English
The main menu appears.
Switching on, entry of patient data and selection of menu functions via the touch-sensitive screen. Note
If the unit is not in use for a certain period of time (four minutes are preset), SpiroPro® automatically switches off to save energy. The data of the current patient as well as all settings are retained in the memory.
The Main Menu Entry of patient data and load or Battery charging status delete saved patient data
Print current measurement
Select type of measurement: Flow-Volume Slow Vital Capacity SpO2 (option) 6-Minute Walk Test
A routine measurement is restricted to a few functions. 1. Check ambient conditions Check ambient conditions once a day and correct them, if necessary. 2. Enter patient data Enter the patient's personal data or load previously saved patient data from the internal data base. 3. Perform measurement, for example Flow-Volume measurement Perform the measurement. The data is automatically saved to the internal database. 4. Print out measurement After the measurement, the results can be printed out.
Enter and Check Ambient Conditions Attention
As important correction factors are calculated from ambient conditions, they should be checked at regular intervals. Incorrect or imprecise ambient conditions result in measuring errors.
in the Main Menu.
The Settings menu appears:
in the Calibration menu.
The Temperature menu is displayed. Deutsch
increases the temperature. decreases the temperature.
accepts and saves the value. ±1°C
The Humidity menu appears. increases humidity. decreases humidity. accepts and saves the value. ±5%
The Barometric Pressure menu is displayed. increases barometric pressure. decreases barometric pressure. accepts and saves the value. ±10 hPa
Returns to the Main Menu without saving the data.
Before recording starts, the patient's personal data have to be entered. Predicted values are calculated from patient data so verify that the entered data are correct. Incorrect patient data produce incorrect predicted values.
In the Main Menu press data.
to enter patient
The following menu allows you to: Enter patient data
Load patient and measuring data
Print all tests of today
Delete patient data
Revert to the Main Menu
Enter Patient Data After pressing
, the Name menu appears.
Several letters are assigned to each key. For entering the first letter, for example "A", press key once. Press twice for "B" and thrice for "C". Special characters, such as "^ -" have to be entered via the key. Note
At least two characters have to be entered.
Example of entry: An incorrect entry can be deleted character by character with the key. confirms the entry and the First name menu is loaded.
Enter the first name as described above. confirms the entry and the ID menu is displayed.
Because an ID can consist of letters and figures, you can use the key to switch to the letter entry mode.
It is mandatory to enter an unique ID. takes you back to the figure entry mode. Incorrect entries can be deleted with the key. confirms the entry and the Sex menu is displayed.
Select either male or female. Your selection is displayed in the status line. Continue with . Enter the date of birth in the following format: DD.MM.YY or MM.DD.YY according to your settings. For numbers smaller than 10, "0" has to be entered to get a two-digit format. Example: 05.12.52 Continue with . Enter height in centimeters or inches according to your settings. Continue with .
Enter weight in kilograms or pounds according to your settings. . Continue with
saves the patient data; the icon appears to directly load the Flow-Volume measurement program.
Measurements Depending on the available options, SpiroPro® allows the following measurements: Flow-Volume Slow Vital Capacity Oxygen saturation SpO2 (option) 6-Minute Walk Test
Slow Vital Capacity SpO2
Flow-Volume 6-Minute Walk Test
returns you to the Main Menu without saving the data.
Once the entries are completed, an overview of the entered data appears. Incorrect entries can be amended with the key.
A measurement is made by recording the Flow-Volume curve. All diagnostically relevant values of slow and forced inspiration and expiration can be determined.
Forced expiratory vital capacity
Forced expiratory volume after 1 second
FEV1 in % of maximal vital capacity
Maximal expiratory flow (peak flow)
Maximal expiratory flow at 25% of maximal VC
Maximal expiratory flow at 50% of maximal VC
Maximal expiratory flow at 75% of max. VC
Mean maximal expiratory flow between 25% and 75% of FVC
Maximal inspiratory flow
Forced expiratory volume after 6 seconds
FEV1%FEV6 FEV1 in % FEV6
Flow-Volume curve and parameter definition
Two recording programs are available to perform a Flow-Volume measurement: 1. Program: "Envelope" 2. Program: "ATS" When using the "Envelope" program, several breathing maneuvers can be performed during a test. When the test is completed, the program calculates the envelope from which the final recording values will be derived. Envelope
Reference: Peslin et al., American Review of Respiratory Disease, Vol. 119, 271-277; 1979
Reference: "Standardization of Spirometry 1994 Update", American Journal of Review of Respiratory and Critical Medicine, Vol. 152, 1107-1134; 1995
The "ATS" (American Thoracic Society) program calculates the best individual measurement on the basis of the highest sum of FEV1 + FVC. 76
Before starting the measurement, verify that a new or a disinfected pneumotach is used. starts the measurement.
Instruct the patient to wait and not to breathe via the pneumotach. Press . Now put a nose clip on the patient's nose and make sure his/her lips seal around the mouthpiece.
The results depend on the patient's cooperation! Explain thoroughly the breathing exercise to your patient. 1. Instruct the patient to breathe normally. 2. Then instruct the patient to expire as deeply as possible, then to inhale to maximum (IC), then to expire as fast and as far as possible (FVC, FEV1, MEF50, ...), then to inhale again as fast and as deeply as possible (IVC, PIF). The breathing maneuvers can be repeated.
Confirm with and the test will be stopped and evaluated. If more than one breathing maneuver was performed during one trial, the best maneuver will be automatically calculated and displayed. Größte Summe von: FVC + FEV1
The recording mode can be selected in the Settings menu. To go to the Settings menu, press in the Main Menu and select and in the subsequent menus. To change the recording mode, switch to the "Mode" line by pressing and select with either "Envelope curve" or "ATS" . Confirm the mode by pressing .
Results after the first trial: Type of measurement: Type of measurement: "Envelope": "ATS":
Options: Additional parameters can be displayed by touching the parameter field.
The graph can be zoomed in by touching it.
The graph can be resized by touching it again. Note: When the SpiroPro® has meanwhile switched off (i.e. it is in the energy-saving mode), switch on the device once again and select the operating mode "Measurement". Of course, the data of the current patient are retained in the memory.
Adds a further trial to the current measurement Starts a new PRE-measurement
Starts a dilatation measurement (POST-measurement)
Perform Additional Trials As the flow-volume measurement is highly dependent on patient cooperation, we recommend performing one or more additional trials.
"Envelope" set Results after the first trial:
Perform additional trial
If the results of the new trial are better (highest sum of FEV1+FVC) than those of the previously performed trial, they will be saved automatically. If the results are worse, they will be displayed but not saved. Note
Only the best trial will be saved.
"ATS" set Results after the first trial:
Perform additional trial
The best three trials will be saved! Three trials are recommended by the ATS.
Additional symbols available in ATS mode
calculates the best trial according to the formula "Highest sum of FEV1+FVC" (provided that several trials have been performed). displays ATS error message(s) in case of incorrect measurement.
shows the zoomed curve(s) as well as the parameters FEV1 and FVC of all available trials (maximally three). The "X" in the column titled "A" means that the trial is accepted according to ATS criteria.
marks the next trial.
deletes the marked trial. the best curve will be recalculated and saved automatically. Back. prints the displayed results. stops the measurement and the Main Menu appears.
If a measurement is performed and "ATS" is set, the system will automatically check whether the results are acceptable and reproducible. The results of an individual measurement are regarded to be acceptable on the basis of the following criteria: - Expiration must at least be 6 seconds and an end-expiratory plateau must be present, i.e. the recorded volume must not be higher than 30 ml during the last second, - or expiration must be longer than 15 seconds, - and back-extrapolated volume must be < 5% of FVC or 150 ml. The accepted individual trial will then be summed up (Sum Measurement). The Sum Measurement is composed of the biggest curve (highest sum of FVC+FEV1) and the highest individual values for FVC and FEV1 from all accepted individual measurements. Special case: If none of the individual measurements is accepted, the sum curve will be composed of all (not accepted) measurements (acc. to the procedure described above). Next, reproducibility is checked according to the following criteria: - Variability of FVC < 0.2 L - and variability of FEV1 < 0.2 L Reproducibility is defined as the difference between the two highest values of the respective parameter. Only accepted trials are used. If there are less than two accepted individual measurements, reproducibility will not be checked. If less than three accepted trials exist, the message insuf. # of acceptable efforts will appear.
Determination of the Best Trial acc. to ATS Criteria
Once a test has been made or a patient's recorded data have been loaded, the data can be printed out on a PCL-compatible printer, i.e., HP Deskjet series (exception: HP Deskjet 7xx). Preparation:
Print Recorded Results
Connect the cable included in the delivery to the appropriate printer port and fix it with the two clamps.
Connect the printer cable to the socket at the bottom part of the SpiroPro®.
Switch on the printer!
Printing is started by touching the
Typical Flow-Volume Curves in Healthy and Ill Subjects
no forced expiration
no maximum expiration
normal flow-volume curve
The inspiratory curve typically shows a semicircular pattern. The expiration curve shows a rapid rise in the first 10% of exhalation, reaches the peak expiratory flow (PEF) and then falls almost linearly from there to the residual volume. The flows are in the individual normal range in each case.
Normal curve and curves produced with bad cooperation
In obstructive ventilation disorder, the whole curve pattern is deformed in a typical manner. The expiratory curve has a clearly convex shape, representing the reduction of the expiratory flows over the whole exhalatory range. The degree of deformation is decisive for the severity of the disease.
Flow-Volume curve in presence of airway obstruction
The curve produced by a respiratory collapse is similar to that of an airway obstruction, it is, however, more distinctive. The kink of the Flow-Volume curve corresponds to a collapse of the central and peripheral airways. Respiratory collapse is often accompanied by a loss of alveolar surface (= emphysema).
Flow-Volume curve in presence of respiratory collapse
In restrictive ventilation disorder, the actual shape of the Flow-Volume curve is largely preserved. However, vital capacity (VC) as well as the flows (MEF) are greatly reduced.
Flow-Volume curve in case of restriction
Flow-Volume curves in case of stenoses
If an airway obstruction is detected the question as to its reversibility automatically arises (i.e. if it can be cured or not). If the parameters indicate an airway obstruction, a bronchospasmolysis test (dilation) is performed. The Flow-Volume curve shows the immediate bronchospasmolytic effect. The expiratory portion of the Flow-Volume curve and consequently, maximal peak flow (PEF), peak flows at 75, 50 and 25% of thoracic vital capacity (MEF75, MEF50, MEF25) as well as forced vital capacity (FVC) change.
Perform Dilation Measurement
Procedure 1. During the patient's visit a Flow-Volume measurement (basic measurement) is performed. If the results indicate an airway obstruction, a bronchospasmolysis test is performed. 2. The patient has to inhale a commercially available, short-term ß2 adrenergic. Onset of effect can be expected after at least 10 minutes. If a long-term ß2 adrenergic is taken, it is recommended to wait for 20 to 30 minutes before bronchospasmolysis test is performed. 3. Perform a Flow-Volume measurement after inhalational bronchospasmolysis (dilation measurement).
Perform a dilation measurement 1. Basic measurement starts the measurement. Perform the test as described before.
2. Administer bronchodilator and perform measurement. Attention Dosage has to be individually adjusted and is incumbent on the doctor. Please adhere to the manufacturers' instructions for use. The dilation measurement can be started after waiting for a period of time (for example 10 minutes) for the drug to take effect. As SpiroPro® has switched off during the waiting period (i.e. it is in the energy saving mode), switch it on again and select the operating mode "Measurement".
Start dilation measurement
Perform a Flow-Volume measurement as described above. Display after measurement: The "Act" column lists the parameters of the dilation measurement. The "%Diff" column shows the deviation of the dilation measurement as compared to the basic measurement in percent.
The graph can be zoomed in by touching it.
Values of, for example, 130% indicate that the bronchospasmolysis test improved the lung function parameters by 30%. This is called a reversible airway obstruction.
Dilation measurement Basic measurement
Display of basic results:
Print Dilation Results
Reversibility check: Not reversible or little influenceable
Each measurement is automatically interpreted according to defined criteria. The assessment, a colloquial text, is saved and output with the report. Attention
1. Interpretation is exclusively based on the best measurement. 2. An interpretation is not a diagnosis. The interpretation program is intended to support physicians in making a diagnosis, which must be based on further criteria, such as ambient conditions, x-rays etc.
Two interpretation programs are available. Select the desired program from the Settings menu (see "Additional Settings"). 1. Interpretation: "Europe": The Flow-Volume measurement is interpreted according to the following criteria: 1. 2. 3. 4. 1.
Expiratory flow limitation? Restrictive curve shape? Expiratory stenoses? Impairment of the peripheral airways?
Expiratory flow limitation? Possible causes:
increased airway resistance (for example asthma), reduced pulmonary elasticity (for example emphysema), airway obstruction
MEF50% VC pred
> 70% 50 - 70% 35 - 49% < 35% If < 70%
Normal* Slight expiratory flow limitation Moderate expiratory flow limitation Severe expiratory flow limitation Additional pulmonary function measurement recommended
Restricted curve? Possible causes: Criterion: Definition:
Reduced pulmonary volume (restriction), increased pulmonary elasticity (fibrosis) FVC act< xx% FVC pred and (VC MAX /(2 x MEF50) < 0.8) Interpretation text:
> 70% 50 - 70% < 49% If < 70%
Normal* Slightly restricted curve Moderately to severely restricted curve Additional pulmonary function measurement recommended
Expiratory stenoses? Possible causes: Criterion: Definition: < 0.8 > 0.8
Upper airway stenoses, extra-thoracic flow impairment, expiratory tracheal stenosis FVC act/PEF > 0.8 Interpretation text: Normal* Additional examination recommended to exclude extra-thoracic flow limitation and expiratory tracheal stenosis. Pay attention to patient cooperation!
Impairment of peripheral airways?
Criterion: Definition: T50% = < 0.8 sec T50% = 0.8 - 1 sec T50% = > 1 sec If > 0.8 sec
Reduced pulmonary elasticity (emphysema), ventilatory distribution disorder, peripheral airway obstruction VC MAX/(2 x MEF50) Interpretation text: Normal* Slight expiratory flow limitation during deep exhalation Moderate to severe expiratory flow limitation during deep exhalation Additional pulmonary function measurement recommended.
* If all criteria are interpreted to be "normal" the following message appears: Normal flow-volume data
2. Interpretation: "CHS" This interpretation model uses the ratio of FEV1 and FVC as the most important criteria and considers the changes of FEV1 and FVC.
XXX = Borderline, slight, moderate or severe obstruction
3. Manual Interpretation For manual interpretation, a selection of predefined interpretation texts are used. If this feature is activated, the icon appears after a F/V measurement. "Envelope" "ATS"
provides access to the predefined interpretation texts. accepts the highlighted interpretation text.
The predefined interpretation texts can be changed in the evaluation program of "SpiroPro for Windows". deletes the interpretation text. provides access to the predefined interpretation texts. the interpretation text is saved.
Interpretation Help for Reversibility Tests (for setting "Interpretation = Europe", only) The comparison of PRE and POST measurements after bronchospasmolysis is the basis of the reversibility test. The program compares VC MAX and FEV1. Interpretation is based on three criteria: 1. Completely reversible 2. Partially reversible 3. Not reversible or hardly susceptible
2. Partially reversible
Definition: The POST measurement is within the normal range.
Definition: The POST measurement improves by more than 10%.
1. Completely reversible
3. Not reversible or hardly susceptible Definition: The POST measurement improves by less than 10%. Definition of the normal range: This definition is based on the ECCS predicted values of 1993, which can be applied to patients aged between 18 and 75 years*1.
Formula Male VCin = 6.10H - 0.028A - 4.65 FVC = 5.76H - 0.026A - 4.34 FEV1 = 4.30H - 0.029A - 2.49
RSD 0.56 0.61 0.51
Female VCin = 4.66H - 0.026A - 3.28 0.42 FVC = 4.43H - 0.026A - 2.89 0.43 FEV1 = 3.95H - 0.025A - 2.60 0.38
1.64 RSD 0.92 1.00 0.84 0.69 0.71 0.62
H = Height in meters A = Age in years *1 = if the patient is aged between 18 and 25 years, an age factor of 25 has to be included in the formula A PRE-POST interpretation for patients aged <18 years is not possible!
VC MAX = Maximum Vital Capacity (VCin or FVC)
The combination of SpiroPro® and the optional evaluation program "SpiroPro for Windows" allows Flow-Volume curves measured with the SpiroPro® to be displayed on-line, i.e. in real time, on a PC monitor. Attention
As the SpiroPro® is to be connected to a PC, specific legal requirements must be met. This means that there must be a 4 KV fixed isolation between the patient breathing at the SpiroPro® and the line-operated PC. According to IEC 601-1-1 there must be a minimum distance of 1.5 m between patient and PC.
Preparing for on-line display: 1. Connect the 4KV fixed SpiroPro on-line adapter to the serial interface (COM1 or COM2) of your PC. 2. Connect the transmission cable to the SpiroPro® on-line adapter and plug the other end into the connection port of the SpiroPro®.
SpiroPro on-line adapter Transmission cable
3. Start evaluation program "SpiroPro for Windows". 4. Switch on the SpiroPro® and activate the on-line display. Press
in the Main Menu and select in the following menus.
Select the appropriate line with
activates the on-line display . accepts and saves the setting. Note
The on-line display should only be activated, if it is actually used, as otherwise the SpiroPro® always tries to setup a connection with "SpiroPro for Windows" before the measurement.
On-line Display of Flow-Volume Curve
5. Start the "Flow-Volume" measurement program. The evaluation program automatically recognizes the connected SpiroPro®. Perform a Flow-Volume measurement as described before.
There must be a distance of 1.5 meters between patient and PC.
The Flow-Volume measurement synchronous to breathing is displayed on the screen. Screen display after three trials.
All measurements are saved on the SpiroPro®; the measurements are exclusively controlled via SpiroPro®. The on-line display is exited by ending the Flow-Volume measurement and returning to the Main Menu. SpiroPro®
Additional Measurement Programs In addition to the Flow-Volume measurement program the following measurements are possible: Slow Vital Capacity Oxygen Saturation "SpO2 6-Minute Walk Test
Select in the Main Menu and the menu Select Measurmode appears from which all measurement programs are started. A measurement symbol which is not displayed means that the corresponding type of measurement is not yet activated. Activate measurement: in the Main Menu and select in the following menus.
Select the appropriate line with
sets the marked type of measurement to "YES", i.e. the measurement is activated. accepts and saves the setting.
Measurement Program "Slow Vital Capacity (SVC)" The measurement records volume versus time. All diagnostically important parameters of Slow Vital Capacity can be determined. VC
Expiratory Reserve Volume
Volume/Time curve with parameter definition
Select started. Attention
and the measurement of the Slow Vital Capacity is Before starting the test, please verify that a new or disinfected pneumotach is attached. 95