Pulmonology Tests and Procedures

OT Dude Academy’s Free NBCOT® Exam Prep Course Pulmonology Pulmonology Tests and Procedures

Bullectomy

Surgical removal of the bulla (air space in the lung). Likely caused by COPD. Other conditions include alpha-1 antitrypsin deficiency, Marfan syndrome, Ehler-Danlos syndrome, cocaine smoking, sarcoidosis, HIV infection, and intravenous drug abuse.1 

Bronchoscopy

A technique used to look at air passages and the lungs with a small camera located at the end of a flexible tube. A flexible bronchoscope is passed through the nose or mouth, down the throat, and into the lungs. Performed if there are symptoms of a persistent cough, infection, or an unusual x-ray. Can be used to obtain samples of mucus or tissue, to remove foreign bodies, and blockages, or to provide treatment for lung problems.

Chest Tube

A plastic tube is used to drain fluid (blood or pus) or air from the chest in the pleural space. May be inserted with anesthesia or with a local painkiller and sedation. Chest tubes vary in size (diameter). They are often connected to drainage systems to collect the fluid and allow are to escape from the chest. Occupational therapy practitioners working with patients who have a chest tube still connected have a risk of dislodging the chest tube, should watch for bleeding at the site of insertion, and practice infection prevention precautions.

CT Guided Lung Biopsy

If a chest x-ray is positive for lung nodules (abnormal shows), a CT scan may be performed including a biopsy of the nodule for further examination if it contains cancer. A needle is guided through the chest wall and into the lung nodule to obtain the sample. While less invasive than other procedures, there is a risk of air leaks due to the needle causing a hole in the lung. There is a chance of infection (being introduced inside the body) in the skin from a tube being inserted and a small chance of bleeding which may require a blood transfusion.

Decortication

Surgical removal of a layer of fibrous tissue of the lung, chest wall, and diaphragm to allow the lung to reexpand. Reasons include empyema (collection of pus in the pleural space), pleural thickening, hemothorax, and tumors.2 

Endobronchial Ultrasound (EBUS)

A procedure used to diagnose different types of lung disorders, infections, or cancer. A flexible tube goes through the mouth, trachea, and lungs with an EBUS scope which contains a video camera and ultrasound probe to create images of the lungs and lymph nodes. There is a small risk of bleeding from biopsy, infection after the procedure, and lung collapse.

Endodracheal Intubation

A resuscitative procedure for emergencies to secure an open airway and provide oxygen and ventilation. Involves visualization of the vocal cords with a laryngoscope and direct placement of an endotracheal tube into the trachea. Indications include altered mental status, poor ventilation, poor oxygenation, acute trauma, or a Glasgow Coma Scale of 8 or less. Complications include misplacement, cardiovascular issues, bradycardia, laceration to the oropharynx, teeth trauma, aspiration, uvular and mucosal necrosis, or tracheal rupture (rare).3 

Exhaled Nitric Oxide Level Test

Used to diagnose and manage asthma by measuring the amount of nitric oxide that is exhaled. Increased levels of nitric oxide are associated with the swelling of lung airways. This test can be used to determine how well someone is responding to asthma medications. This test is quick and safe. Some people may feel lightheaded during the test.

Lobectomy

A surgical provide where an entire lobe of the lung is removed due to cancer, infection, COPD, or benign tumors. The procedure may be minimally invasive with a few small incisions or involve a thoracotomy on the side of the chest. Lymph nodes are also removed to prevent the spread of disease or cancer. The risk of bleeding is minimal besides the risks associated with general anesthesia. There is a small chance a drainage tube is needed.

Lung Function Tests

Also called pulmonary function tests – a variety of tests to determine how well the lungs are working. The basic test is spirometry (measures the amount of air the lungs can hold and how forcefully one can empty air from the lungs). Spirometry screens for COPD and asthma. Lung volume testing is more precise than spirometry and measures the air at the end of a normal breath. A diffusing capacity test measures how easily oxygen enters the bloodstream. Exercise testing evaluates the causes of shortness of breath. Exercise testing is contraindicated for MI/CVA in the past 3 months, aneurysms, TBI, recent eye surgery, or confusion.

Lung Transplant

  1. Transplant evaluation
  2. Lung allocation score – determines the place on the United Network for Organ Sharing waiting list.
  3. Waiting list placement
  4. Transplant surgery – length and time depend if single or double lung and overall health of the patient.
  5. Life after surgery – monitoring, medications, recovery, diet, exercise, and pain management.

Exercise intolerance and impaired quality of life are characteristic of lung transplant candidates and recipients. Patients may still experience physical impairments such as limited exercise capacity and skeletal muscle weakness after transplant surgery. Patients who participate in exercise-based pulmonary rehabilitation have a higher survival rate (90% vs 60%), a shorter length of stay in the ICU and hospital, and lower requirement for invasive mechanical ventilation.4 

Lung Volume Reduction Surgery

A procedure that helps to breathe by removing areas that are affected by diseases such as COPD. Good candidates may have severe lung damage, are younger than 75 years old, have not smoked in the last 6 months, and are not able to exercise well after completing pulmonary rehabilitation. Risks include air leaks and a chest tube may be used. Some patients may require a ventilator, develop pneumonia, or have blood clots.

Methacholine Challege Test

Also known as a bronchoprovocation test – evaluates how reactive or responsive the lungs are. Evaluates symptoms of asthma. A patient inhales doses of methacholine (which narrows the airways) and breathes until a 20% drop in breathing ability is observed. Risks include bronchoconstriction, having an asthma attack, feeling dizzy, or uncomfortable.

Minimally Invasive Lung Surgery

Involves small incisions, a camera, and instruments to get the lung through in between the ribs. May be video-assisted (VATS) or robotic-assisted. Beneficial compared to open chest surgery through a thoracotomy due to faster recovery, fewer complications, shorter length of stay, less pain/medications, smaller scars, less blood loss, and no cutting of the sternum. Risks include infection, bleeding, arrhythmia, air leaking from the lungs, and pain.

Oxygen Therapy

Use of supplemental oxygen for chronic lung diseases including COPD, pulmonary fibrosis, pneumonia, asthma, cystic fibrosis, and sleep apnea. May be used at home. Provided with an oxygen cannula or face mask. Therapists and patients should observe precautions when working with oxygen and associated equipment.

Pleurodesis

A procedure that uses medicine to adhere the long to the chest wall seal up the pleural cavity and prevent fluid or air from building up. Indications include pneumothorax (lung collapse) or pleural effusion (fluid buildup). Conditions that may cause increased extra fluid collection in the pleural cavity include heart failure, pneumonia, TB, cancer, liver and kidney disease, pancreas inflammation, and rheumatoid arthritis. Symptoms include pain, coughing, and shortness of breath.5 

Pneumonectomy

An invasive procedure that involves the surgical removal of the entire lung. Indications are classified as malignant and non-malignant lung disease. Non-malignant conditions include inflammatory lung disease (likely due to infection) or blunt and penetrating lung trauma. Complications cardiac arrhythmias, cardiac herniation, pneumonia, atelectasis, respiratory failure, or injury y to other organs and major vessels. Pulmonary edema, multiorgan dysfunction, acute lung injury, acute respiratory distress syndrome (ARDS), and postoperative acute kidney injury is rare.6 

Six Minute Walk Test (6MWT)

A measure of functional status, fitness, and exercise capacity. The patient walks at a normal pace for six minutes while being monitored for responses to treatments for lung, heart, and other health problems such as pulmonary hypertension, lung disease, pre-lung transplant, or COPD. The tester observes for dyspnea or angina and has oxygen and other supplies nearby if needed.

Thoracotomy

A surgical procedure in which a cut is made between the ribs to reach the lungs and other organs in the chest. Performed on the sides of the chest via an incision for diagnosis or treatment of disease. Can be used to visualize or biopsy tissue as needed. Risks include infection, bleeding, air leakage from the lungs, and pain. Some patients may experience post-thoracotomy pain syndrome – persistent chest pain relative to nerve damage months after the procedure.

Tracheostomy

A commonly performed and simple procedure that involves surgically making a hole from the anterior of the neck to the trachea for placement of a breathing tube (trach) and improvement of breathing. Often done for critical patients. Complications include bleeding, infection, pneumothorax, or subcutaneous emphysema. Long-term complications include windpipe scarring or difficulty securing a trach tube.7 

Wedge Resection

Surgery to remove a slide of lung tissue that may be due to a tumor. 8 

References

American Lung Association. (n.d.). Lung Procedures, Tests, & Treatments. Retrieved from https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/lung-function-tests

Mayo Clinic. (n.d.). Pulmonary Medicine: Tests and procedures. Retrieved from https://www.mayoclinic.org/departments-centers/pulmonary-medicine/sections/tests-procedures/orc-20397849

  1. Gulati, N. (2020). Bullectomy: Background. Retrieved from https://emedicine.medscape.com/article/1894169-overview[↩]
  2. Kumar A, Anand S. Lung Decortication. [Updated 2021 May 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564375/[↩]
  3. Alvarado AC, Panakos P. Endotracheal Tube Intubation Techniques. [Updated 2021 Jul 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560730/[↩]
  4. Hume, E., Ward, L., Wilkinson, M., Manifield, J., Clark, S., & Vogiatzis, I. (2020). Exercise training for lung transplant candidates and recipients: a systematic review. European Respiratory Review, 29(158).[↩]
  5. Watson, S. (2018). Pleurodesis: Overview. Retrieved from https://www.healthline.com/health/pleurodesis[↩]
  6. Beshara M, Bora V. Pneumonectomy. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK555969/[↩]
  7. National Heart, Lung, and Blood Institute. (n.d.). Tracheostomy. Retrieved from https://www.nhlbi.nih.gov/health-topics/tracheostomy[↩]
  8. National Cancer Institute. (n.d.). Retrieved from https://www.cancer.gov/publications/dictionaries/cancer-terms/def/wedge-resection[↩]
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