Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul 29;45(5):e20180032.
doi: 10.1590/1806-3713/e20180032.

Accuracy of chest auscultation in detecting abnormal respiratory mechanics in the immediate postoperative period after cardiac surgery

[Article in English, Portuguese]
Glaciele Xavier  1   2 , César Augusto Melo-Silva  1   3 , Carlos Eduardo Ventura Gaio Dos Santos  1   4 , Veronica Moreira Amado  1   4
Affiliations

Accuracy of chest auscultation in detecting abnormal respiratory mechanics in the immediate postoperative period after cardiac surgery

[Article in English, Portuguese]
Glaciele Xavier et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objective: To investigate the accuracy of chest auscultation in detecting abnormal respiratory mechanics.

Methods: We evaluated 200 mechanically ventilated patients in the immediate postoperative period after cardiac surgery. We assessed respiratory system mechanics - static compliance of the respiratory system (Cst,rs) and respiratory system resistance (R,rs) - after which two independent examiners, blinded to the respiratory system mechanics data, performed chest auscultation.

Results: Neither decreased/abolished breath sounds nor crackles were associated with decreased Cst,rs (≤ 60 mL/cmH2O), regardless of the examiner. The overall accuracy of chest auscultation was 34.0% and 42.0% for examiners A and B, respectively. The sensitivity and specificity of chest auscultation for detecting decreased/abolished breath sounds or crackles were 25.1% and 68.3%, respectively, for examiner A, versus 36.4% and 63.4%, respectively, for examiner B. Based on the judgments made by examiner A, there was a weak association between increased R,rs (≥ 15 cmH2O/L/s) and rhonchi or wheezing (ϕ = 0.31, p < 0.01). The overall accuracy for detecting rhonchi or wheezing was 89.5% and 85.0% for examiners A and B, respectively. The sensitivity and specificity for detecting rhonchi or wheezing were 30.0% and 96.1%, respectively, for examiner A, versus 10.0% and 93.3%, respectively, for examiner B.

Conclusions: Chest auscultation does not appear to be an accurate diagnostic method for detecting abnormal respiratory mechanics in mechanically ventilated patients in the immediate postoperative period after cardiac surgery.

Objetivo:: Investigar a acurácia da ausculta torácica na detecção de mecânica respiratória anormal.

Métodos:: Foram avaliados 200 pacientes sob ventilação mecânica no pós-operatório imediato de cirurgia cardíaca. Foi avaliada a mecânica do sistema respiratório - complacência estática do sistema respiratório (Cest,sr) e resistência do sistema respiratório (R,sr) - e, em seguida, dois examinadores independentes, que desconheciam os dados referentes à mecânica do sistema respiratório, realizaram a ausculta torácica.

Resultados:: Nem murmúrio vesicular diminuído/abolido nem crepitações foram associados à Cest,sr reduzida (≤ 60 ml/cmH2O), independentemente do examinador. A acurácia global da ausculta torácica foi de 34,0% e 42,0% para os examinadores A e B, respectivamente. A sensibilidade e a especificidade da ausculta torácica para a detecção de murmúrio vesicular diminuído/abolido e/ou crepitações foi de 25,1% e 68,3%, respectivamente, para o examinador A, versus 36,4% e 63,4%, respectivamente, para o examinador B. Com base nos julgamentos feitos pelo examinador A, houve uma fraca associação entre R,sr aumentada (≥ 15 cmH2O/l/s) e roncos e/ou sibilos (ϕ = 0,31, p < 0,01). A acurácia global para a detecção de roncos e/ou sibilos foi de 89,5% e 85,0% para os examinadores A e B, respectivamente. A sensibilidade e a especificidade para a detecção de roncos e/ou sibilos foi de 30,0% e 96,1%, respectivamente, para o examinador A, versus 10,0% e 93,3%, respectivamente, para o examinador B.

Conclusões:: A ausculta torácica não parece ser um método diagnóstico acurado para a detecção de mecânica respiratória anormal em pacientes sob ventilação mecânica no pós-operatório imediato de cirurgia cardíaca.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Study design. Cst,rs: static compliance of the respiratory system; and R,rs: respiratory system resistance.
Figure 2
Figure 2. A and B: static compliance of the respiratory system (Cst,rs); C and D: respiratory system resistance (R,rs). Open circles represent individual values of Cst,rs and R,rs; open diamonds represent individual values of Cst,rs and R,rs when examiners classified chest auscultation as normal; open triangles represent individual values of Cst,rs and R,rs when examiners classified chest auscultation as abnormal; dotted horizontal lines mark the cut-off values for Cst,rs (≥ 60 mL/cmH2O) and R,rs (≤ 15 cmH2O/L/s); and solid horizontal lines are the mean Cst,rs and R,rs values for each chest auscultation classification.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Bohadana A, Izbicki G, Kraman SS. Fundamentals of lung auscultation. N Engl J Med. 2014;370(8):744–751. doi: 10.1056/NEJMra1302901. - DOI - PubMed
    1. Sarkar M, Madabhavi I, Niranjan N, Dogra M. Auscultation of the respiratory system. Ann Thorac Med. 2015;10(3):158–168. doi: 10.4103/1817-1737.160831. - DOI - PMC - PubMed
    1. Xavier GN, Duarte AC, Melo-Silva CA, dos Santos CE, Amado VM. Accuracy of pulmonary auscultation to detect abnormal respiratory mechanics a cross-sectional diagnostic study. Med Hypotheses. 2014;83(6):733–734. doi: 10.1016/j.mehy.2014.09.029. - DOI - PubMed
    1. Oliveira A, Marques A. Respiratory sounds in healthy people a systematic review. Respir Med. 2014;108(4):550–570. doi: 10.1016/j.rmed.2014.01.004. - DOI - PubMed
    1. Staszko KF, Lincho C, Engelke Vda C, Fiori NS, Silva KC, Nunes EI. Pulmonary auscultation terminology employed in Brazilian medical journals between January of 1980 and December of 2003. J Bras Pneumol. 2006;32(5):400–404. doi: 10.1590/S1806-37132006000500005. - DOI - PubMed