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. 2024 Jun 5;16(1):9.
doi: 10.1186/s41479-024-00131-1.

Back to the future: the novel art of digital auscultation applied in a prospective observational study of critically ill Covid-19 patients

Evangelos Kaimakamis  1 , Serafeim Kotoulas  2 , Myrto Tzimou  2 , Christos Karachristos  2 , Chrysavgi Giannaki  2 , Vassileios Kilintzis  3   4 , Leandros Stefanopoulos  3   4 , Evangelos Chatzis  3 , Nikolaos Beredimas  3 , Bruno Rocha  5 , Diogo Pessoa  5 , Rui Pedro Paiva  5 , Nicos Maglaveras  4 , Militsa Bitzani  2
Affiliations

Back to the future: the novel art of digital auscultation applied in a prospective observational study of critically ill Covid-19 patients

Evangelos Kaimakamis et al. Pneumonia (Nathan). .

Abstract

Background: The Covid-19 pandemic has caused immense pressure on Intensive Care Units (ICU). In patients with severe ARDS due to Covid-19, respiratory mechanics are important for determining the severity of lung damage. Lung auscultation could not be used during the pandemic despite its merit. The main objective of this study was to investigate associations between lung auscultatory sound features and lung mechanical properties, length of stay (LOS) and survival, in adults with severe Covid-19 ARDS.

Methods: Consecutive patients admitted to a large ICU between 2020 and 2021 (n = 173) were included. Digital stethoscopes obtained auscultatory sounds and stored them in an on-line database for replay and further processing using advanced AI techniques. Correlation and regression analysis explored relationships between digital auscultation findings and lung mechanics or the ICU outcome. The resulting annotated lung sounds database is also publicly available as supplementary material.

Results: The presence of squawks was associated with the ICU LOS, outcome and 90-day mortality. Other features (age, SOFA score & oxygenation index upon admission, minimum crackle entropy) had significant impact on outcome. Additional features affecting the 90-d survival were age and mean crackle entropy. Multivariate logistic regression showed that survival was affected by age, baseline SOFA, baseline oxygenation index and minimum crackle entropy.

Conclusions: Respiratory mechanics were associated with various adventitious sounds, whereas the lung sound analytics and the presence of certain adventitious sounds correlated with the ICU outcome and the 90-d survival. Spectral features of crackles sounds can serve as prognostic factors for survival, highlighting the importance of digital auscultation.

Keywords: ARDS; Adventitious lung sounds; ICU survival; Lung sounds database; Spectral analysis; Squawks.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Frequency spectrograms from a patient who survived (below) and from one who perished (above) 90 days after ICU admission. The red squares highlight the presence of squawks as adventitious lung sounds
Fig. 2
Fig. 2
The flowchart for patient selection in the study
Fig. 3
Fig. 3
Scatter plot showing the static compliance in relation to median crackle entropy for survivors and non-survivors in the ICU
Fig. 4
Fig. 4
Bar chart with the auscultatory sounds found in patients who survived and those who did not, 90 days later
See this image and copyright information in PMC

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