Accuracy of Chest Auscultation in Detecting Abnormal Respiratory Mechanics in the Immediate Postoperative Period After Cardiac Surgery

Overview

Journal J Bras Pneumol

Specialty Pulmonary Medicine

Date 2019 Aug 1

PMID 31365614

Citations 1

Authors

Glaciele Xavier

Cesar Augusto Melo-Silva

Carlos Eduardo Ventura Gaio Dos Santos

Veronica Moreira Amado

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial.

Boden I, Reeve J, Robertson I, Browning L, Skinner E, Anderson L Perioper Med (Lond). 2021; 10(1):36.

PMID: 34689825 PMC: 8543902. DOI: 10.1186/s13741-021-00206-3.

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