1/15/2024 0 Comments Lung sounds heart failureThis study was approved by the institutional review board of Brigham and Women's/Faulkner Hospitals, and written consent was obtained from all patients or their next of kin. Specifically, then, our objectives were to determine the within-maneuver crackle variability and the influence of breathing effort and cough on the crackle pitch and crackle rate in patients with pneumonia, CHF, and IPF during a single automated-auscultation session. To examine whether these variables influence crackle pitch and crackle rate we studied automated auscultation recordings from before and after deep breathing and cough, in patients with pneumonia, CHF, and IPF, as crackles are common in those disorders. They can also be caused by secretions in the airways. Crackles can be present due to atelectasis, and deep breathing is associated with clearing of this type of crackles. If the crackle pitch or crackle rate varies greatly from breath to breath, it would be difficult to interpret this measurement as an indicator of improvement or worsening of illness. Accordingly, we are interested in how much the measurement of crackle pitch (spectral frequency) and crackle rate changes between breaths. Automated computerized crackle counting, introduced over 2 decades ago, eliminates inter-observer variability and allows longitudinal crackle monitoring, 6 which could aid in following the course of various illnesses. Unfortunately, there is substantial observer variability in auscultation findings, so auscultation has been considered unreliable. Crackles are common in patients with pneumonia and often clear when pneumonia resolves. Clinicians have long recognized that crackles often increase in number as congestive heart failure (CHF) worsens, and that crackles are more numerous in late-stage than in early-stage interstitial pulmonary fibrosis (IPF). The degree of profusion of crackles often reflects the severity of disease. 4, 6Ĭrackles are important abnormal lung sounds. Numerous studies support the hypothesis that computerized lung-sounds analysis has clinical value 1– 5 and can identify sounds as well as experienced clinicians do. Advances in acoustic technology now allow precise detection and quantification of lung sounds, so we have been studying computerized lung-sound analytic methods under the assumption that this technology can improve diagnosis and monitoring of cardiopulmonary disorders. Lung sounds detected over the chest reflect the underlying pulmonary pathophysiology. In patients with CHF the average crackle rate during normal breathing was not significantly different from that during the first deep-breathing maneuver (108%). 001) and significantly higher in the patients with IPF (147%, P <. However, during normal breathing the crackle rate was significantly lower in the patients with pneumonia (74%, P <. Similarly, the average crackle rate did not change significantly following coughing (pneumonia 105%, CHF 110%, IPF 90%) or the vital-capacity maneuver (pneumonia 102%, CHF 101%, IPF 99%). Compared to the first deep-breathing maneuver (100%), the average crackle pitch did not significantly change following coughing (pneumonia 100%, CHF 103%, IPF 100%), the vital-capacity maneuver (pneumonia 100%, CHF 92%, IPF 104%), or during quiet breathing (pneumonia 97%, CHF 100%, IPF 104%). Crackle rate variability was also small: pneumonia 31%, CHF 32%, IPF 24%. RESULTS: Crackle pitch variability, expressed as a percentage of the average crackle pitch, was small in all patients and in all maneuvers: pneumonia 11%, CHF 11%, pulmonary fibrosis 7%.
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