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Revista Chilena de Pediatria Aug 2020Lung auscultation is an essential part of the physical examination for diagnosing respiratory diseases. The terminology standardization for lung sounds, in addition to... (Review)
Review
Lung auscultation is an essential part of the physical examination for diagnosing respiratory diseases. The terminology standardization for lung sounds, in addition to advances in their analysis through new technologies, have improved the use of this technique. However, traditional auscultation has been questioned due to the limited concordance among health professionals. Despite the revolu tionary use of new diagnostic tools of imaging and lung function tests allowing diagnostic accuracy in respiratory diseases, no technology can replace lung auscultation to guide the diagnostic process. Lung auscultation allows identifying those patients who may benefit from a specific test. Moreover, this technique can be performed many times to make clinical decisions, and often with no need for- complicated and sometimes unavailable tests. This review describes the current state-of-the-art of lung auscultation and its efficacy based on the current respiratory sound terminology. In addition, it describes the main evidence on respiratory sound concordance studies among health professionals and its objective analysis through new technology.
Topics: Adolescent; Auscultation; Child; Child, Preschool; Clinical Decision-Making; Humans; Infant; Infant, Newborn; Observer Variation; Pediatrics; Respiratory Sounds; Terminology as Topic
PubMed: 33399725
DOI: 10.32641/rchped.v91i4.1465 -
Internal Medicine (Tokyo, Japan) Mar 2022
Topics: Exercise; Humans; Respiratory Sounds; Weight Lifting
PubMed: 34483215
DOI: 10.2169/internalmedicine.8179-21 -
Journal of Osteopathic Medicine Oct 2022
Topics: Bronchiolitis; Humans; Infant; Respiratory Sounds
PubMed: 35512006
DOI: 10.1515/jom-2022-0034 -
The European Respiratory Journal Nov 1995Wheezes are continuous adventitious lung sounds. The American Thoracic Society Committee on pulmonary nomenclature define wheezes as high-pitched continuous sounds with... (Review)
Review
Wheezes are continuous adventitious lung sounds. The American Thoracic Society Committee on pulmonary nomenclature define wheezes as high-pitched continuous sounds with a dominant frequency of 400 Hz or more. Rhonchi are characterized as low-pitched continuous sounds with a dominant frequency of about 200 Hz or less. The large variability in the predominant frequency of wheezes is one of the difficulties encountered with automated analysis and quantification of wheezes. The large variations observed in automated wheeze characterization emphasize the need for standardization of breath sound analysis. This standardization would help determine diagnostic criteria for wheeze identification. The mechanism of wheeze production was first compared to a toy trumpet whose sound is produced by a vibrating reed. The pitch of the wheeze is dependent on the mass and elasticity of the airway walls and on the flow velocity. More recently, a model of wheeze production based on the mathematical analysis of the stability of airflow through a collapsible tube has been proposed. According to this model, wheezes are produced by the fluttering of the airways walls and fluid together, induced by a critical airflow velocity. Many circumstances are suitable for the production of continuous adventitious lung sounds. Thus, wheezes can be heard in several diseases, not only asthma. Wheezes are usual clinical signs in patients with obstructive airway diseases and particularly during acute episodes of asthma. A relationship between the degree of bronchial obstruction and the presence and characteristics of wheezes has been demonstrated in several studies. The best result is observed when the degree of bronchial obstruction is compared to the proportion of the respiratory cycle occupied by wheeze (tw/ttot). However, the relationship is too scattered to predict forced expiratory volume in one second (FEV1) from wheeze duration. There is no relationship between the intensity or the pitch of wheezes and the pulmonary function. The presence or quantification of wheezes have also been evaluated for the assessment of bronchial hyperresponsiveness. Wheeze detection cannot fully replace spirometry during bronchial provocation testing but may add some interesting information. Continuous monitoring of wheezes might be a useful tool for evaluation of nocturnal asthma and its treatment.
Topics: Asthma; Auscultation; Bronchial Hyperreactivity; Bronchial Provocation Tests; Humans; Lung Diseases, Obstructive; Respiratory Sounds
PubMed: 8620967
DOI: 10.1183/09031936.95.08111942 -
Revista Chilena de Pediatria Dec 2020Stridor is an abnormal respiratory sound caused by obstruction or collapse of the laryngotracheal airway, either acutely or chronically. There are different causes, both... (Review)
Review
Stridor is an abnormal respiratory sound caused by obstruction or collapse of the laryngotracheal airway, either acutely or chronically. There are different causes, both congenital and acquired, that can produce shortness of breath which may be severe and potentially life-threatening. The clini cal diagnosis must be complemented with an endoscopic airway assessment and sometimes with imaging, to try to determine the areas involved and possible associated malformations. Treatment should be individualized, considering the patient's overall condition, stridor etiology, its impact on breathing and swallowing, prognosis, and technical capacity of the managing team, among others. Alternatives may include observation, non-pharmacological measures, local or systemic medications, endoscopic and open surgeries, or a temporary or long-term tracheostomy. A thorough understan ding of the pathophysiology and etiopathogenesis of persistent pediatric stridor is essential for the correct management of these complex patients, ideally in a multidisciplinary manner.
Topics: Airway Obstruction; Child; Endoscopy; Humans; Prognosis; Respiratory Sounds; Tracheostomy
PubMed: 33861835
DOI: 10.32641/rchped.vi91i6.2115 -
Anesthesiology Oct 2013
Topics: Humans; Infant, Premature; Inhalation; Intubation, Intratracheal; Respiratory Sounds
PubMed: 24195882
DOI: 10.1097/ALN.0b013e3182a354a8 -
American Journal of Respiratory and... Apr 2022
Topics: Asthma; Child; Humans; Respiratory Sounds
PubMed: 35196479
DOI: 10.1164/rccm.202201-0108ED -
Tidsskrift For Den Norske Laegeforening... Oct 2023
Topics: Humans; Respiratory Sounds; Goiter
PubMed: 37830973
DOI: 10.4045/tidsskr.23.0347 -
Respiratory Care Jun 2022During the coronavirus disease 2019 (COVID-19) pandemic, 60-80% of patients admitted to ICU require mechanical ventilation for respiratory distress. We aimed to compare... (Observational Study)
Observational Study
BACKGROUND
During the coronavirus disease 2019 (COVID-19) pandemic, 60-80% of patients admitted to ICU require mechanical ventilation for respiratory distress. We aimed to compare the frequency of postextubation stridor (PES) and to explore risk factors in COVID-19 subjects compared to those without COVID-19.
METHODS
We performed an observational retrospective study on subjects admitted for severe COVID-19 requiring mechanical ventilation > 48 h during the first and second waves in 2020 and compared these subjects to historical controls without COVID-19 who received mechanical ventilation > 48 h between 2016-2019. The primary outcome was the frequency of PES, defined as audible stridor within 2 h following extubation.
RESULTS
Of the 134 subjects admitted with severe COVID-19 requiring mechanical ventilation, 96 were extubated and included and compared to 211 controls. The frequency of PES was 22.9% in the COVID-19 subjects and 3.8% in the controls < .001). Factors independently associated with PES were having COVID-19 (odds ratio 3.72, [95% CI 1.24-12.14], = .02), female sex (odds ratio 5.77 [95% CI 2.30-15.64], < .001), and tube mobilization or re-intubation or prone positioning (odds ratio 3.01 [95% CI 1.04-9.44], = .047) after adjustment on Simplified Acute Physiology Score II expanded). During the first wave, PES was significantly more common in subjects with a positive SARS-CoV-2 RT-PCR test on tracheal samples on the day of extubation (73.3% vs 24.3%, = .018).
CONCLUSIONS
PES affected nearly one-quarter of subjects with COVID-19, a proportion significantly higher than that seen in controls. Independent risk factors for PES were COVID-19, female sex, and tube mobilization or re-intubation or prone positioning. PES was associated with persistent viral shedding at the time of extubation.
Topics: COVID-19; Female; Humans; Intubation, Intratracheal; Male; Respiration, Artificial; Respiratory Sounds; Retrospective Studies; Risk Factors; SARS-CoV-2; Severity of Illness Index
PubMed: 35318237
DOI: 10.4187/respcare.09527 -
Indian Journal of Pediatrics Nov 2021To evaluate various causes of pediatric stridor and their management among admitted patients in last 2 y.
OBJECTIVE
To evaluate various causes of pediatric stridor and their management among admitted patients in last 2 y.
METHODS
Retrospective study of 67 stridor cases in pediatric age group (from birth to 18 y), admitted to the Department of Pediatrics and ENT (Ear, Nose and Throat) from May 2018 to April 2020 were included in the study. Data were obtained from medical records regarding age, gender, clinical presentation, and management.
RESULTS
Out of 67 cases of pediatric stridor, 28.3% were infants, 50.7% were between 1 to 5 y, while 20.9% were between 5 to 18 y. Foreign body trachea (FB) was the most common (38.8%) cause of stridor. The commonest cause of stridor among infants was laryngomalacia (47.4%) while FB trachea (55.9%) was the commonest cause among 1 to 5 y age group. In age group between 5 to 18 y, peritonsillar abscess and bacterial tracheitis (21.4% each) were found to be the most common. Primary management with securing of airways were done in all cases. Curative treatment was provided according to the underlying pathology. Eight patients (11.9%) required tracheostomy to bypass airway obstruction. There was no mortality in the present study population.
CONCLUSION
Pediatric stridor management is a teamwork between ENT surgeons, pediatricians, and anaesthetists. Management starts with suspicion from history followed by clinical and radiological evaluation. Securing airway is of utmost importance and precise management of cause is carried out later.
Topics: Airway Obstruction; Child; Humans; Infant; Respiratory Sounds; Retrospective Studies; Tracheal Diseases; Tracheostomy
PubMed: 33728566
DOI: 10.1007/s12098-021-03722-8