RESUMO
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 (Ï = 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.
Assuntos
Auscultação/métodos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Transtornos Respiratórios/diagnóstico , Transtornos Respiratórios/etiologia , Respiração Artificial/efeitos adversos , Mecânica Respiratória/fisiologia , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valores de Referência , Reprodutibilidade dos Testes , Transtornos Respiratórios/fisiopatologia , Testes de Função Respiratória , Sensibilidade e EspecificidadeRESUMO
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.
RESUMO 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.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Respiração Artificial/efeitos adversos , Transtornos Respiratórios/diagnóstico , Transtornos Respiratórios/etiologia , Auscultação/métodos , Mecânica Respiratória , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Valores de Referência , Transtornos Respiratórios/fisiopatologia , Testes de Função Respiratória , Variações Dependentes do Observador , Estudos Transversais , Reprodutibilidade dos Testes , Sensibilidade e EspecificidadeRESUMO
OBJECTIVE: There are few studies on chronic obstructive pulmonary disease (COPD) establishing differences between the functional parameters of the disease and sleep variables. The aim of the study was to describe the sleep pattern of these patients and to correlate spirometric, gasometric and polysomnographic variables. METHODS: Transversal study using COPD patients submitted to spirometry, arterial gasometry, and polysomnography. RESULTS: 21 male patients were studied with average age = 67 ± 9; 7 ± 4 average points in the Epworth sleepiness scale, average Tiffenau's index (FEV1/FVC) = 54 ± 13.0 percent, average PaO2 = 68 ± 11 mmHg, average PaCO2 = 37 ± 6 mmHg. Sleep efficiency decreased (65 ± 16 percent) with the reduction of slow wave sleep (8 ± 9 percent) and rapid eye movement (REM) sleep (15 ± 8 percent). Average T90 was 43 ± 41 percent. Average apnea-hypopnea index (AHI) = 3 ± 5/h, where two patients (9.5 percent) presented obstructive sleep apnea. A significant correlation was observed between PaO2 and T90 (p < 0.01), PaCO2 and T90 (p < 0.05), and AHI and the cardiac rate during REM (p < 0.01). A higher number of arousals and stage change was observed. There was no linear correlation between spirometric and polysomnographic variables. CONCLUSION: Poor sleep quality of these patients was characterized by low sleep efficiency, high number of awakenings and shift of stages. There were no correlations between the spirometric and polysomnographic variables.