Computerized Lung Acoustic Monitoring Can Help to Differentiate between Various Chest Radiographic Densities in Critically Ill Patients

Abstract

Background: Complementary bedside lung monitoring modalities are often sought in order to assist in the differentiation between several lung opacities in the intensive care unit (ICU). Objectives: To evaluate the use of computerized lung acoustic monitoring as a complementary approach in the differentiation between various chest radiographic densities in critically ill patients. Methods: Lung vibration intensity was assessed in 82 intensive care patients using vibration response imaging. Patients were classified according to their primary findings on chest radiography (CXR): consolidation (n = 35), congestion (n = 10), pleural effusion (n = 15), atelectasis/hypoinflation (n = 10) and normal findings (n = 12). Sixty patients were mechanically ventilated and 22 patients were spontaneously breathing. Results: Significantly elevated vibration intensity was detected in patients with consolidation, as opposed to pleural effusion, atelectasis and normal CXR (p < 0.01, Mann-Whitney U test). Vibration intensity was also increased for congestion, but this increase was not significant. The positive predictive value of CXR lung opacity in combination with increased vibration intensity to detect consolidations and/or congestions was 95% (20/21). Furthermore, vibration intensity was significantly higher in mechanically ventilated patients compared to spontaneously breathing patients (p = 0.001, Mann-Whitney U test). Differences related to gender, age and body position were not significant. Conclusions: Computerized lung acoustic monitoring at the bedside was found to be a useful, readily available, noninvasive, adjunctive tool in the differentiation between various CXR densities in critically ill patients.

Effects of Bronchodilators on Regional Lung Sound Distribution in Patients with Chronic Obstructive Pulmonary Disease

“…Vibration response imaging (VRI) is a commercially available acoustic lung imaging system that displays breath sound energy distribution as a dynamic grey-scale image [12,13,14,15]. VRI is a noninvasive, radiation-free technique that requires minimal patient effort and can be transported to the bedside [16,17]. We recently reported that the locations of central airway obstructions and the outcomes of procedures could be reliably identified by analyzing the specific patterns of lung images obtained with the use of VRI [18].…”

Perspectives in respiratory monitoring

“…Tout d'abord, les images obtenues sont des images planaires (comme la radiographie pulmonaire) et non des coupes tomographiques, ce qui fait que la fiabilité de cette technique risque de décroître avec l'hétérogénéité de l'atteinte respiratoire (typiquement importante au cours du SDRA). Par ailleurs, la plupart des études ayant cherché à valider cette technique dans le contexte de l'agression pulmonaire expérimentale ou chez les patients de réanimation sous ventilation mécanique ont utilisé la radiographie pulmonaire comme méthode de référence [40,41], dont les limites sont parfaitement connues [42]. Une seule étude [43] a utilisé le scanner thoracique comme référence pour identifier les phénomènes de recrutement-dérecrutement sur modèle porcin d'agression pulmonaire et a objectivé une excellente corrélation avec l'analyse fréquentielle du signal d'IRV.…”

Vibration response imaging: protocol for a systematic review

“…Furthermore, the ability of VRI to evaluate physiological changes and infer clinical response to an intervention has been explored, both in self-ventilating [10,21] and mechanically ventilated patients [16,22]. Naturally, comparisons have been made against ‘gold standard’ imaging technologies (that is, CT) in order to establish levels of sensitivity and specificity [10,15]. Reproducibility of images, intra-rater reliability and inter-rater agreement when interpreting images have also been routes of exploration [11,20].…”