Dynamic Visualization of Breath Sound Distribution in Suspected Foreign Body Aspiration

Bentur, Lea; Livnat, Galit; Husein, D.; Pollack, Shirley; Rotschild, Moshe

doi:10.1097/lbr.0b013e3180959ad8

Cited by 17 publications

(11 citation statements)

References 17 publications

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“…Although pilot data are already available in the fields of obstructive airways disease and alveolar diseases [7,9,10,11], this study was not designed to evaluate this issue. There remain concerns that the diagnosis of other conditions using VRI may not be as intuitive as pleural effusions.…”

Section: Discussionmentioning

confidence: 99%

“…Lung vibration energy is presented on the screen in various gray shades from black in maximum energy areas to white in zero energy areas. Pilot data suggest that VRI can distinguish breath sounds in normal patients from those with intrathoracic pathology based on distinctive patterns of vibration energy [9,10,11]. Reproducibility of VRI recordings and consistency of interobserver interpretation have also been documented [12].…”

Section: Introductionmentioning

confidence: 99%

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Vibration Response Imaging in the Detection of Pleural Effusions: A Feasibility Study

Anantham

Herth²,

Majid

et al. 2008

Respiration

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Background: Computerized analysis of the regional distribution of breath sound intensity during respiration has generated interest as a possible diagnostic modality. Objectives: We hypothesized that pleural effusions would create a dependent region of absent breath sounds and thus vibration response imaging (VRI) could be used in the detection of such pleural effusions. Methods: A prospective, single-blinded and open-labeled trial was carried out, and VRI recordings were compared to upright chest X-rays, bedside ultrasound examinations and volume of fluid drained via thoracentesis. VRI images were interpreted by a physician who was blinded to the patients’ clinical history, physical examination and diagnostic tests. Quantitative assessment of pleural effusion size in the VRI images was performed by ImageJ software and an automatic pixel count analysis. Results: VRI recordings were performed on 57 consecutive patients and correctly predicted the diagnosis in 45 cases (45/56, 80%) as compared to chest X-rays. The calculated sensitivity, specificity, positive predictive value and negative predictive value for diagnosis of pleural effusion were 86% (62/72), 93% (37/40), 95% (62/65) and 79% (37/47), respectively, in a per-hemithorax analysis. In the quantification of effusion size, there were high correlations between VRI images and chest X-ray area as assessed by ImageJ (r = 0.67) and pixel count (r = –0.77). The level of agreement between VRI readings and ultrasonography was 75% (41/55), and correlation with the volume of fluid drained in therapeutic thoracentesis was moderate (r = –0.49). No side effects from the VRI recordings were documented. Conclusions: VRI can be used to detect and quantify pleural effusions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vibration Response Imaging in the Detection of Pleural Effusions: A Feasibility Study

Anantham

Herth²,

Majid

et al. 2008

Respiration

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“…Vibration response imaging technology has recently been approved by the U.S. Food and Drug Administration for monitoring and recording lung sounds, and by the European regulatory authority; but, as with any new technology, time and experience are required to determine the eventual "real-world" clinical applications of this technology. [14][15][16][17][18] In conclusion, this case report demonstrates the VRI patterns associated with inadvertent esophageal intubation. The VRI image allows rapid visualization of vibrations derived from altered airflow patterns, which could provide additional information to assist in the differentiation of endotracheal vs endobronchial or esophageal positioning of the endotracheal tube.…”

Section: Discussionmentioning

confidence: 99%

Case report: Vibration response imaging findings following inadvertent esophageal intubation

Cinel

Smith

Tay

et al. 2008

Can J Anesth/J Can Anesth

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Purpose:We describe the effect that inadvertent esophageal intubation has on the images and on the vibration distribution of vibration response imaging (VRI). Clinical features:Vibration response imaging (VRI) is a novel, non-invasive, computer-based technology that measures vibration energy of lung sounds during respiration and displays regional intensity, in both visual and graphic format. Vibration response images, obtained prior to tracheal intubation (spontaneous breathing) and during endotracheal ventilation using a controlled mode, resulted in evenly distributed vibrations throughout the patient's lungs. During inadvertent esophageal ventilation, however, the majority of vibrations were detected in the upper regions of the image, compared to those of the lower (60% vs 8%, respectively). During spontaneous breathing and endotracheal ventilation, the midclavicular column of sensors, located over the centre of each lung, detected more vibrations compared to either the medial or the axillary column of sensors. During inadvertent esophageal ventilation, more vibrations were detected by the medial column of sensors (nearest to the midline/esophagus); and fewer were detected by the sensors that were positioned more laterally. Conclusion: This report illustrates the potential for a visual image of distribution of lung vibration energy to differentiate endotracheal intubation from inadvertent esophageal intubation. Éléments cliniques : L'imagerie par réponse vibratoire (VRI) est une nouvelle technologie informatique non invasive qui mesure l'énergie de vibration des sons pulmonaires pendant la respiration et affiche l'intensité régionale en format visuel et graphique. Les images de réponse vibratoire obtenues avant l'intubation trachéale (respiration spontanée) et pendant la ventilation endotrachéale à l'aide d'un mode contrôlé ont eu pour résultat des vibrations uni-

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“…These distinct breath sound features are considerably different from those of patients with lung diseases such as pneumonia, pleural effusion [25], COPD and asthma [26]. As was previously demonstrated in patients with obstruction due to foreign-body aspiration [27], we proposed that distinct features in VRI images could be used to identify central airway stenosis and to evaluate treatment outcome in these subjects. Although a sensitive method might not be considered necessary to locate a stenosis since bronchoscopy is utilized for both the diagnosis and treatment of airway disorders as well as for immediate treatment outcome assessment, a comparatively simple method may be useful for surgical planning.…”

Section: Introductionmentioning

confidence: 92%

“…They comprise, among others, functional and organic obstruction of the airways, structural pulmonary changes and infiltrates as well as pleural effusion. Recent VRI studies include evaluation and reproducibility of recordings in healthy individuals [23, 24];correlation with graft function in lung transplant patients [30];evaluation of foreign body aspiration in pediatric patients [27];effect of ventilator mode on VRI images in patients under mechanical ventilation [29];differences in lung sound timing in asthmatic and healthy individuals [26], and differentiation between healthy subjects and patients with pleural effusion or pneumonia [25]. …”

Section: Methodsmentioning

confidence: 99%

Vibration Response Imaging as a New Tool for Interventional-Bronchoscopy Outcome Assessment: A Prospective Pilot Study

Becker

Slawik²,

Miyazawa³

et al. 2008

Respiration

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Background: In many patients, the benefit of interventional bronchoscopy cannot be appropriately objectified. Objectives: We investigated a new technique, vibration response imaging (VRI), for breathing sound mapping to determine whether it could provide additional, valuable objective qualitative and quantitative information in central airway obstruction (CAO) and patient outcome following interventional bronchoscopy. Methods: VRI images from 83 patients with suspected central airway stenosis and 25 healthy volunteers were evaluated by two raters blinded to the subjects’ status. Qualitative and quantitative dynamic and static features were documented for the final assessment of images as normal or abnormal and changes after the intervention. As a secondary goal, stenosis location was also evaluated and compared to bronchoscopic findings. Treatment outcome analysis (improved vs. not improved) was performed by comparing baseline and follow-up images in 64 evaluations of interventional bronchoscopy. VRI measurements of treatment outcome were compared to standard tests, i.e. dyspnea score, pulmonary function testing (PFT, i.e. FEV₁, FVC and FEV₁/FVC), chest X-ray/computed tomography and bronchoscopy, the latter being considered the gold standard). Results: There was 95% (115/121) agreement between raters and clinical assessment in distinguishing between normal and abnormal images. The sensitivity and specificity of VRI were 97 and 88%, respectively. The accuracy of VRI in locating the pathology compared to bronchoscopy was 85% (17/20) for tracheal and 88% (51/58) for bronchial obstruction; overall accuracy was 83%. Correct detection of the affected side in bronchial obstructions was 88%. The overall accuracy of VRI in defining the outcome of interventional bronchoscopy was 84%. Conclusions: Obstruction location and procedure outcome were reliably identified according to specific patterns of lung images. VRI proved at least as good as standard tests in locating CAO and has the potential for becoming a valuable complementary tool in evaluating treatment outcome in patients with CAO. If our results are confirmed by further studies, VRI may replace PFT or imaging procedures in cases in which such tests cannot be performed or are not readily available at the time of the intervention.

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Dynamic Visualization of Breath Sound Distribution in Suspected Foreign Body Aspiration

Cited by 17 publications

References 17 publications

Vibration Response Imaging in the Detection of Pleural Effusions: A Feasibility Study

Vibration Response Imaging in the Detection of Pleural Effusions: A Feasibility Study

Case report: Vibration response imaging findings following inadvertent esophageal intubation

Vibration Response Imaging as a New Tool for Interventional-Bronchoscopy Outcome Assessment: A Prospective Pilot Study

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