Gravity Dependence of Crackles

  • Frank DavidsonJr.
  • Raymond L. H. Murphy


The detection of local and diffuse lung disease and the assessment of pulmonary function in the critically ill patient is usually done by radiologic and physiologic techniques. Many of these are invasive, expensive, and difficult to perform. Since the time of Laennec1 lung sounds have been recognized to show abnormalities that correlate with lung pathology. Unfortunately, observer variability and the lack of objective assessment of pulmonary sounds have prevented reliable interpretation of auscultatory changes. Recently, objective methods for recording and display of lung sounds have become available. We attempted to quantify the association between clinical and physiological measurements and breath sounds in critically ill patients using one such method, the time-expanded waveform2. Because of the severity of their disease, such patients often cannot be examined in the sitting position. As they often lie or can easily be placed in the right or left decubitus positions, we examined the behavior of breath sounds in the non-dependent and the dependent lung with the patient lying on his side. In the first patient studied, we observed, as have others3,4,5 that crackles or rales** were markedly increased toward the dependent lung whereas breath sound amplitude decreased. The striking change in the sounds with changing position was reproducible on repeated examination. For correlation of lung sounds with disease states to be accurate, the nature of magnitude of this change must be understood. It has not been well studied. Accordingly, with subjects in the lateral decubitus position, we examined the relationship of crackles and breath sound amplitude to the recording site on the chest wall in normals, and in critically and non-critically ill patients with lung disease. **which are discontinuous sounds believed to represent the opening of lung units


Lateral Decubitus Position Adult Respiratory Distress Syndrome Breath Sound Lung Sound Tidal Breathing 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    R.T.H. Laennec, De’L’auscultation mediate. II: 1, 1819 (Paris)Google Scholar
  2. 2.
    R.L.H. Murphy, S.K. Holford, W.C. Knowler, Visual lung-sound characterization by time-expanded wave-form analysis, New Eng. J. Med., 296: 968–971, 1977.CrossRefGoogle Scholar
  3. 3.
    P. Forgacs, Crackles and wheezes, Lancet 2: 203–205, 1967.CrossRefGoogle Scholar
  4. 4.
    J. Kerr, Jr., The influence of position on breath sounds, New Eng. J. Med., 245: 58–59, 1951.CrossRefGoogle Scholar
  5. 5.
    E.B. Weiss, C.J. Carlson, Recording of breath sounds, Am. Rev. Resp. Dis. 105: 835–839, 1972.Google Scholar
  6. 6.
    R.D. Adams, H.C. Pillsbury, Position and activities of diaphragm as affected by changes of posture, Arch. Int. Med. 29: 245–252, 1922.Google Scholar
  7. 7.
    T.R. Watson, M.D. Tyson, M.L. Heller, J.J. Cincotti, E.A. Gaensler, Bronchospirometry, Am. Rev. Tubercul. & Pulm Dis. 75 (5): 730–744, 1957.Google Scholar
  8. 8.
    K. Kaneko, J. Milic-Emili, M.B. Dolovich, et al, Regional distribution of ventilation and perfusion as a functional body position, J. Appl. Physiol. 21: 767, 1966.Google Scholar
  9. 9.
    J.C. Chevrolet, J.G. Martin, R. Flood, et al, Topographical ventilation and perfusion distribution during IPPB in the lateral posture. Am. Rev. Resp. Dis. 118: 847, 1978.Google Scholar
  10. 10.
    Y. Ploy-Song-Sang, P.T. Macklem, W.R.D. Ross, Distribution of regional ventilation measured by breath sounds. Am. Rev. Resp. Dis. 118: 657–664, 1978.Google Scholar
  11. 11.
    J.B. West, Pulmonary Pathophysiology - The essentials, Williams & Wilkins, Co., Baltimore, MD, 1977.Google Scholar

Copyright information

© Plenum Press, New York 1983

Authors and Affiliations

  • Frank DavidsonJr.
    • 1
  • Raymond L. H. Murphy
    • 1
  1. 1.The Pulmonary ServiceFaulkner and Lemuel Shattuck HospitalsBostonUSA

Personalised recommendations