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Gravity Dependence of Crackles

  • Frank DavidsonJr.
  • Raymond L. H. Murphy

Abstract

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

Keywords

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.

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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

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