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Detection of intratracheal accumulation of thick secretions by using continuous monitoring of respiratory acoustic spectrum: a preliminary analysis

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Abstract

The accumulation of tracheobronchial secretions may contribute to a deterioration in pulmonary function and its early detection is important. In this study, we analyzed the respiratory sound spectrum in patients with intratracheal secretion, and compared acoustic characteristics before and after therapeutic endotracheal suctioning. After review of anesthetic records of liver transplant recipients, we included recipients with identified intratracheal secretion during surgery. Intraoperative breath sounds recorded through esophageal stethoscope were sampled in 20 s-period before and after suctioning of secretion and analyzed using fast Fourier transform. We also analyzed normal breath sounds from recipients without any respiratory problem as control group. The maximal power (dBmMax), total power from whole frequency range of 80–500 Hz (Pt), total power of each frequency range (80–200 Hz, P80–200; 200–300 Hz, P200–300; 300–400 Hz, P300–400; 400–500 Hz, P400–500), and their ratio (P80–200/Pt, P200–300/Pt, P300–400/Pt, P400–500/Pt) were compared. Breath sounds were obtained from 20 recipients; 9 pairs of breath sound before and after suctioning of secretion and 11 normal breath sounds. Patients with intratracheal secretion showed significantly higher P80–200, P200–300, P300–400, P400–500 when compared to the those of normal control patients (P = 0.003, P = 0.002, and P = 0.009, respectively), while dBmMax did not differ. Elimination of secretions attenuated P80–200, P200–300, P300–400, and P400–500 by 22.4%, 25.7%, 48.5%, and 15.3%, respectively (P = 0.002, 0.024, 0.009, and 0.016, respectively). Identifying the presence of intratracheal secretions with power ratio at 80–200 Hz and 300–400 Hz showed the highest area under the curve of 0.955 in receiver operating characteristic curve analysis. We suggest that spectral analysis of breath sounds obtained from the esophageal stethoscope might be a useful non-invasive respiratory monitor for accumulation of intratracheal secretion. Further prospective studies to evaluate the utility of acoustic analysis in surgical patients are warranted.

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Abbreviations

FFT:

Fast Fourier transform

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Acknowledgements

We thanks to Jae-Man Kim BSc. and Young-Hen Jo MSc. for their efforts in analysis of data.

Funding

This study was supported by a grant (2017-7013) from the Asan Institute for Life Sciences, Asan Medical Center, Seoul, Korea. This research was also supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (Grant Numbers 2016M3A9E8941259 and 2019R1A2C4069504).

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea

    Young-Jin Moon, Sung-Hoon Kim & Jae-Won Kim

  2. Department of Anesthesiology, University of Virginia School of Medicine, Charlottesville, VA, USA

    Allison J. Bechtel, Robert H. Thiele & Randal S. Blank

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  1. Young-Jin Moon
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Correspondence to Sung-Hoon Kim.

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Moon, YJ., Bechtel, A.J., Kim, SH. et al. Detection of intratracheal accumulation of thick secretions by using continuous monitoring of respiratory acoustic spectrum: a preliminary analysis. J Clin Monit Comput 34, 763–770 (2020). https://doi.org/10.1007/s10877-019-00359-z

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  • DOI: https://doi.org/10.1007/s10877-019-00359-z

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