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Research ArticleOriginal Contributions

Wheeze Detection in the Pediatric Intensive Care Unit: Comparison Among Physician, Nurses, Respiratory Therapists, and a Computerized Respiratory Sound Monitor

Parthak Prodhan, Reynaldo S Dela Rosa, Maria Shubina, Kenan E Haver, Benjamin D Matthews, Sarah Buck, Robert M Kacmarek and Natan N Noviski
Respiratory Care October 2008, 53 (10) 1304-1309;
Parthak Prodhan
Division of Pediatric Critical Care Medicine, MassGeneral Hospital Children, Harvard Medical School.
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Reynaldo S Dela Rosa
Division of Pediatric Critical Care Medicine, MassGeneral Hospital Children, Harvard Medical School.
Division of Pediatric Critical Care Medicine, University of Arkansas Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas.
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Maria Shubina
Intermediate Care Program, Children's Hospital, Harvard Medical School
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Kenan E Haver
Center for Clinical Investigation, Brigham and Women's Hospital, Harvard Medical School.
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Benjamin D Matthews
Division of Pediatric Critical Care Medicine, MassGeneral Hospital Children, Harvard Medical School.
Division of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, Indiana
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Sarah Buck
Division of Pediatric Pulmonology Division of Pediatric Critical Care Medicine, MassGeneral Hospital for Children, Harvard Medical School
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Robert M Kacmarek
Division of Respiratory Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Natan N Noviski
Division of Pediatric Pulmonology Division of Pediatric Critical Care Medicine, MassGeneral Hospital for Children, Harvard Medical School
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  • For correspondence: [email protected]
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Abstract

OBJECTIVE: To correlate wheeze detection in the pediatric intensive care unit among staff members (a physician, nurses, and respiratory therapists [RTs]) and digital recordings from a computerized respiratory sound monitor (PulmoTrack).

METHODS: We prospectively studied 11 patients in the pediatric intensive care unit. A physician, nurses, and RTs auscultated the patients and recorded their opinions about the presence of wheeze at baseline and then every hour for 6 hours. The clinician auscultated while the PulmoTrack recorded the lung sounds. The data were analyzed by a technician trained in interpretation of acoustic data and by a panel of experts blinded to the source of the recorded data, who scored all tracks for the presence or absence of wheeze. The degree of correlation among the expert panel, the staff, and the PulmoTrack was evaluated with the Kappa coefficient and McNemar's test. The determinations of the expert panel were taken as the true state (accepted standard).

RESULTS: The PulmoTrack and expert panel were in agreement on detection of wheeze during inspiration, expiration, and the whole breath cycle; in all cases the Kappa coefficients were 0.54, 0.42, and 0.50 respectively. The PulmoTrack was significantly more sensitive than the physician (P = .002), nurses (P < .001), or RTs (P .001). However, the specificity of the PulmoTrack was not significantly different from that of the physician, nurses, or RTs.

CONCLUSIONS: Between the physician, RTs, and nurses there was agreement about the presence of wheeze in critically ill patients in the pediatric intensive care unit. Compared to the objective acoustic measurements from the PulmoTrack, the intensive care unit staff was similar in their ability to detect the absence of wheeze. The PulmoTrack was better than the staff in detecting wheeze.

  • wheeze
  • computerized respiratory sound monitor
  • pulmotrack
  • pediatric intensive care unit
  • inter-rater agreement
  • auscultation

Footnotes

  • Correspondence: Natan N Noviski MD, Pediatric Intensive Care Unit, MassGeneral Hospital for Children, 175 Cambridge Street, 5th Floor, Boston MA 02114. Email: nnoviski{at}partners.org.
  • Natan N Noviski MD presented a version of this paper at the 31st Critical Care Congress of the Society of Critical Care Medicine, held January 26-30, 2002, in San Diego, California.

  • This research was supported by Karmel Medical Acoustic Technologies, Yokneam Illit, Israel. The authors report no conflicts of interest related to the content of this paper.

  • Copyright © 2008 by Daedalus Enterprises Inc.
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Respiratory Care: 53 (10)
Respiratory Care
Vol. 53, Issue 10
1 Oct 2008
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Wheeze Detection in the Pediatric Intensive Care Unit: Comparison Among Physician, Nurses, Respiratory Therapists, and a Computerized Respiratory Sound Monitor
Parthak Prodhan, Reynaldo S Dela Rosa, Maria Shubina, Kenan E Haver, Benjamin D Matthews, Sarah Buck, Robert M Kacmarek, Natan N Noviski
Respiratory Care Oct 2008, 53 (10) 1304-1309;

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Wheeze Detection in the Pediatric Intensive Care Unit: Comparison Among Physician, Nurses, Respiratory Therapists, and a Computerized Respiratory Sound Monitor
Parthak Prodhan, Reynaldo S Dela Rosa, Maria Shubina, Kenan E Haver, Benjamin D Matthews, Sarah Buck, Robert M Kacmarek, Natan N Noviski
Respiratory Care Oct 2008, 53 (10) 1304-1309;
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Keywords

  • wheeze
  • computerized respiratory sound monitor
  • pulmotrack
  • pediatric intensive care unit
  • inter-rater agreement
  • auscultation

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