"GURGLING" BREATH SOUNDS MAY PREDICT HOSPITAL-ACQUIRED PNEUMONIA.
Chest. 2010 Mar 26;
Authors: Vazquez R, Gheorghe C, Ramos F, Dadu R, Amoateng-Adjepong Y, Manthous CA
ABSTRACTHypothesis: Gurgling sounds heard during speech or quiet breathing, with or without a stethoscope over the glottis, predict hospital- acquired pneumonia (HAP). SETTING: Medical wards of a 350-bed community teaching hospital. METHODS: All patients admitted to a respiratory and general medicine ward were eligible. Patients were examined each day and those who had upper airway gurgling, heard with or without the stethoscope, during breathing or speech at any point during admission, were termed "gurglers." Assuming an overall incidence of HAP of 5-10% and estimated incidence of 30-50% in gurglers, twenty gurglers and 60 non-gurglers, matched on the same day and ward of admission, were included in the study. Demographic, physiologic and outcome variables were compared using univariate and multivariate techniques to ascertain whether gurgling is independently associated with HAP, rate of transfer to intensive care (ICU) and in-hospital mortality. RESULTS: Twenty gurglers were compared with 60 non-gurglers. Gurglers were older (78.5 vs. 65.2 y, p<0.001), more likely to reside in nursing homes (75% vs. 6%; p<0.001) and were more likely to have dementia (70% vs. 13%; p<0.001). In multivariate analysis, dementia (odds ratio=23.4; 95%CI=4.2-131.9) and recent (within 24 hours) treatment with opiates (odds ratio=14.7; 95%CI=2.2-97.5) emerged as the only statistically significant independent predictors of gurgling. HAP occurred in 55% of gurglers compared to 1.7% of non-gurglers (p<0.001) and 50% of the gurglers vs. 3.3% of the non-gurglers required transfer to ICU (p<0.001). After adjustment for age, Charlson score, dementia, opiate administration and stroke, gurgling emerged as the sole independent predictor of HAP (odds ratio=140.1; 95%CI=5.6-3529.4) and ICU transfer (odds ratio=35.1; 95%CI=4.1-303.7). Gurgling did not predict mortality; the Charlson comorbidity index was the only significant predictor of in-hospital death. CONCLUSIONS: Gurgling sounds heard during quiet breathing or speech are independently associated with HAP.
PMID: 20348197 [PubMed - as supplied by publisher]