Evaluación de la enseñanza en técnica auscultatoria de estudiantes de posgrado de medicina y su correlación con los hallazgos de mecánica respiratoria

Introduction

The invention of the stethoscope allowed the incorporation of lung auscultation into the physical examination and into medical education. Its performance in critically ill patients and its correlation with mechanical ventilatory parameters is uncertain.

Objective

To explore whether the retraining of clinical postgraduate students in pulmonary auscultation improves performance and correlation indices with parameters of ventilatory mechanics.

Materials and methods

Diagnostic test evaluation study was performed in an Intensive Care Unit in Medellín, from March to August 2022. Intubated patients, on mechanical ventilation and with a RASS score ≥−3 were included.

Clinical postgraduate students underwent a pedagogical intervention on the semiology of lung auscultation. Patients were auscultated with a Littman® Classic II stethoscope before and after the intervention. Findings of abnormal respiratory sounds were noted according to the nomenclature of the international association. Simultaneously, an evaluation of ventilatory mechanics was performed. The kappa concordance index was used. A value of P<.05 (95% CI) was considered significant.

Results

Fifty-three patients were analyzed. Abnormal lung auscultation was reported in 38% of the patients before the intervention and in 43% after it. A concordance of 94% and a kappa coefficient of 0.88 (P<.001) were found. When comparing the clinical findings with the parameters of ventilatory mechanics, a sensitivity of 55% and a specificity of 65% were found with an LR⁺ 1.54 and LR⁻ 0.7.

Conclusions

Lung auscultation continues to be part of the physical examination despite its low sensitivity and diagnostic specificity, especially in critically ill patients. Lung auscultation retraining has little impact on physical examination in the intubated patient. The correlation of these findings with ventilatory mechanics is poor and requires its concomitant use with other diagnostic methods.