In a side-lying position, the weight of the abdominal contents pushes the dome of the lower diaphragm farther into the thorax than does the dome of the upper diaphragm. In clinical circumstances, lung sound intensity is often related to lung volume, and an increase in lung sound intensity on auscultation is considered indicative of lung expansion. When comparative auscultation of the chest wall is used by physical therapists to assess the adequacy of pulmonary ventilation, patient posture and regional differences in breath sound intensity can influence clinical interpretation.Īuscultation is defined as “the act of listening for sounds within the body, chiefly for ascertaining the condition of the lungs, heart, pleura, abdomen, and other organs.” 1(p139) Through auscultation, physical therapists look for signs of excessive secretions (presence of added sounds) or obtain evidence of satisfactory lung inflation (satisfactory “air entry”). There was no difference in the sound intensity recorded between the sitting and dependent side-lying postures. In side-lying positions, the upper hemithorax is “nondependent,” and the side in contact with the bed is “dependent.” Sound intensities recorded over both posterior chest walls in the sitting position were louder than those recorded over the same lung area in the nondependent side-lying position. In the side-lying positions, the sound intensity recorded from the dependent chest wall was louder than that recorded from the nondependent chest wall. In the sitting position, inspiratory sounds recorded over the left posterior chest wall were louder than those recorded on the right side. Measures included peak intensity, frequency at maximum power, and median frequency. Lung sounds electronically recorded over the posterior chest wall of subjects in sitting and side-lying positions were compared. Subjects with lung disease were excluded because pulmonary pathology is difficult to standardize. The subjects (5 male, 6 female) were young physical therapist students without pulmonary dysfunction (mean age=20.4 years, mean height=166.3 cm, mean weight=57.5 kg). This study was designed to examine whether clinical interpretation of auscultatory findings is warranted. An increase in lung sound intensity on auscultation is considered indicative of lung expansion. Physical therapists often use positioning to assist in the reexpansion of collapsed lung segments.
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