American journal of respiratory and critical care medicine
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Am. J. Respir. Crit. Care Med. · Sep 1994
Comparative StudyUse of flow-volume curves in detecting secretions in ventilator-dependent patients.
A noninvasive means of detecting airway secretions in ventilator-dependent patients is desirable because endotracheal suctioning can result in life-threatening complications. In a patient who had copious secretions, we observed a sawtooth pattern on his flow-volume curve that disappeared after suctioning. Accordingly, we systematically examined the usefulness of a sawtooth pattern on flow-volume curves in detecting secretions in ventilator-dependent patients and compared its accuracy with clinical examination. ⋯ Interobserver agreement, assessed by the kappa statistic, was excellent: 0.76, 0.76, and 0.84. In the subgroup of patients evaluated by both clinical examination and flow-volume curve analysis, clinical examination was less accurate in 11 of the 15 patients. In conclusion, detection of a sawtooth pattern strongly suggests the presence of secretions, and the absence of this pattern suggests that secretions are unlikely to be present.