The respiratory sound features of COVID-19 patients fill gaps between clinical data and screening methods

Ying hui Huang; Si jun Meng; Yi Zhang; Shui sheng Wu; Yu Zhang; Ya wei Zhang; Yi xiang Ye; Qi feng Wei; Nian gui Zhao; Jian ping Jiang; Xiao ying Ji; Chun xia Zhou; Chao Zheng; Wen Zhang; Li zhong Xie; Yong chao Hu; Jian quan He; Jian Chen; Wang yue Wang; Chang hua Zhang; Liming Cao; Wen Xu; Yunhong Lei; Zheng hua Jian; Wei ping Hu; Wen juan Qin; Wan yu Wang; Yu long He; Hang Xiao; Xiao fang Zheng; Yi Qun Hu; Wen Sheng Pan; Jian feng Cai

The respiratory sounds of 10 patients with COVID-19 infection were recorded and analyzed by electronic stethoscope in this research. Except for the two patients with poor audio quality, all other patients were found to have abnormal breath sounds, including cackles, unable to classified murmurs, abnormal vesicular breath sounds, enhanced or weakened voice resonance. Recent pathological studies indicated that the lungs of patients with COVID-19 presented different degrees of consolidation 11, 12 . The imaging examination results suggested that multiple pulmonary plaques, ground glass shadows and infiltrating shadows were the main manifestations of COVID-19 patients, and in severe cases, lung consolidation occurred 4, 13 . The auscultation results of patients with COVID-19 infected pneumonia was concordant with the pathological and imaging results, which indicated that the pulmonary signs of patients infected with COVID-19 were not specific compared with other pulmonary inflammation. However, auscultation can be used as a simple monitoring and screening method to effectively obtain the physiological and pathological information of patients, and no other clinical procedure matches auscultation, providing clinical information about the respiratory system quickly, easily, and almost universally available methods. At present, the focus of pulmonary examination is on Xray or CT. However, the development of acoustic devices may provide an indirect-contact, credible, repeatable way to monitor the patient's pulmonary lesions. With the above equipment, the physician wearing protective clothing can collect the lung sound of patient infected COVID-19 without increasing the potential infection rate of his own, and analyze the stored lung sound just as any other clinical information is measured and stored. Existing electronic stethoscopes can already be combined with remote diagnosis and treatment, and automatically detect abnormal respiratory sounds through machine learning 9 . Using this technology to screen patients infected with COVID-19 can improve the recognition rate of infected patient without bringing additional pressure on the use of medical resources. Another remarkable output is the positive auscultation results of two atypical patients and one asymptomatic patient, which are consistent with the chest CT findings of these patients. Recently, mild or asymptomatic patients with COVID-19 infections attract more attentions 14 . A report based on the passengers of Diamond Princess cruise ship indicate that 4 of the 13 evacuees were asymptomatic patients with positive nucleic acid 15 . Another study found that 56 percent infected children had mild or asymptomatic symptoms 16 . However, these patients showed no reduction in the ability to transmit the virus comparing to typical patients 17 . In the current global pandemic situation, medical resources are scarce in all countries. At present, the initial screening of suspected patients is mainly based on the exposure history of confirmed patients, and it is impossible to conduct large-scale nucleic acid testing or chest imaging screening. However, with the exponential increase of cases, the disease surveillance capacity is limited, and the epidemiological history of many populations is not clear. The accumulation of asymptomatic patients makes it even difficult to control disease. Based on the results of our case-series research, the application of auscultation with electronic stethoscope can make