Intensive Care Medicine

, Volume 36, Issue 4, pp 656–664

Multiplane ultrasound approach to quantify pleural effusion at the bedside

  • Francis Remérand
  • Jean Dellamonica
  • Zhang Mao
  • Fabio Ferrari
  • Belaïd Bouhemad
  • Yang Jianxin
  • Charlotte Arbelot
  • Qin Lu
  • Carole Ichaï
  • Jean-Jacques Rouby
Original

DOI: 10.1007/s00134-010-1769-9

Cite this article as:
Remérand, F., Dellamonica, J., Mao, Z. et al. Intensive Care Med (2010) 36: 656. doi:10.1007/s00134-010-1769-9

Abstract

Objective

To assess the accuracy of a multiplane ultrasound approach to measure pleural effusion volume (PEV), considering pleural effusion (PE) extension along the cephalocaudal axis and PE area.

Methods

Prospective study performed on 58 critically ill patients with 102 PEs. Thoracic drainage was performed in 46 patients (59 PEs) and lung computed tomography (CT) in 24 patients (43 PEs). PE was assessed using bedside lung ultrasound. Adjacent paravertebral intercostal spaces were examined, and ultrasound PEV was calculated by multiplying the paravertebral PE length by its area, measured at half the distance between the apical and caudal limits of the PE.

Results

Ultrasound PEV was compared to either the volume of the drained PE (59 PE) or PEV assessed on lung CT (43 PE). In patients with lung CT, the accuracy of this new method was compared to the accuracy of previous methods proposed for PEV measurement. Ultrasound PEV was tightly correlated with drained PEV (r = 0.84, p < 0.001) and with CT PEV (r = 0.90, p < 0.001). The mean biases between ultrasound and actual volumes of PE were −33 ml when compared to drainage (limits of agreement −292 to +227 ml) and −53 ml when compared to CT (limits of agreement −303 to +198 ml). This new method was more accurate than previous methods to measure PEV.

Conclusion

Using a multiplane approach increases the accuracy of lung ultrasound to measure the volume of large to small pleural effusions in critically ill patients.

Keywords

Pleural effusionCritical careUltrasound imagingComputed tomography scanPleural drainage

Abbreviations

CT

Computed tomography

PE

Pleural effusion

PEV

Pleural effusion volume

LUS

Pleural effusion length measured by ultrasound in paravertebral regions between apical and caudal limits

AUS

Pleural effusion cross-sectional area measured at half the distance between the apical and caudal limits

PEVUS

Pleural effusion volume measured by ultrasound and calculated as LUS × AUS

LCT

Pleural effusion length measured by computed tomography in paravertebral regions between apical and caudal limits

ACT

Pleural effusion cross-sectional area measured at the mid length of pleural effusion by computed tomography

ACTMAX

Largest pleural effusion cross-sectional area between apical and caudal limits measured by computed tomography

PEVCT

Pleural effusion volume measured by computed tomography

PEDCT

Pleural effusion depth measured at the lung base in paravertebral and juxta diaphragmatic regions by computed tomography

PEDCTMAX

The largest pleural effusion depth between apical and caudal limits measured by computed tomography

Supplementary material

134_2010_1769_MOESM1_ESM.doc (768 kb)
Supplementary material (DOC 768 kb)

Copyright information

© Copyright jointly hold by Springer and ESICM 2010

Authors and Affiliations

  • Francis Remérand
    • 1
    • 2
    • 3
  • Jean Dellamonica
    • 1
    • 4
  • Zhang Mao
    • 1
    • 5
  • Fabio Ferrari
    • 1
    • 6
  • Belaïd Bouhemad
    • 1
    • 2
  • Yang Jianxin
    • 1
    • 5
  • Charlotte Arbelot
    • 1
    • 2
  • Qin Lu
    • 1
    • 2
  • Carole Ichaï
    • 1
    • 7
  • Jean-Jacques Rouby
    • 1
    • 2
  1. 1.Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care MedicineLa Pitié-Salpêtrière Hôpital, Assistance Publique Hôpitaux de Paris, UPMC Univ Paris 06ParisFrance
  2. 2.Réanimation Polyvalente Pierre Viars, Département d’Anesthésie-RéanimationHôpital Pitié-Salpêtrière, Assistance Publique Hôpitaux de ParisParisFrance
  3. 3.Groupement d’Anesthésie RéanimationHôpital Trousseau, CHRU de ToursTours Cedex 1France
  4. 4.Réanimation MédicaleCentre Hospitalo-Universitaire de Nice, Hôpital L’ArchetNiceFrance
  5. 5.The Second Affiliated Hospital of Zhejiang UniversityHangzhouChina
  6. 6.Department of AnesthesiologyFaculdade de Medicina da Universidade Estadual Paulista Julio de Mesquita FilhoBotucatuBrazil
  7. 7.The Surgical Intensive Care Unit, Département d’Anesthésie et de RéanimationCentre Hospitalo-Universitaire de Nice, Hôpital Saint RochNiceFrance