Intensive Care Medicine

, Volume 40, Issue 10, pp 1475–1480 | Cite as

Ultrasonographic identification and semiquantitative assessment of unloculated pleural effusions in critically ill patients by residents after a focused training

  • Emmanuelle Begot
  • Ana Grumann
  • Tiffany Duvoid
  • François Dalmay
  • Nicolas Pichon
  • Bruno François
  • Marc Clavel
  • Philippe Vignon
Original

Abstract

Purpose

Chest ultrasonography is currently a required element to achieve competence in general critical care ultrasound (GCCUS) which should be part of the training of every intensivist. We sought to assess the ability of resident novices in ultrasonography to identify and quantify unloculated pleural effusions in ICU patients after a limited training program.

Methods

A total of 147 patients (mean age, 62 ± 17 years; simplified acute physiology score II, 35 ± 15; 78 % ventilated) with a suspected pleural effusion underwent a thoracic ultrasonography performed successively by a recently trained resident novice in ultrasound and by an experienced intensivist with expertise in GCCUS, considered as reference. Ultrasonographic examinations were performed randomly and independently. In the presence of a pleural effusion, the maximal interpleural distance was measured at the thoracic base.

Results

Residents performed a mean of 15 ± 9 examinations. Agreement between residents and experienced intensivists for the diagnosis of left- and right-sided pleural effusions was good to excellent [kappa 0.74 (95 % CI 0.63–0.85) and 0.86 (95 % CI 0.78–0.94), respectively)]. Agreement for the measurement of left and right maximal interpleural distance was excellent (intraclass concordance coefficient, 0.86 [95 % CI 0.77–0.91] and 0.85 [95 % CI 0.75–0.90], respectively). Mean bias for left and right interpleural distance was −0.3 mm (95 % CI −2.4, 1.8 mm) and −1.2 mm (95 % CI −3.4, 1.1 mm), respectively.

Conclusions

After a focused training program, resident novices in ultrasound identify and quantify unloculated pleural effusions in ICU patients using chest ultrasonography with a good agreement with experts.

Keywords

Chest ultrasonography Lung ultrasonography Ultrasound Pleural effusion Training 

Notes

Acknowledgments

Philippe Vignon takes responsibility for the content of the manuscript, including the data and analysis.

Conflicts of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg and ESICM 2014

Authors and Affiliations

  • Emmanuelle Begot
    • 1
  • Ana Grumann
    • 1
  • Tiffany Duvoid
    • 1
  • François Dalmay
    • 3
  • Nicolas Pichon
    • 1
  • Bruno François
    • 1
    • 2
  • Marc Clavel
    • 1
  • Philippe Vignon
    • 1
    • 2
    • 4
  1. 1.Medical-surgical intensive care unit, Réanimation PolyvalenteCHU Dupuytren University HospitalLimogesFrance
  2. 2.Inserm, CIC1435LimogesFrance
  3. 3.Department of BiostatisticsDupuytren University HospitalLimogesFrance
  4. 4.University of LimogesLimogesFrance

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