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



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.


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.


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.


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.


Chest ultrasonography Lung ultrasonography Ultrasound Pleural effusion Training 



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.


  1. 1.
    Nishida O, Arenallo R, Cheng DCH, DeMajo W, Kavanagh BP (1999) Gas exchange and hemodynamics in experimental pleural effusion. Crit Care Med 27:583–587PubMedCrossRefGoogle Scholar
  2. 2.
    Piccoli M, Trambaiolo P, Salustri A et al (2005) Bedside diagnosis and follow-up of patients with pleural effusion by a hand-carried ultrasound device early after cardiac surgery. Chest 128(5):3413–3420PubMedCrossRefGoogle Scholar
  3. 3.
    Kataoka H, Takada S (2000) The role of thoracic ultrasonography for evaluation of patients with decompensated chronic heart failure. J Am Coll Cardiol 35(6):1638–1646PubMedCrossRefGoogle Scholar
  4. 4.
    Vignon P, Chastagner C, Berkane V et al (2005) Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography. Crit Care Med 33(8):1757–1763PubMedCrossRefGoogle Scholar
  5. 5.
    Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ (2004) Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 100(1):9–15PubMedCrossRefGoogle Scholar
  6. 6.
    Rocco M, Carbone I, Morelli A et al (2008) Diagnostic accuracy of bedside ultrasonography in the ICU: feasibility of detecting pulmonary effusion and lung contusion in patients on respiratory support after severe blunt thoracic trauma. Acta Anaesth Scand 52:776–784PubMedCrossRefGoogle Scholar
  7. 7.
    Tayal VS, Nicks BA, Norton HJ (2006) Emergency ultrasound evaluation of symptomatic nontraumatic pleural effusions. J Emerg Med 24(7):782–786Google Scholar
  8. 8.
    Gardelli G, Feletti F, Nanni A, Mughetti M, Piraccini A, Zompatori M (2012) Chest ultrasonography in the ICU. Respir Care 57(5):773–781PubMedCrossRefGoogle Scholar
  9. 9.
    Bouhemad B, Zhang M, Lu Q, Rouby JJ (2007) Clinical review: bedside lung ultrasound in critical care practice. Crit Care 11(1):205PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Balik M, Plasil P, Waldauf P et al (2006) Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensiv Care Med 32(2):318–321CrossRefGoogle Scholar
  11. 11.
    Roch A, Bojan M, Michelet P et al (2005) Usefulness of ultrasonography in predicting pleural effusions >500 mL in patients receiving mechanical ventilation. Chest 127(1):224–232PubMedCrossRefGoogle Scholar
  12. 12.
    Remérand F, Dellamonica J, Mao Z et al (2010) Multiplane ultrasound approach to quantify pleural effusion at the bedside. Intensive Care Med 36(4):656–664PubMedCrossRefGoogle Scholar
  13. 13.
    MacLoud TC, Flower CDR (1991) Imaging the pleura: sonography, CT, and MR imaging. AJR 156:1145–1153CrossRefGoogle Scholar
  14. 14.
    Expert roundtable on ultrasound in ICU (2011) International expert statement on training standards for critical care echocardiography. Intensive Care Med 37(7):1077–1083CrossRefGoogle Scholar
  15. 15.
    Mayo P, Beaulieu Y, Doelken P et al (2009) Statement on competence in critical care ultrasonography. Chest 135(4):1050–1060PubMedCrossRefGoogle Scholar
  16. 16.
    Vignon P, Mücke F, Bellec F et al (2011) Basic critical care echocardiography: validation of a curriculum dedicated to noncardiologist residents. Crit Care Med 39(4):636–642PubMedCrossRefGoogle Scholar
  17. 17.
    Lichtenstein D, Hulot JS, Rabiller A, Tostivint I, Mezière G (1999) Feasibility and safety of ultrasound-guided thoracentesis in mechanically ventilated patients. Intensive Care Med 25(9):955–958PubMedCrossRefGoogle Scholar
  18. 18.
    Koenig SJ, Narasimhan M, Mayo PH (2011) Thoracic ultrasonography for the pulmonary specialist. Chest 140(5):1332–1341PubMedCrossRefGoogle Scholar
  19. 19.
    Volpicelli G, Elbarbary M, Lichtenstein DA et al (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591PubMedCrossRefGoogle Scholar
  20. 20.
    Bloch DA, Kraemer HC (1989) 2 x 2 kappa coefficients: measures of agreement or association. Biometrics 45(1):269–287PubMedCrossRefGoogle Scholar
  21. 21.
    Fermanian J (1984) Measurement of agreement between 2 judges. Rev Epidemiol Sante Publique 32(2):140–147PubMedGoogle Scholar
  22. 22.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 327(1):307–310CrossRefGoogle Scholar
  23. 23.
    Moore CL, Copel JA (2011) Point-of-care ultrasonography. New Engl J Med 364(8):749–757PubMedCrossRefGoogle Scholar
  24. 24.
    Volpicelli G, Lamorte A, Tullio M et al (2013) Point-of-care multiorgan ultrasonography for the evaluation of undifferentiated hypotension in the emergency department. Intensive Care Med 39:1290–1298PubMedCrossRefGoogle Scholar
  25. 25.
    Lisi M, Cameli M, Mondillo S et al (2012) Incremental value of pocket-sized imaging device for bedside diagnosis of unilateral pleural effusions and ultrasound-guided thoracentesis. Interact Cardiovasc Thorac Surg 15(4):596–602PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Mayo PH, Goltz HR, Tafreshi M, Doelken P (2004) Safety of ultrasound-guided thoracentesis in patients receiving mechanical ventilation. Chest 125(3):1059–1062PubMedCrossRefGoogle Scholar

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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