Surgeon-performed ultrasound in the critical care setting: its use as an extension of the physical examination to detect pleural effusion.
BACKGROUND
Critically ill surgical patients are often difficult to assess for complications because of their altered sensorium, multiple monitoring devices, and immobility. Surgeon-performed ultrasound may enhance the physical examination of these patients and provide for an early detection of select complications. We hypothesized that a focused thoracic ultrasound examination could reliably detect a pleural effusion and the results could be used in the decision matrix for patient care.


METHODS
Serial focused thoracic ultrasound examinations were performed by a surgeon and a medical student on critically ill patients. The medical student learned select facets of the physical examination and then demonstrated how ultrasound imaging could enhance these findings. Ultrasound images were recorded on hard copy and videotape, with the results available to the surgical intensive care unit and surgery teams. The images were reviewed and compared with the chest radiograph readings.


RESULTS
Forty-seven patients underwent 140 ultrasound examinations. There were 85 true-negative, 46 true-positive, 9 false-negative, and zero false-positive examination results, yielding an 83.6% sensitivity, 100% specificity, and 94% accuracy. Of the 46 true-positive results, thoracentesis was performed or a thoracostomy tube was placed in 5 patients. Nine false-negative ultrasound examinations occurred in six patients, five of whom had their effusions detected on computed tomographic scans.


CONCLUSIONS
A focused thoracic ultrasound examination reliably detects pleural effusions in critically ill patients, and the results can be used successfully in the decision matrix for patient care.
Rozycki
G S
GS
Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia 30303, USA.
Pennington
S D
SD
Feliciano
D V
DV
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness; D003663:Decision Trees; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D013502:General Surgery / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications; D018579:Patient Selection; D010808:Physical Examination / Q000379:methods*; D010819:Physician's Role; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods / Q000592:standards