The "lung pulse": an early ultrasound sign of complete atelectasis.
OBJECTIVE
Complete atelectasis can be immediately generated by selective intubation. A dynamic lung ultrasound sign can be described as the association of absent lung sliding with the perception of heart activity at the pleural line, a sign which was called "lung pulse." We examined whether this sign be used promptly to confirm complete atelectasis due to selective intubation.


METHODS
Prospective study in the medical intensive care unit of a university-affiliated teaching hospital.


METHODS
Consecutive patients with no history of respiratory disorders and needing intubation were enrolled. Fifteen patients with selective intubation of the right lung were compared with 30 patients with nonselective intubation and 15 healthy volunteers.


METHODS
The "lung pulse" was sought at the left anterolateral chest wall in intubated patients. Healthy subjects were studied during breathing and apnea.


RESULTS
A left "lung pulse" was immediately present in 14 of 15 patients with right selective intubation, and absent, with normal lung sliding, in all 30 correctly intubated patients and in all 15 healthy subjects during breathing. All healthy subjects exhibited a "lung pulse" in apnea. The "lung pulse" had a sensitivity of 93% and a specificity of 100% for the diagnosis of complete atelectasis following selective intubation in patients without previous respiratory disorders.


CONCLUSIONS
The "lung pulse" is a sign of complete atelectasis which is observable immediately before radiological changes. Its absence which is correlated with the absence of selective intubation and of conserved lung inflation can eliminate the need for confirmation radiography.
Lichtenstein
Daniel A
DA
Service de Réanimation Médicale, Hôpital Ambroise-Paré, 9 rue Charles de Gaulle, 92100, Boulogne (Paris), France.
Lascols
Nathalie
N
Service de Réanimation Médicale, Hôpital Ambroise-Paré, 9 rue Charles de Gaulle, 92100, Boulogne (Paris), France.
Prin
Sébastien
S
Service de Réanimation Médicale, Hôpital Ambroise-Paré, 9 rue Charles de Gaulle, 92100, Boulogne (Paris), France.
Mezière
Gilbert
G
Service de Réanimation Médicale, Hôpital Ambroise-Paré, 9 rue Charles de Gaulle, 92100, Boulogne (Paris), France.
D001049:Apnea / Q000000981:diagnostic imaging; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D001261:Pulmonary Atelectasis / Q000000981:diagnostic imaging*; D011859:Radiography; D014463:Ultrasonography