Multiplane ultrasound approach to quantify pleural effusion at the bedside.
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.


CONCLUSIONS
Using a multiplane approach increases the accuracy of lung ultrasound to measure the volume of large to small pleural effusions in critically ill patients.
Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, La Pitié-Salpêtrière Hôpital, Assistance Publique Hôpitaux de Paris, UPMC Univ Paris 06, Paris, France.
Francis
F
Remérand
Jean
J
Dellamonica
Zhang
Z
Mao
Fabio
F
Ferrari
Belaïd
B
Bouhemad
Yang
Y
Jianxin
Charlotte
C
Arbelot
Qin
Q
Lu
Carole
C
Ichaï
Jean-Jacques
JJ
Rouby
D016638:Critical Illness; D004322:Drainage; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000601:surgery; D019095:Point-of-Care Systems; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography