title: Ultrasonographic identification and semiquantitative assessment of unloculated pleural effusions in critically ill patients by residents after a focused training.
abstract: OBJECTIVE
  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.
authors.affiliation: Medical-surgical intensive care unit, Réanimation Polyvalente, CHU Dupuytren University Hospital, 2 Ave. Martin Luther King, 87042, Limoges, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Begot
authors.forename: Ana
authors.initials: A
authors.lastname: Grumann
authors.forename: Tiffany
authors.initials: T
authors.lastname: Duvoid
authors.forename: François
authors.initials: F
authors.lastname: Dalmay
authors.forename: Nicolas
authors.initials: N
authors.lastname: Pichon
authors.forename: Bruno
authors.initials: B
authors.lastname: François
authors.forename: Marc
authors.initials: M
authors.lastname: Clavel
authors.forename: Philippe
authors.initials: P
authors.lastname: Vignon
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007318:Inservice Training / Q000379:methods; D007362:Intensive Care Units; D007396:Internship and Residency / Q000592:standards*; D008168:Lung / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000000981:diagnostic imaging*; D019095:Point-of-Care Systems; D013909:Thorax / Q000000981:diagnostic imaging; D014463:Ultrasonography