title: Lung Sliding Identification Is Less Accurate in the Left Hemithorax.
abstract: OBJECTIVE
  The aim of our study was to compare the accuracy of lung sliding identification for the left and right hemithoraxes, using prerecorded short US sequences, in a group of physicians with mixed clinical and US training.
  
  
  METHODS
  A total of 140 US sequences of a complete respiratory cycle were recorded in the operating room. Each sequence was divided in two, yielding 140 sequences of present lung sliding and 140 sequences of absent lung sliding. Of these 280 sequences, 40 were randomly repeated to assess intraobserver variability, for a total of 320 sequences. Descriptive data, the mean accuracy of each participant, as well as the rate of correct answers for each of the original 280 sequences were tabulated and compared for different subgroups of clinical and US training. A video with examples of present and absent lung sliding and a lung pulse was shown before testing.
  
  
  RESULTS
  Two sessions were planned to facilitate the participation of 75 clinicians. In the first group, the rate of accurate lung sliding identification was lower in the left hemithorax than in the right (67.0% [interquartile range (IQR), 43.0-83.0] versus 80.0% [IQR, 57.0-95.0]; P < .001). In the second group, the rate of accurate lung sliding identification was also lower in the left hemithorax than in the right (76.3% [IQR, 42.9-90.9] versus 88.7% [IQR, 63.1-96.9]; P = .001). Mean accuracy rates were 67.5% (95% confidence interval, 65.7-69.4) in the first group and 73.1% (95% confidence interval, 70.7-75.5) in the second (P < .001).
  
  
  CONCLUSIONS
  Lung sliding identification seems less accurate in the left hemithorax when using a short US examination. This study was done on recorded US sequences and should be repeated in a live clinical situation to confirm our results.
authors.affiliation: Department of Emergency Medicine, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada .
authors.forename: Eric
authors.initials: E
authors.lastname: Piette
authors.affiliation: Departments of Family and Emergency Medicine, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Raoul
authors.initials: R
authors.lastname: Daoust
authors.affiliation: Preventive and Social Medicine, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Lambert
authors.affiliation: Department of Anesthesiology, Montréal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: André
authors.initials: A
authors.lastname: Denault
mesh_terms: D000368:Aged; D005260:Female; D007839:Functional Laterality; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging*; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D013909:Thorax / Q000000981:diagnostic imaging; D014463:Ultrasonography
keywords: endotracheal intubation; lung; lung sliding; point-of-care ultrasound; ultrasound