L’utilisation de l’échographie pulmonaire dans la prise en charge des patients de soins critiques
The field of targeted lung ultrasound in critical care is in constant expansion.  Its many proven use include pneumothorax diagnosis, differentiation of the different causes of acute dyspnoea and endotracheal intubation confirmation.  These studies on endotracheal intubation evaluated sonographers with extensive ultrasound training using sometimes lengthy exam.  Hence, with the growing presence of bedside lung ultrasound we devised a study to evaluate the capacity of a heterogeneous group of physicians, with different levels of ultrasound training, to correctly identify lung sliding on random short sequences of recorded thoracic ultrasound.  280 short ultrasound sequences (4 to 7 seconds) of present and absent lung sliding of intubated patients recorded in the operating room were randomly presented to 2 groups of physicians.  Descriptive data, mean accuracy of each participant, as well as the rate of correct answers for each of the sequences was measured and compared for different subgroups.  Participants in the second group where instructed that they could abstain from answering in uncertain cases.  Mean accuracy was 67.5% (95%CI: 65.7-69.4) in the first group and 73.1% (95%CI: 70.7-75.5) in the second (p<0.001). When considering each sequence individually, median accuracy was 74.0% (IQR: 48.0-90.0) in the first group and 83.7% (IQR: 53.3-96.2) in the second (p=0.006).  The rate of correct answer was higher for right hemithorax sequences (p=0.001). Accuracy in lung sliding identification is better when participants have the possibility to abstain themselves from answering in uncertain cases. It is also improved in the right hemithorax, probably owing to the presence of the heart and the lung pulse artefact in the left hemithorax.  Considering our results, caution should be taken when using short ultrasound sequences for identifying lung sliding as a mean of confirming endotracheal intubation, particularly in the left hemithorax.  Emphasis should also be put on knowledge and identification of the Lung pulse artefact when teaching chest ultrasound curriculum.
lung ultrasound lung sliding endotracheal intubation lung pulse artefact