La tunisie Medicale - 2022 ; Vol 100 ( n°08 ) : 642-646
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Summary

Introduction: Lung ultrasound (LUS) has been recommended by the British Thoracic Society as a standard of care before performing pleural procedures since 2010. Indeed, the choice of the puncture site based only on physical examination and chest x-ray can lead to complications.
The aim of this study was to compare the accuracy of pleural puncture sites using LUS as opposed to clinical examination.
Methods: An evaluative prospective study including 43 patients hospitalized in the pneumology department at the Military Hospital of Tunis was conducted between January and November 2021.Pleural puncture sites were proposed by two groups involving ‘senior’ and ‘junior’ physicians, classified according to their experience and grades, based on the clinical examination and the chest x-ray findings. The accuracy of the proposed sites was then verified by an ultrasound-qualified “expert” using LUS.
Results. The mean age was 60 ± 17 years. LUS revealed the presence of pleural effusion in 88% of the cases (n=38). Differential diagnosis was therefore excluded in 12% of the cases (n=5), including pleural thickening (5%, n=2) and atelectasis (7%, n=3). Compared to LUS, clinical examination and chest x-ray had lower sensitivities, estimated at 74% and 83%, respectively. The clinical identification error rate was significantly higher in junior (77%) compared to senior physicians (49%) (p<0.05). LUS prevented possible accidental organ puncture in 36% of the cases (n=31). The risk factors associated with inaccurate clinical site selection included right-sided effusion and minimal pleural effusion on chest radiography, with an estimated relative risk (RR) of 1.44 [CI95%:0.56-3.72] and 1.82 [CI95%:0.52-6.40], respectively. The experience of the senior physicians influenced the choice of the clinical sites with moderate agreement (Kappa index: 0.4-0.6).
Conclusion. Compared to the ACPA- group, the ACPA+ one had more lung-hyperinflation and OVI, and comparative percentages of RVI, MVI, and NSVI.
Conclusion:LUS significantly improves the accuracy of pleural puncture sites, thus minimizing the risk of complications regardless of the operator’s level of clinical experience

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Reference
  1. Dietrich CF, Mathis G, Cui X-W, Ignee A, Hocke M, Hirche TO. Ultrasound of the pleurae and lungs. Ultrasound Med Biol. 2015;41(2):351‑65.
  2. Dietrich CF, Hirche T, Schreiber D, Wagner T. Ultrasonography of pleura and lung. Ultraschall in Med. 2003;24(05):303‑11.
  3. Lichtenstein DA. General ultrasound in the critically ill. Berlin: Springer; 2005.
  4. Bloom BA, Gibbons RC. Focused assessment with sonography for trauma. 2022 May 8. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
  5. Havelock T, Teoh R, Laws D, Gleeson F, on behalf of the BTS pleural disease guideline group. Pleural procedures and thoracic ultrasound: British Thoracic Society pleural disease guideline 2010. Thorax. 2010;65(Suppl 2):i61‑76.
  6. Maskell N, on behalf of the British Thoracic Society pleural disease guideline group. British Thoracic Society pleural disease guidelines - 2010 update. Thorax. 2010;65(8):667‑9.
  7. The INEAS guides means of protection around the patient suspected of or suffering from COVID-19 [Online]. 2020. Available : https://www. ineas.tn/fr/actualite/synthese-du-guide-parcours-du-patient-suspectou-confirme-de-la-covid-19- version-novembre.
  8. Pourhoseingholi MA, Vahedi M, Rahimzadeh M. Sample size calculation in medical studies. Gastroenterol Hepatol Bed Bench. 2013;6(1):14‑7.
  9. Puchalski JT, Argento AC, Murphy TE, Araujo KLB, Pisani MA. The safety of thoracentesis in patients with uncorrected bleeding risk. Annals ATS. 2013;10(4):336‑41.
  10. Craig Blackmore C, Black WC, Dallas RV, Crow HC. Pleural fluid volume estimation: A chest radiograph prediction rule. Acad Radiol. 1996;3(2):103‑9.
  11. Diacon AH, Brutsche MH, Solèr M. Accuracy of pleural puncture sites. Chest. 2003;123(2):436‑41.
  12. Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby J-J. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology. 2004;100(1):9‑15.
  13. Xirouchaki N, Magkanas E, Vaporidi K, Kondili E, Plataki M, Patrianakos A, et al. Lung ultrasound in critically ill patients: comparison with bedside chest radiography. Intensive Care Med. 2011;37(9):1488.
  14. Ibitoye BO, Idowu BM, Ogunrombi AB, Afolabi BI. Ultrasonographic quantification of pleural effusion: comparison of four formulae. Ultrasonography. 2018;37(3):254‑60.
  15. Hansell L, Milross M, Delaney A, Tian DH, Ntoumenopoulos G. Lung ultrasound has greater accuracy than conventional respiratory assessment tools for the diagnosis of pleural effusion, lung consolidation and collapse: a systematic review. J Physiother. 2021;67(1):41‑8.
  16. Zhang M, Liu Z-H, Yang J-X, Gan J-X, Xu S-W, You X-D, et al. Rapid detection of pneumothorax by ultrasonography in patients with multiple trauma. Crit Care. 2006;10(4):R112.
  17. Ault MJ, Rosen BT, Scher J, Feinglass J, Barsuk JH. Thoracentesis outcomes: a 12-year experience. Thorax. 2015;70(2):127‑32.
  18. Blehar DJ, Barton B, Gaspari RJ. Learning curves in emergency ultrasound education.Acad Emerg Med. 2015;22(5):574‑82.
  19. Duncan DR, Morgenthaler TI, Ryu JH, Daniels CE. Reducing iatrogenic risk in thoracentesis. Chest. 2009;135(5):1315‑20.
  20. American College of Emergency Physicians. Emergency ultrasound guidelines. Ann Emerg Med. 2009;53(4):550-70 .
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