Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Intensive Care Medicine
Published in: Intensive Care Medicine 9/2019

01-09-2019 | Ultrasound | Original

Speckle tracking quantification of lung sliding for the diagnosis of pneumothorax: a multicentric observational study

Authors: Gary Duclos, Xavier Bobbia, Thibaut Markarian, Laurent Muller, Camille Cheyssac, Sarah Castillon, Noémie Resseguier, Alain Boussuges, Giovanni Volpicelli, Marc Leone, Laurent Zieleskiewicz

Published in: Intensive Care Medicine | Issue 9/2019

Login to get access

Abstract

Purpose

Lung ultrasound is used for the diagnosis of pneumothorax, based on lung sliding abolition which is a qualitative and operator-dependent assessment. Speckle tracking allows the quantification of structure deformation over time by analysing acoustic markers. We aimed to test the ability of speckle tracking technology to quantify lung sliding in a selected cohort of patients and to observe how the technology may help the process of pneumothorax diagnosis.

Methods

We performed retrospectively a pleural speckle tracking analysis on ultrasound loops from patients with pneumothorax. We compared the values measured by two observers from pneumothorax side with contralateral normal lung side. The receiver operating characteristic (ROC) curve was constructed to evaluate the performance of maximal pleural strain to detect the lung sliding abolition. Diagnosis performance and time to diagnosis between B-Mode and speckle tracking technology were compared from a third blinded observer.

Results

We analysed 104 ultrasound loops from 52 patients. The area under the ROC curve of the maximal pleural strain value to identify lung sliding abolition was 1.00 [95%CI 1.00; 1.00]. Specificity was 100% [95%CI 93%; 100%] and sensitivity was 100% [95%CI 93%; 100%] with the best cut-off of 4%. Over 104 ultrasound loops, the blinded observer made two errors with B-Mode and none with speckle tracking. The median diagnosis time was 3 [2–5] seconds for B-Mode versus 2 [1–2] seconds for speckle tracking (p = 0.001).

Conclusion

Speckle tracking technology allows lung sliding quantification and detection of lung sliding abolition in case of pneumothorax on selected ultrasound loops.
Appendix
Available only for authorised users
Literature
1.
Lichtenstein DA (2015) BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest 147:1659–1670CrossRefPubMed
2.
Charbit J, Millet I, Maury C et al (2015) Prevalence of large and occult pneumothoraces in patients with severe blunt trauma upon hospital admission: experience of 526 cases in a French level 1 trauma center. Am J Emerg Med 33:796–801CrossRefPubMed
3.
Kirkpatrick AW, Sirois M, Laupland KB et al (2004) Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the extended focused assessment with sonography for trauma (EFAST). J Trauma 57:288–295CrossRefPubMed
4.
Volpicelli G, Elbarbary M, Blaivas M et al (2012) International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 38:577–591CrossRefPubMed
5.
6.
7.
Lichtenstein D, Goldstein I, Mourgeon E et al (2004) Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 100:9–15CrossRefPubMed
8.
Targhetta R, Bourgeois JM, Chavagneux R, Balmes P (1992) Diagnosis of pneumothorax by ultrasound immediately after ultrasonically guided aspiration biopsy. Chest 101:855–856CrossRefPubMed
9.
Alrajhi K, Woo MY, Vaillancourt C (2012) Test characteristics of ultrasonography for the detection of pneumothorax: a systematic review and meta-analysis. Chest 141:703–708CrossRefPubMed
10.
Staub LJ, Biscaro RRM, Kaszubowski E, Maurici R (2018) Chest ultrasonography for the emergency diagnosis of traumatic pneumothorax and haemothorax: a systematic review and meta-analysis. Injury 49:457–466CrossRefPubMed
11.
Hamada SR, Delhaye N, Kerever S et al (2016) Integrating eFAST in the initial management of stable trauma patients: the end of plain film radiography. Ann Intensive Care 6:62CrossRefPubMedPubMedCentral
12.
Zieleskiewicz L, Fresco R, Duclos G et al (2018) Integrating extended focused assessment with sonography for trauma (eFAST) in the initial assessment of severe trauma: impact on the management of 756 patients. Injury 49:1774–1780CrossRefPubMed
13.
Ding W, Shen Y, Yang J et al (2011) Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest 140:859–866CrossRefPubMed
14.
Cavaliere F, Zamparelli R, Soave MP et al (2014) Ultrasound artifacts mimicking pleural sliding after pneumonectomy. J Clin Anesth 26:131–135CrossRefPubMed
15.
Ianniello S, Di Giacomo V, Sessa B, Miele V (2014) First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of e-FAST and comparison with multidetector computed tomography. Radiol Med (Torino) 119(674–680):16
16.
Sperandeo M, Maggi M, Catalano D, Trovato G (2014) No sliding, no pneumothorax: thoracic ultrasound is not an all-purpose tool. J Clin Anesth 26:425–426CrossRefPubMed
17.
Lichtenstein D, Mezière G, Biderman P, Gepner A (1999) The comet-tail artifact: an ultrasound sign ruling out pneumothorax. Intensive Care Med 25:383–388CrossRefPubMed
18.
Lichtenstein DA, Menu Y (1995) A bedside ultrasound sign ruling out pneumothorax in the critically ill. Lung sliding Chest 108:1345–1348CrossRefPubMed
19.
20.
Press GM, Miller SK, Hassan IA et al (2014) Prospective evaluation of prehospital trauma ultrasound during aeromedical transport. J Emerg Med 47:638–645CrossRefPubMed
21.
Richards JR, Awrey JM, Medeiros SE, McGahan JP (2017) Color and power doppler sonography for pneumothorax detection. J Ultrasound Med 36:2143–2147CrossRefPubMed
22.
Mondillo S, Galderisi M, Mele D et al (2011) Speckle-tracking echocardiography: a new technique for assessing myocardial function. J Ultrasound Med 30:71–83CrossRefPubMed
23.
Perk G, Tunick PA, Kronzon I (2007) Non-Doppler two-dimensional strain imaging by echocardiography–from technical considerations to clinical applications. J Am Soc Echocardiogr 20:234–243CrossRefPubMed
24.
Collier P, Phelan D, Klein A (2017) A test in context: myocardial strain measured by speckle-tracking echocardiography. J Am Coll Cardiol 69:1043–1056CrossRefPubMed
25.
Oppersma E, Hatam N, Doorduin J et al (2017) Functional assessment of the diaphragm by speckle tracking ultrasound during inspiratory loading. J Appl Physiol Bethesda Md 123:1063–1070
26.
27.
Duclos G, Muller L, Leone M, Zieleskiewicz L (2019) A picture’s worth a thousand words: speckle tracking for quantification and assessment of lung sliding. Intensive Care Med 45:101–102CrossRefPubMed
28.
Toulouse E, Masseguin C, Lafont B et al (2018) French legal approach to clinical research. Anaesth Crit Care Pain Med 37:607–614CrossRefPubMed
29.
Gauss T, Balandraud P, Frandon J et al (2019) Strategic proposal for a national trauma system in France. Anaesth Crit Care Pain Med 38:121–130CrossRefPubMed
30.
31.
Lichtenstein D, Mezière G, Biderman P, Gepner A (2000) The “lung point”: an ultrasound sign specific to pneumothorax. Intensive Care Med 26:1434–1440CrossRefPubMed
32.
Lichtenstein DA, Lascols N, Prin S, Mezière G (2003) The “lung pulse”: an early ultrasound sign of complete atelectasis. Intensive Care Med 29:2187–2192CrossRefPubMed
33.
Summers SM, Chin EJ, Long BJ et al (2016) Computerized diagnostic assistant for the automatic detection of pneumothorax on ultrasound: a pilot study. West J Emerg Med 17:209–215CrossRefPubMedPubMedCentral
34.
Dori G, Jakobson DJ (2016) Speckle tracking technology for quantifying lung sliding. Med Hypotheses 91:81–83CrossRefPubMed
35.
36.
Hovnanians N, Win T, Makkiya M et al (2017) Validity of automated measurement of left ventricular ejection fraction and volume using the Philips EPIQ system. Echocardiogr Mt Kisco N 34:1575–1583CrossRef
Metadata
Title
Speckle tracking quantification of lung sliding for the diagnosis of pneumothorax: a multicentric observational study
Authors
Gary Duclos
Xavier Bobbia
Thibaut Markarian
Laurent Muller
Camille Cheyssac
Sarah Castillon
Noémie Resseguier
Alain Boussuges
Giovanni Volpicelli
Marc Leone
Laurent Zieleskiewicz
Publication date
01-09-2019
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 9/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-019-05710-1

Other articles of this Issue 9/2019

Intensive Care Medicine 9/2019 Go to the issue

Original

Analysis of the medical response to November 2015 Paris terrorist attacks: resource utilization according to the cause of injury

Imaging in Intensive Care Medicine

Massive tricuspid valve regurgitation: sonographic findings of jugular and hepatic veins

Correction

Correction to: Functional outcomes in adult patients with herpes simplex encephalitis admitted to the ICU: a multicenter cohort study

Correspondence

Dose of enteral nutrition and enterocyte biomarker: a circular link?

Review

Acute ischaemic stroke: challenges for the intensivist

Focus On

Focus on delirium, sedation and neuro critical care 2019: towards a more brain-friendly environment?