Vol.:(0123456789) 1 3 J Clin Monit Comput DOI 10.1007/s10877-017-0042-y ORIGINAL RESEARCH Lung real time three-dimensional imaging in critically ill ventilated patients: a global diagnosis concordance study Jean-Marc Le Gof 1  · Claire Roger 1  · Benjamin Louart 1  · Pierre Géraud Claret 1  · Aurélien Daurat 1  · Stéphanie Bulyez 1  · Jean-Yves Lefrant 1  · Xavier Bobbia 1  · Laurent Muller 1   Received: 21 March 2017 / Accepted: 22 June 2017 © Springer Science+Business Media B.V. 2017 reliability. However, the diagnosis concordance for lung consolidation is poor. Keywords Lung ultrasound · LUS · 3-Dimensional ultrasonography · ICU · Pilot study · Concordance 1 Introduction Lung ultrasonography (LUS) has been increasingly used as a surrogate of chest X-ray in the intensive care unit (ICU) since more than 15 years. Lung ultrasound is the second type of ultrasound exam performed in critically ill patients [1]. The diagnosis accuracy of LUS is superior to conventional chest X-ray in ICU or emergency department, especially for pleural efusion, atelectasis and pneumotho- rax [2–4]. Finally, the daily use of LUS was shown to be associated with a reduction of the number of computer- ized tomography (CT) scanner or conventional chest X-ray without increasing the morbi–mortality [5–7]. Lichtenstein and coworkers emphasized the idea that a very simple and low-cost device with a microconvex 5 MHz probe was sufcient for LUS in ICU patients. The feasibility of LUS with such device was largely demon- strated [3]. However, the rapid development of new ultrasound tech- niques such as 3-D imaging raises the question of their potential usefulness for LUS. The 3-D LUS semiology has never been described. Therefore, the primary objective of the present study was to determine the global diagnosis concordance between 2-D and 3-D LUS in ventilated criti- cally ill patients. The secondary endpoint aimed at assess- ing the inter-observer reliability. Finally, the concordance between 2-D and 3-D exam was assessed considering four Abstract Lung ultrasound (LUS) increases clinical diag- nosis performance in intensive care unit (ICU). Real-time three-dimensional (3-D) imaging was compared with two- dimensional (2-D) LUS by assessing the global diagnosis concordance. In this single center, prospective, observa- tional, pilot study, one trained operator performed a 3-D LUS immediately after a 2-D LUS in eight areas of inter- est on the same areas in 16 ventilated critically ill patients. All cine loops were recorded on a computer without vis- ible link between 2-D and 3-D exams. Two experts blindly reviewed cine loops. Four main diagnoses were proposed: normal lung, consolidation, pleural efusion and intersti- tial syndrome. Fleiss κ and Cohen’s κ values were calcu- lated. In 252 LUS cine loops, the concordance between 2-D and 3-D exams was 83.3% (105/126), 77.6% (99/126) and 80.2% (101/126) for the trained operator and the experts respectively. The Cohen’s κ coefcient value was 0.69 [95% Confdence Interval (CI) 0.58–0.80] for expert 1 meaning a substantial agreement. The inter-rater reliability was very good (Fleiss’ κ value = 0.94 [95% CI 0.87–1.0]) for 3-D exams. The Cohen’s κ was excellent for pleural efusion (κ= 0.93 [95% CI 0.76–1.0]), substantial for nor- mal lung diagnosis (κ = 0.68 [95% CI 0.51–0.86]) and interstitial syndrome (κ = 0.62 [95% CI 0.45–0.80]) and fair for consolidation diagnoses (κ = 0.47 [95% CI 0.30–0.64]). In ICU ventilated patients, there was a substantial concord- ance between 2-D and 3-D LUS with a good inter-rater * Jean-Yves Lefrant jean-yves.lefrant@wanadoo.fr 1 Division of Anaesthesia Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes, Place du Professeur Robert Debré, 30029 Nîmes, France