Advertisement

The “lung pulse”: an early ultrasound sign of complete atelectasis

Abstract

Objective

Complete atelectasis can be immediately generated by selective intubation. A dynamic lung ultrasound sign can be described as the association of absent lung sliding with the perception of heart activity at the pleural line, a sign which was called “lung pulse.” We examined whether this sign be used promptly to confirm complete atelectasis due to selective intubation.

Design and setting

Prospective study in the medical intensive care unit of a university-affiliated teaching hospital.

Patients

Consecutive patients with no history of respiratory disorders and needing intubation were enrolled. Fifteen patients with selective intubation of the right lung were compared with 30 patients with nonselective intubation and 15 healthy volunteers.

Interventions

The “lung pulse” was sought at the left anterolateral chest wall in intubated patients. Healthy subjects were studied during breathing and apnea.

Results

A left “lung pulse” was immediately present in 14 of 15 patients with right selective intubation, and absent, with normal lung sliding, in all 30 correctly intubated patients and in all 15 healthy subjects during breathing. All healthy subjects exhibited a “lung pulse” in apnea. The “lung pulse” had a sensitivity of 93% and a specificity of 100% for the diagnosis of complete atelectasis following selective intubation in patients without previous respiratory disorders.

Conclusions

The “lung pulse” is a sign of complete atelectasis which is observable immediately before radiological changes. Its absence which is correlated with the absence of selective intubation and of conserved lung inflation can eliminate the need for confirmation radiography.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.

References

  1. 1.

    Wiener MD, Garay SM, Leitman BS, Wiener DN, Ravin CE (1991) Imaging of the intensive care unit patient. Clin Chest Med 12:169–198

  2. 2.

    Brenner DJ, Elliston CD, Hall EJ, Berdon WE (2001) Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol 176:289–296

  3. 3.

    Lichtenstein D (2001) Lung ultrasound in the intensive care unit. Recent Res Dev Respir Critical Care Med 1:83–93

  4. 4.

    Lichtenstein D, Mezière G, Courret JP, Gepner A (2001) Le “pneumocardiogramme,” un signe échographique précoce d’atélectasie complète. Reanim Urgence 10 [Suppl 1]:137s

  5. 5.

    Lichtenstein D, Menu Y (1995) A bedside ultrasound sign ruling out pneumothorax in the critically ill: lung sliding. Chest 108:1345–1348

  6. 6.

    Lichtenstein D, Mezière G, Biderman P, Gepner A, Barré O (1997) The comet-tail artifact: an ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 156:1640–1646

  7. 7.

    Lichtenstein D, Mezière G, Biderman P, Gepner A (1999) The comet-tail artifact, an ultrasound sign ruling out pneumothorax. Intensive Care Med 25:383–388

  8. 8.

    Jardin F, Valtier B, Beauchet, Dubourg O, Bourdarias JP (1994) Invasive monitoring combined with two-dimensional echocardiographic study in septic shock. Intensive Care Med 20:550–554

  9. 9.

    Peruzzi W, Garner W, Bools J, Rasanen J, Mueller CF, Reilley T (1998) Portable chest roentgenography and CT in critically ill patients. Chest 93:722–726

  10. 10.

    Lichtenstein D (2002) General ultrasound in the critically ill (L’échographie générale en réanimation), 2nd edn. Springer, Berlin Heidelberg New York, pp 101–142

Download references

Acknowledgements

We thank David Marsh, Ph.D., for translation of this work and Prof. François Jardin for his constant support.

Author information

Correspondence to Daniel A. Lichtenstein.

Electronic Supplementary Material

The following three video clips have been prepared in avi format

AVI (1.9 MB)

AVI (1.6 MB)

AVI (1.5 MB)

AVI (1.9 MB)

AVI (1.6 MB)

AVI (1.5 MB)

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Lichtenstein, D.A., Lascols, N., Prin, S. et al. The “lung pulse”: an early ultrasound sign of complete atelectasis. Intensive Care Med 29, 2187–2192 (2003). https://doi.org/10.1007/s00134-003-1930-9

Download citation

Keywords

  • Atelectasis
  • Ultrasound diagnosis
  • Intensive care unit
  • Lung, ultrasound diagnosis
  • Thorax, ultrasound diagnosis