Correspondence  |   March 2018
In Reply
Author Notes
  • Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
  • (Accepted for publication November 21, 2017.)
    (Accepted for publication November 21, 2017.)×
Article Information
Correspondence   |   March 2018
In Reply
Anesthesiology 3 2018, Vol.128, 679-680. doi:10.1097/ALN.0000000000002042
Anesthesiology 3 2018, Vol.128, 679-680. doi:10.1097/ALN.0000000000002042
We thank Dr. Vetrugno et al., Drs. Jacobsohn and Grocott, and Dr. Iwasaki et al. for their interest and positive appreciations of our study, “Prevalence and Impact on Weaning of Pleural Effusion at the Time of Liberation from Mechanical Ventilation: A Multicenter Prospective Observational Study,” recently published in Anesthesiology.1 
As pointed out by Dr. Vetrugno et al., we used a slightly different method of estimating pleural effusion volume than the method used by Balik et al.2  In the study by Balik et al.,2  patients were investigated supine with a mild torso elevation of 15°, whereas in our study pleura ultrasound was performed while patients were semirecumbent. We choose this approach because pleura ultrasound was performed at the end of the spontaneous breathing trial, which requires the patients to be semiseated. Accordingly, Dr. Vetrugno et al., as well as Dr. Iwasaki et al., suggested that our method could misclassify some patients and potentially bias our findings. We wish to point out, however, that in our study, patients were classified as “no or small pleural effusion” or “moderate to large pleural effusion” based on the British Thoracic Society (BTS) classification3  rather than on the Balik formula.2  Dr. Vetrugno et al. also challenged the sample size of our study given that the majority of patients with pleural effusion had “no or small” pleural effusion. This comment is legitimate, and we agree that further studies are required to investigate specifically the impact of large pleural effusion on weaning outcome.
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