Indian Journal of Respiratory Care

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VOLUME 12 , ISSUE 2 ( April-June, 2023 ) > List of Articles

Original Article

Lung Ultrasound in Respiratory Therapy: A Pre- and Post-Training Analysis

Chris S Mathew, Edwin Dias, Duane Wong, Manjush Karthika

Keywords : Lung ultrasound, Respiratory therapists, Training

Citation Information : Mathew CS, Dias E, Wong D, Karthika M. Lung Ultrasound in Respiratory Therapy: A Pre- and Post-Training Analysis. Indian J Respir Care 2023; 12 (2):151-162.

DOI: 10.5005/jp-journals-11010-1050

License: CC BY-NC-SA 4.0

Published Online: 30-06-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Abstract

Background: Lung ultrasound (LUS) is a bedside diagnostic tool to assess the pulmonary status of patients in diverse scenarios of acute care and is typically performed and interpreted by physicians. Within the multidisciplinary group of clinicians, respiratory therapists (RTs) are considered to be one of the principal caregivers for patients who require comprehensive respiratory support. However, the practice and use of LUS by RTs over other healthcare professionals is still in its infancy. Hence this study aimed to look at the outcome of a 2-day training offered to RTs in terms of their acquired knowledge and practical skill. Methodology: This is a pilot study of a doctoral thesis that explores the scope of LUS in the respiratory therapy profession. The study was designed with a pre and posttraining analysis to determine the effectiveness of the skillset of RTs before and after training. The RTs were selected based on their participation consent, and the training was approved by the Department of Allied Health (respiratory therapy), Sidra Medicine, Qatar. The training program included didactic theory sessions and application sessions for 16 hours (2 days). The sociodemographic data was measured, and the analysis was based on a questionnaire, which measures the techniques and terminologies of LUS and its clinical applications. In addition, the competency of the RTs was determined, and a comparative study was done with their different levels of educational qualifications and years of experience. Results: The demographic data revealed the age, gender, educational qualification, and years of experience of the RTs. The pretest results showed that only five out of 24 participants (21%) scored >60%, whereas, in the posttest, it was observed that 23 out of 24 (96%) scored >60% of the total score, reflecting the importance of didactic theory sessions and practical sessions. The competency results revealed that even RTs who had >10 years of experience also needed some ongoing education and training periodically, as few of them failed to identify the clinical signs. This study indicates that irrespective of educational qualification and years of experience; RTs require continuing education, periodic assessment, and hands-on training sessions to upgrade their skill set in performing LUS. Conclusion: We conclude that our study has proven to be beneficial in terms of the knowledge and skills attained by RTs on LUS. Acquiring such skills sets a benchmark in the current practice of RTs, and this may reduce adverse events, specifically in ventilated patients, leading to improved patient care and safety.


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  1. Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care 2014;4(1):1. DOI: 10.1186/2110-5820-4-1
  2. Lichtenstein DA. Current misconceptions in lung ultrasound: a short guide for experts. Chest 2019;156(1):21–25. DOI: 10.1016/j.chest.2019.02.332
  3. Saraogi A. Lung ultrasound: Present and future. Lung India 2015;32(3):250–257. DOI: 10.4103/0970-2113.156245
  4. Ebrahimi A, Yousefifard M, Mohammad Kazemi H, et al. Diagnostic accuracy of chest ultrasonography versus chest radiography for identification of pneumothorax: a systematic review and meta-analysis. Tanaffos 2014;13(4):29–40
  5. Lichtenstein D, Goldstein I, Mourgeon E, et al. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004;100(1):9–15. DOI: 10.1097/00000542-200401000-00006
  6. Staub, LJ, Mazzali Biscaro RR, Kaszubowski, E, et al. Lung ultrasound for the emergency diagnosis of pneumonia, acute heart failure, and exacerbations of chronic obstructive pulmonary disease/asthma in adults: a systematic review and meta-analysis. J Emerg Med 2019;56(1):53–69. DOI: 10.1016/j.jemermed.2018.09.009
  7. Stoller JK. 2000 Donald F. Egan scientific lecture. are respiratory therapists effective? assessing the evidence. Respir Care 2001;46(1):56–66.
  8. Stoller JK. The effectiveness of respiratory care protocols. Respir Care 2004;49(7):761–765
  9. Karthika M, Wong D, Nair SG, et al. Lung ultrasound: the emerging role of respiratory therapists. Respir Care 2019;64(2):217–229. DOI: 10.4187/respcare.06179
  10. Levine A, Buchner J, Verceles AC, et al. Brief training can improve nonphysician comfort in obtaining remotely guided ultrasound images. Chest 2014;146(4)487A. DOI: 10.1378/chest.1988611
  11. Li J, Ni Y, Tu M, et al. Respiratory care education and clinical practice in mainland China. Respir Care 2018;63(10):1239–1245. DOI: 10.4187/respcare.06217
  12. Kappel C, Chaudhuri D, Hassall K, et al. Point-of-care ultrasound training for respiratory therapists: a scoping review. Can J Respir Ther 2022;58:28–33. DOI: 10.29390/cjrt-2021-065
  13. Mojoli F, Bouhemad B, Mongodi S, et al. Lung ultrasound for critically ill patients. Am J Respir Crit Care Med 2019;199(6):701–714. DOI: 10.1164/rccm.201802-0236CI
  14. Leech M, Bissett B, Kot M, et al. Lung ultrasound for critical care physiotherapists: a narrative review. Physiother Res Int 2015;20(2):69–76. DOI: 10.1002/pri.1607
  15. Vitale J, Mumoli N, Giorgi-Pierfranceschi M, et al. Comparison of the accuracy of nurse-performed and physician-performed lung ultrasound in the diagnosis of cardiogenic dyspnea. Chest 2016;150(2):470–471. DOI: 10.1016/j.chest.2016.04.033
  16. Sreedharan JK, Karthika M, Alqahtani JS, et al. Routine application of lung ultrasonography in respiratory care: knowledge, perceptions, and barriers to instigate. Adv Med Educ Pract 2022;13:1395–1406. DOI: 10.2147/AMEP.S389013
  17. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med 2012;38(4):577–591. DOI: 10.1007/s00134-012-2513-4
  18. Soldati G, Sher S. Bedside lung ultrasound in critical care practice. Minerva Anestesiol 2009;75(9):509–517.
  19. See KC, Ong V, Wong SH, et al. Lung ultrasound training: curriculum implementation and learning trajectory among respiratory therapists. Intensive Care Med 2016:42(1):63–71. DOI: 10.1007/s00134-015-4102-9
  20. Lim JS, Lee S, Do HH, et al. Can limited education of lung ultrasound be conducted to medical students properly? a pilot study. Biomed Res Int 2017;2017:8147075. DOI: 10.1155/2017/8147075
  21. Beaulieu Y, Laprise R, Drolet P, et al. Bedside ultrasound training using web-based e-learning and simulation early in the curriculum of residents. Crit Ultrasound J 2015; 7:1. DOI: 10.1186/s13089-014-0018-9
  22. Arbelot C, Dexheimer Neto FL, Gao Y, et al. Lung ultrasound in emergency and critically ill patients: number of supervised exams to reach basic competence. Anesthesiology 2000;132(4):899–907. DOI: 10.1097/ALN.0000000000003096
  23. Miller AG, Cappiello JL, Gentile MA, et al. Analysis of radial artery catheter placement by respiratory therapists using ultrasound guidance. Respir Care 2014;59(12):1813–1816. DOI: 10.4187/respcare.02905
  24. Russell FM, Ferre R, Ehrman RR, et al. What are the minimum requirements to establish proficiency in lung ultrasound training for quantifying B-lines?. ESC Heart Failure 2020;7(5):2941–2947. DOI: 10.1002/ehf2.12907
  25. Laursen CB, Clive A, Hallifax R, et al. European respiratory society statement on thoracic ultrasound. Eur Respir J 2021;57(3):2001519. DOI: 10.1183/13993003.01519-2020
  26. Galbois A, Ait-Oufella H, Baudel JL, et al. Pleural ultrasound compared with chest radiographic detection of pneumothorax resolution after drainage. Chest 2010;138(3):648–655. DOI: 10.1378/chest.09-2224
  27. Bedetti G, Gargani L, Corbisiero A, et al. Evaluation of ultrasound lung comets by hand-held echocardiography. Cardiovasc Ultrasound 2006:4:34. DOI: 10.1186/1476-7120-4-34
  28. Chalumeau-Lemoine L, Baudel JL, Das V, et al. Results of short-term training of naïve physicians in focused general ultrasonography in an intensive-care unit. Intensive Care Med 2009;35(10):1767–1771. DOI: 10.1007/s00134-009-1531-3
  29. Uppalapati A, Oropello J, Mukkera SR, et al. Efficacy of a training program to achieve competence in lung and pleural ultrasound. Chest 2011;140(4):1033. DOI: 10.1378/chest.1119868
  30. Mukherjee T, Mehta S, Walker D. The development of an in-house thoracic ultrasound teaching programme on a UK intensive care unit. Intensive Care Med 2011;37:1.
  31. Flato UAP, Guimarães HP, Petisco G, et al. Use of lung ultrasonography in the detection of pneumothorax among medical students and emergency physicians. Crit Care 2011;15(Suppl 2):46. DOI: 10.1186/cc10194
  32. Reissig A, Copetti R, Mathis G, et al. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study. Chest 2012;142(4):965–972. DOI: 10.1378/chest.12-0364
  33. Bouhemad B, Zhang M, Lu Q, et al. Clinical review: bedside lung ultrasound in critical care practice. Crit Care 2007;11(1):205. DOI: 10.1186/cc5668
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