Lung ultrasound in respiratory therapy: a global reflective survey

Lung ultrasound in respiratory therapy: a global reflective survey

Authors

  • Chris Sara Mathew A. Srinivas Institute of Medical Sciences and Research Center, Srinivas University, Mangalore, India B. Liwa College, Abu Dhabi, UAE https://orcid.org/0000-0001-5235-3033
  • Edwin Dias Srinivas Institute of Medical Sciences and Research Center, Srinivas University, Mangalore, India
  • Jithin Kalathikudiyil Sreedharan University of Doha for Science and Technology, Doha, Qatar
  • Mohammed Al Ahmari Dammam Health Network, Dammam, KSA
  • Lisa Trujillo University of Kansas Medical Center, Kansas, USA
  • Andrew West Canadian Society of Respiratory Therapists, Canada
  • Manjush Karthika Liwa College, Abu Dhabi, UAE https://orcid.org/0000-0001-5032-9283

Keywords:

Respiratory therapists, Lung Ultrasound, Survey, Knowledge, Attitude, Practice

Abstract

Background: Lung ultrasound (LUS) is a non-invasive point of care diagnostic tool used to assess the presence and severity of various lung disorders for more than two decades. Within the healthcare professionals are the respiratory therapists (RTs) who play a vital role in managing ventilated and other patients requiring respiratory support, but the incorporation of LUS into their scope of practice has not been well highlighted. This international cross-sectional survey was specifically designed to evaluate the knowledge, attitude, and practice of RTs with respect to LUS. Methods: This observational cross-sectional study was conducted among RTs from different parts of the world using a questionnaire-based study tool. 514 RTs responded to all the questions and were considered for statistical analysis. Descriptive statistics, Analysis of variance, Fisher’s exact, Chi-square, Bonferroni post-hoc analysis, and Binomial logistic regression analyses were performed to identify the significance of the data. Results: From 22 countries, 514 RTs responded to the survey, with the major share from the middle eastern countries. Out of the 514 responders, 44.9% of the responders were in the age group of 23-30 years; 67.1% were bachelor’s degree holders; and 40.9% of participants had more than 10 years of experience. The knowledge-based questions revealed that RTs with higher experience and academic qualification provided more positive responses. While in the attitude-related domain it is observed that standardized training in LUS helps them to enhance the current practice and to add LUS to the academic curriculum of respiratory therapy schools; however there remains barriers to practice LUS based on their responses. The practice-based questions revealed that RTs expect some additional seminars/workshops/webinars to be done on LUS frequently. More than half of the participants are found to be knowledgeable with a positive attitude and working towards the inclusion of LUS in respiratory therapy profession. Conclusion: It is concluded that respiratory therapists have a positive attribute towards the inclusion of lung ultrasound in their clinical practice. Providing more structured training for professional respiratory therapists and including lung ultrasound modules in the respiratory therapy school curriculum may facilitate mastering their diagnostic skills, thereby expanding the scope of practice.

References

Lerchbaumer MH, Lauryn JH, Bachmann U, Enghard P, Fischer T, Grune J et al. Point-of-care lung ultrasound in COVID-19 patients: inter- and intra-observer agreement in a prospective observational study. Sci Rep. 2021 May 21;11(1):10678.

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.

Lichtenstein D, Goldstein I, Mourgeon E, Cluzel P, Grenier P, Rouby JJ. Comparative diagnostic performances of auscultation, chest radiography, and lung ultrasonography in acute respiratory distress syndrome. Anesthesiology 2004;100(1):9–15.

Maw AM, Hassanin A, Ho PM, et al. Diagnostic Accuracy of Point-of-Care Lung Ultrasonography and Chest Radiography in Adults with Symptoms Suggestive of Acute Decompensated Heart Failure: A Systematic Review and Meta-analysis. JAMA Netw Open 2019;2(3):e190703.

Ye X, Xiao H, Chen B, Zhang S. Accuracy of Lung Ultrasonography versus Chest Radiography for the Diagnosis of Adult Community-Acquired Pneumonia: Review of the Literature and Meta-Analysis. PLoS One 2015;10(6): e0130066

Via G, Lichtenstein D, Mojoli F, et al. Whole lung lavage: a unique model for ultrasound assessment of lung aeration changes. Intensive Care Med 2010; 36:999-1007.

Chiumello D, Mongodi S, Algieri I, et al. Assessment of Lung Aeration and Recruitment by CT scan and Ultrasound in Acute Respiratory Distress Syndrome Patients. Crit Care Med 2018; 46:1761-8.

Dubé BP, Dres M, Mayaux J, et al. Ultrasound evaluation of diaphragm function in mechanically ventilated patients: comparison to phrenic stimulation and prognostic implications. Thorax 2017; 72:811-8.

Lichtenstein D, Mézière G, Biderman P, et al. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med 1997; 156:1640-6.

Mongodi S, Via G, Girard M, et al. Lung Ultrasound for Early Diagnosis of Ventilator-Associated Pneumonia. Chest 2016; 149:969-80.

Bianco F, Bucciarelli V, Ricci F, De Caterina R, Gallina S. Lung ultrasonography: a practical guide for cardiologists. J Cardiovasc Med (Hagerstown). 2017 Jul;18(7):501-509.

Song G, Bae SC, Lee YH. Diagnostic accuracy of lung ultrasound for interstitial lung disease in patients with connective tissue diseases: a meta-analysis. Clin Exp Rheumatol. 2016 Jan-Feb;34(1):11-6.

Stoller JK. 2000 Donald F. Egan Scientific Lecture. Are respiratory therapists effective? Assessing the evidence. Respir Care 2001; 46(1):56-66.

Stoller JK. The effectiveness of respiratory care protocols. Respir Care 2004;49(7):761-765.

Kollef MH, Shapiro SD, Clinkscale D, et al. The effect of respiratory therapist-initiated treatment protocols on patient outcomes and resource utilization. Chest 2000; 117:467-75

Stoller JK, Mascho EJ, Kester L, Haney D. Randomized control trial of physician-directed versus respiratory therapy consult servicedirected respiratory care to non-ICU inpatients. Am J Respir Crit Care Med 1998; 158:1068-75.

Karthika M, Wong D, Nair SG, Pillai LV, Mathew CS. Lung ultrasound: the emerging role of respiratory therapists. Respiratory Care. 2019;64(2):217-29.

Oveland NP, Sloth E, Andersen G, et al. A porcine pneumothorax model for teaching ultrasound diagnostics. Acad Emerg Med. 2012; 19:586–592.

Connolly K, Beier L, Langdorf MI, et al. Ultrafest: a novel approach to ultrasound in medical education leads to improvement in written and clinical examinations. West J Emerg Med. 2015; 16:143–148.

Dinh VA, Giri PC, Rathinavel I, et al. Impact of a 2-day critical care ultrasound course during fellowship training: a pilot study. Crit Care Res Pract. 2015; 2015:675041.

Greenstein YY, Littauer R, Narasimhan M, et al. Effectiveness of a critical care ultrasonography course. Chest. 2017; 151:34–40.

House DR, Amatya Y, Nti B, Russell FM. Lung ultrasound training and evaluation for proficiency among physicians in a low-resource setting. Ultrasound J. 2021 Jun 30;13(1):34.

Guy, A.; Bryson, A.; Wheeler, S.; McLean, N.; Kanji, H.D. A Blended Prehospital Ultrasound Curriculum for Critical Care Paramedics. Air Med. J. 2019, 38, 426–430

Swamy V, Brainin P, Biering-Sørensen T, Platz E. Ability of non-physicians to perform and interpret lung ultrasound: A systematic review. Eur J Cardiovasc Nurs. 2019 Aug;18(6):474-483.

Arbelot C, Dexheimer Neto FL, Gao Y, Brisson H, Chunyao W, Lv J, Valente Barbas CS. et al. APECHO Study Group. Lung Ultrasound in Emergency and Critically Ill Patients: Number of Supervised Exams to Reach Basic Competence. Anesthesiology. 2020 Apr;132(4):899-907.

See KC, Ong V, Wong SH, Leanda R, Santos J, Taculod J, Phua J, Teoh CM. Lung ultrasound training: curriculum implementation and learning trajectory among respiratory therapists. Intensive Care Med. 2016 Jan;42(1):63-71.

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.

Kappel C, Chaudhuri D, Hassall K, Theune S, Sharif S, Alhazzani W, Lewis K. Point-of-care ultrasound training for respiratory therapists: A scoping review. Can J Respir Ther. 2022 Mar 7; 58:28-33.

Liu K, Yao YL, Wang YX, Wei BL, Li LC, Wang QX. A cross-sectional survey on the lung ultrasound training and practice of respiratory therapists in mainland China. BMC Pulm Med. 2022 Nov 18;22(1):425.

Sreedharan JK, Karthika M, Alqahtani JS, AlRabeeah SM, Alnasser M, Alqahtani AS. Routine Application of Lung Ultrasonography in Respiratory Care: Knowledge, Perceptions, and Barriers to Instigate. Adv Med Educ Pract. 2022 Nov 15; 13:1395-1406.

Barnes TA, Kacmarek RM, Durbin CG. Survey of respiratory therapy education program directors in the United States. Respiratory Care. 2011;56(12):1906-15

Smallwood N, Matsa R, Lawrenson P, Messenger J, Walden A. A UK wide survey on attitudes to point of care ultrasound training amongst clinicians working on the Acute Medical Unit. Acute Med. 2015;14(4):159-164

Pietersen PI, Madsen KR, Graumann O, Konge L, Nielsen BU, Laursen CB. Lung ultrasound training: a systematic review of published literature in clinical lung ultrasound training. Critical ultrasound journal. 2018;10(1):1-5.

Keene S, McHenry KL, Byington RL, Washam M. Respiratory therapists as physician extenders: perceptions of practitioners and educators. Respiratory Care Education Annual. 2015; 2372-0735.

Schroder J, Handels H. Real-time ultrasound simulation for training of US-guided needle insertion in breathing virtual patients. Medicine Meets Virtual Reality 22: NextMed/MMVR22. 2016; 220:219.

Arbelot C, Dexheimer Neto FL, Gao Y, Brisson H, Chunyao W, Lv J, et al,. Lung ultrasound in emergency and critically ill patients: number of supervised exams to reach basic competence. Anesthesiology. 2020;132(4):899-907.

Mukherjee T, Mehta S, Walker D. The development of an in-house thoracic ultrasound teaching programme on a UK Intensive Care Unit. intensive care medicine 2011;37, pp. S66-S66). 233 Spring ST, New York, NY 10013 USA: Springer.

Chalumeau-Lemoine L, Baudel JL, Das V, Arrive´ L, Noblinski B, Guidet B, 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.

Uppalapati A, Oropello J, Mukkera SR, Jamkhana ZA, DelGiudice R, Sherman B. Efficacy of a training program to achieve competence in lung and pleural ultrasound. Chest 2011;140(4):1033.

UAP Flato, HP Guimara˜es, G Petisco, F Bezerra, AB Cavalcante, O Berwanguer. Use of lung ultrasonography in the detection of pneumothorax among medical students and emergency physicians. Crit Care 2011;15(S2):46.

Mayo PH, Goltz HR, Tafreshi M, Doelken P. Safety of ultrasound guided thoracentesis in patients receiving mechanical ventilation. Chest 2004;125(3):1059-1062.

Poletti PA, Kinkel K, Vermeulen B, Irmay F, Unger PF, Terrier F. Blunt abdominal trauma: should US be used to detect both free fluid and organ injuries? Radiology 2003;227(1):95-103.

Ojaghi Haghighi SH, Morteza Begi HR, Sorkhabi R, Tarzamani MK, Zonouz GK, Mikaeilpour A, Rahmani F. Diagnostic accuracy of ultrasound in detection of traumatic lens dislocation. Emergency 2014;2(3):121-124.

Rooney KP, Lahham S, Lahham S, et al. Pre-hospital assessment with ultrasound in emergencies: Implementation in the field. World J Emerg Med 2016;7(2):117–23.

Leech M, Bissett B, Kot M, Ntoumenopoulos G. Lung ultrasound for critical care physiotherapists: A narrative review. Physiother Res Int 2015;20(2):69–76.

Henderson SO, Ahern T, Williams D, Mailhot T, Mandavia D. Emergency department ultrasound by nurse practitioners. J Am Acad Nurs Pract 2010;22(7):352–5.

.

Downloads

Published

02-07-2024

Issue

Section

Original Research Articles

How to Cite

1.
Mathew CS, Dias E, Kalathikudiyil Sreedharan J, Al Ahmari M, Trujillo L, West A, et al. Lung ultrasound in respiratory therapy: a global reflective survey. Multidiscip Respir Med [Internet]. 2024 Jul. 2 [cited 2024 Jul. 4];19(1). Available from: https://mrmjournal.org/index.php/mrm/article/view/980