Ability of non-physicians to perform and interpret lung ultrasound: A systematic review

Abstract

Background: Lung ultrasound is a useful tool in the assessment of pulmonary congestion in heart failure that is typically performed and interpreted by physicians at the point-of-care. Aims: To investigate the ability of nurses, students, and paramedics to accurately identify B-lines and pleural effusions for the detection of pulmonary congestion in heart failure and to examine the training necessary. Methods and results: We conducted a systematic review and searched online databases for studies that investigated the ability of nurses, students, and paramedics to perform lung ultrasound and detect B-lines and pleural effusions. Of 979 studies identified, 14 met our inclusion criteria: five in nurses, eight in students, and one in paramedics. After 0–12 h of didactic training and 58–62 practice lung ultrasound examinations, nurses were able to identify B-lines and pleural effusions with a sensitivity of 79–98% and a specificity of 70–99%. In image adequacy studies, medical students with 2–9 h of training were able to acquire adequate images for B-lines and pleural effusions in 50–100%. Only one eligible study investigated paramedic-performed lung ultrasound which did not support the ability of paramedics to adequately acquire and interpret lung ultrasound images after 2 h of training. Conclusions: Our findings suggest that nurses and students can accurately acquire and interpret lung ultrasound images after a brief training period in a majority of cases. The examination of heart failure patients with lung ultrasound by non-clinicians appears feasible and warrants further investigation.

Prevalence and prognostic impact of subclinical pulmonary congestion at discharge in patients with acute heart failure

“…Hospital readmission of patients with HF is a major public health problem, and residual pulmonary congestion at discharge is one of the leading responsible conditions. In last years, LUS has emerged as an attractive tool in HF because of it is a rapid point‐of‐care test with a fast learning curve and a high inter‐observer agreement 1,26,27 . Moreover, our group recently showed that a LUS‐guided strategy significantly improved the combined endpoint of urgent visit, hospitalization for worsening HF, and death during a 6 month follow‐up in patients after HF admission 11 .…”

“…In last years, LUS has emerged as an attractive tool in HF because of it is a rapid point-of-care test with a fast learning curve and a high inter-observer agreement. 1,26,27 Moreover, our group recently showed that a LUS-guided strategy signifi- cantly improved the combined endpoint of urgent visit, hospitalization for worsening HF, and death during a 6 month follow-up in patients after HF admission. 11 Then, it is conceivable that adding LUS to clinical practice will reinforce the ability of clinicians to promptly detect and treat fluid overload and, ultimately, improve the prognosis of patients with HF.…”

Point-of-Care Ultrasound and Modernization of the Bedside Assessment

“…Although novice POCUS operators can attain basic competency in image acquisition and image interpretation with relatively brief training, 11,33 expert use of any test requires a more complex skill set to integrate test results into clinical decision-making. This higher order skill includes the ability to combine an accurate pretest probability with knowledge of the test characteristics and limitations of the POCUS examination performed to arrive at an accurate posttest probability and appropriate management plan.…”

Discharge-ready volume status in acute decompensated heart failure: a survey of hospitalists

“…Two recent randomized controlled trials demonstrated the use of point-of-care lung ultrasound both decreased length of stay and number of urgent visits in patients recently hospitalized for heart failure [ 11 , 12 ]. Further, lung ultrasound is a relatively easy POCUS application for to learn [ 13 ] and perform [ 14 ]. Although POCUS has become more readily available in all hospitals over the past 25 years, only 4% of respondents indicated POCUS was among their most useful bedside tools, suggesting a provider training gap exists and should be a focus of future quality improvement efforts.…”