Lung ultrasound in internal medicine: training and clinical practice

Abstract

BackgroundLung ultrasound (LUS) represents an emerging technique for bedside chest imaging in different clinical settings. A standardized approach allows the diagnosis, the quantification, and the follow-up of different conditions for which acute respiratory failure is the main clinical presentation. The aim of this study was to test what skill targets could be achieved in LUS, with a short-training course offered to 19 Medical Doctors attending the certification board school in Internal Medicine at the University of Verona, Italy.MethodsThe training course (theoretical and practical) consisted of 9 h subdivided in 4 days. Each trainee examined three healthy volunteers during the first day that was also the day of the theoretical lessons. Moreover, they examined nine patients per day (a total of 27 patients). Trainees were tested in the recognition of the basic signs in LUS, the managing of the Bedside Lung Ultrasound Evaluation (the BLUE protocol), and the recognition of the broad clinical scenarios recognized by the LUS. Kappa statistic was used to calculate the inter-observer agreement (trainees/tutor).ResultsTwenty-seven patients were examined by the 19 trainees (ten trainees had previous limited experience in general ultrasound). The agreement among the trainees and the tutor in the recognition of the LUS basic signs and in the recognition of the BLUE protocol profiles ranged from “fair” to “excellent”. In particular, the agreement among the trainees and the tutor in the final LUS diagnosis was “excellent” for the recognition of the interstitial syndrome and the pleural effusion, “substantial” for the recognition of the normal lung, and “moderate” for the recognition of consolidation and pneumothorax. LUS outcome gave useful information and drove change in therapy in 16 patients. It affected immediate management in nine patients. The concordance between the previous X chest ray and LUS was observed in 21 patients.ConclusionsA short training in LUS provided good proficiency in the recognition only of the main signs of the BLUE protocol, but allowed a correct LUS diagnosis in the Internal Medicine most frequent clinical settings of acute respiratory failure. This study supports incorporating LUS into Internal Medicine fellowship training programs.

Diagnostic Accuracy of Point-of-Care Lung Ultrasonography and Chest Radiography in Adults With Symptoms Suggestive of Acute Decompensated Heart Failure

“…Lung ultrasonography has also be shown to be easy for clinicians to learn, perform, and interpret. 37 , 46 , 47 , 48 , 49 As presented in the clinical practice guidelines, the role of CXR in the evaluation of ADHF is, in part, to assess other causes of dyspnea. Because LUS has been shown to offer comparable or superior accuracy over many of the other most common causes of dyspnea, 10 , 11 , 12 , 50 it has the potential to become an initial imaging modality in the evaluation of patients with dyspnea.…”

Lung Ultrasound in COVID-19 Pneumonia: Correlations with Chest CT on Hospital admission

“…Moreover, the false-negative and false-positive rates of LUS findings in COVID-19 pneumonia in comparison with CT have not been elucidated yet. The interobserver agreement of LUS is also uncertain in COVID-19 pneumonia, although it was demonstrated as good to excellent in several other respiratory diseases [31, 32]. The limited availability of ultrasound equipment dedicated to isolated patients may also be an important barrier for the use of this technique in the context of COVID-19 patients [33].…”

Lung Ultrasound in COVID‐19 A Role Beyond the Acute Phase?

“…Moreover, an LUS examination is easy to perform, requires short training, 11,12 and has several advantages that may overcome undeniable CT limitations: low cost, no radiation exposure, frequently repeatable, and the option to be performed with portable devices. Therefore, whereas CT remains the central tool for the initial diagnostic assessment and in-hospital management, LUS may be adopted in primary care and outpatient settings for the effective monitoring of patients after discharge, particularly after a severe acute phase.…”

“…In addition, considering that the advanced stage of the disease is hallmarked by the peripheral distribution of lesions, 10 LUS maybe even more effective in monitoring the subacute phase of the disease, allowing an earlier and safer hospital discharge. Finally, an LUS examination is easy to perform and requires short training, 11,12 and its point-of-care use would allow feasible outpatient follow-up in many different settings (eg, general practitioners and primary care physician groups). This study was aimed at assessing whether LUS could be an effective indicator of subclinical persistence of COVID-19-related lung damage in clinically healed patients; this might help in identifying those who will need more careful monitoring after discharge that could be performed with the same technique.…”