Q&A: Benefits of pulmonary point-of-care ultrasonography

Key takeaways:

• Point-of-care ultrasonography allows ICU clinicians to quickly detect pulmonary symptoms and work out the right treatment.
• This tool is favored over chest radiography and CT for rapid evaluation and diagnosis.

In the ICU, point-of-care ultrasonography is recognized as a key device/tool for diagnosing various diseases and conditions, especially those in the field of pulmonology.

Further, use of point-of-care ultrasonography (POCUS) has become more prevalent over the years thanks to technological advancements, according to a press release from the American Association of Critical Care Nurses (AACN).

To emphasize the importance of POCUS and widen knowledge on its use in different settings, a two-part symposium on the topic that includes several articles has been published in AACN Advanced Critical Care, with one article focusing specifically on pulmonary POCUS in the ICU.

Healio spoke with Shameek Gayen, MD, lead author of the article and assistant professor of medicine in the department of thoracic medicine and surgery at Temple University’s Lewis Katz School of Medicine, to learn more about the benefits of POCUS, how it is useful in pulmonology and practices to adopt when using this tool in the ICU.

Healio: What are some benefits of POCUS from both a clinician standpoint and a patient standpoint?

Gayen: The benefits of POCUS are shared for both clinicians and patients. POCUS is a very quick, noninvasive diagnostic tool that can be performed at the bedside at any time. The timing of the study is in the hands of the clinician, and patients do not have to worry about moving for another study when they are having difficulty breathing. With POCUS, clinicians can come to an assessment of breathing trouble or hypoxemia within minutes and quickly carry out a plan for patients to improve their symptoms almost instantaneously.

Healio: Who is eligible for pulmonary POCUS? What diseases can this tool detect?

Gayen: In short — anyone! Because it is a quick and noninvasive test that can be done at the bedside, any patient with shortness of breath or hypoxemia is eligible for pulmonary POCUS. Pulmonary POCUS can detect a whole scope of pulmonary diseases, ranging from pulmonary edema due to heart failure, pneumonia, pleural effusions and pneumothorax.

Healio: Why may POCUS be favored over chest radiography and chest CT?

Gayen: The primary reason POCUS may be favored is how quickly the test can be performed. POCUS can be performed as soon as the patient complains of shortness of breath or as soon as oxygen levels drop. Chest radiography and chest CT often require waiting for the test to be completed, which can delay diagnosis and, in turn, action. Also, POCUS can more reliably detect conditions than chest radiography, in particular pleural effusions and their size and complexity, smaller pneumothoraxes, etc.

Healio: What are some good practices when performing pulmonary POCUS for patients in the ICU?

Gayen: Appropriately positioning both the patient and the ultrasound probe is essential. Obviously, knowledge of pulmonary anatomy on the ultrasound is crucial as well. Familiarity with the Basic Lung Ultrasound Examination, or BLUE, protocol, which developed a systematic method for using pulmonary POCUS when assessing patients, is beneficial for clinicians incorporating pulmonary POCUS in their care of patients in the ICU.

Healio: Are there any downsides to POCUS or challenges that need to be overcome before it can become widely implemented?

Gayen: I can’t think of any downsides or challenges. Education in POCUS is becoming more and more widespread and built into medical training for both critical care and general medicine, and the majority of ICUs have ultrasounds readily available for use.

Healio: What does the future of POCUS look like in pulmonology? How do you think this tool will grow over the years?

Gayen: The future is bright! I can see POCUS becoming a standard part of the physical exam when assessing patients along with auscultation with the stethoscope. POCUS is built into medical training, and more and more clinicians over the years will be familiar with and comfortable using POCUS.

References:

• Gayen S, et al. AACN Adv Crit Care. 2023;doi:10.4037/aacnacc2023550.
• POCUS provides ICU clinicians clear benefits. https://www.aacn.org/newsroom/pocus-provides-icu-clinicians-clear-benefits. Published Oct. 17, 2023. Accessed Oct. 18, 2023.