British Thoracic Society Training Standards for Thoracic Ultrasound (TUS)

Stanton, Andrew; Edey, Anthony; Evison, Matthew; Forrest, Ian; Hippolyte, Sabrine; Kastelik, Jack A.; Latham, Jennifer; Loewenthal, Lola; Roberts, Mark; Smallwood, Nicholas; Park, John E. S.

doi:10.1136/bmjresp-2019-000552

Cited by 23 publications

(29 citation statements)

References 11 publications

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“…Clinical data included the patient's age and sex, presenting symptoms, medical history, oxygen saturation from pulse oximetry, and chest radiograph. A level 4 operator (entrusted to act unsupervised) in critical care ultrasound who was blinded to the RT‐PCR results, 4 if available at the time of examination, performed the lung ultrasound within 12 hours of the patient's admission to the ICU (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

Appropriateness of lung ultrasound for the diagnosis of COVID‐19 pneumonia

Bitar

Shamsah

Maadarani

et al. 2021

Health Science Reports

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Background Chest radiography (CXR) and computerized tomography (CT) are the standard methods for lung imaging in diagnosing COVID‐19 pneumonia in the intensive care unit (ICU), despite their limitations. This study aimed to assess the performance of bedside lung ultrasound examination by a critical care physician for the diagnosis of COVID‐19 pneumonia during acute admission to the ICU. Method This was an observational, prospective, single‐center study conducted in the intensive care unit of Adan General Hospital from April 10, 2020, to May 26, 2020. The study included adults with suspicion of COVID‐19 Infection who were transferred to the ICU. Patients were admitted to the ICU directly from the ED after reverse transcriptase‐polymerase chain reaction (RT‐PCR) swabs were sent to the central virology laboratory in Kuwait, and the results were released 16 to 24 hours after the time of admission. A certified intensivist in critical care ultrasound performed the lung ultrasound within 12 hours of the patient's admission to the ICU. The treating physician confirmed the diagnosis of COVID‐19 pneumonia based on a set of clinical features, inflammatory markers, biochemical profile studies, RT‐PCR test results, and CXR. Results Of 77 patients with suspected COVID‐19 pneumonia, 65 (84.4%) were confirmed. The median age of the patients was 48 (31‐68) years, and 51 (71%) were men. In the group of patients with confirmed COVID‐19 pneumonia, LUS revealed four signs suggestive of COVID‐19 pneumonia in 63 patients (96.9%) (sensitivity 96.9%, CI 85%‐99.5%). Two patients presented with unilateral lobar pneumonia without other ultrasonic signs of COVID‐19 pneumonia but with positive RT‐PCR results. Among patients in the group without COVID‐19 pneumonia who had negative RT‐PCR results, 11 (91.7%) were LUS negative for COVID‐19 pneumonia (specificity 91.7%, 95% CI 58.72%‐99.77%). Conclusions During the COVID‐19 outbreak, LUS allows the identification of early signs of interstitial pneumonia. LUS patterns that show a combination of the four major signs offer high sensitivity and specificity compared to nasopharyngeal RT‐PCR.

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Section: Methodsmentioning

confidence: 99%

Appropriateness of lung ultrasound for the diagnosis of COVID‐19 pneumonia

Bitar

Shamsah

Maadarani

et al. 2021

Health Science Reports

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“…The British Thoracic Society (BTS) has recently produced a Thoracic Ultrasound Training Standard. 16 This new training pathway aims to create a new pool of thoracic ultrasound operators that can provide thoracic ultrasound in an emergency scenario, for example, out of hours large pleural effusion requiring…”

Section: Future Applicationsmentioning

confidence: 99%

Pulmonary passport: a service evaluation study of a standardised web-based procedure logbook to aid specialist respiratory training and appraisal

et al. 2020

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IntroductionThe pulmonary passport (PP) is a secure web-based procedural logbook for specialist respiratory trainees with enhanced functionality that includes automated analysis to provide key performance metrics and in-platform interactions with supervisors.MethodsThis service evaluation study used preimplementation and postimplementation online surveys in both trainees and supervisors along with analysis of recorded data within the PP to evaluate the impact of this service on data capture, training, appraisal and quality assurance.ResultsFrom August 2017 to August 2019, 69/73 (95%) specialist respiratory trainees eligible to use the PP across two UK health education deaneries registered with the system and logged 7352 procedures. 3105 thoracic ultrasound procedures identified 2145 pleural effusions and resulted in 1253 pleural procedures of which 96% were successful. 4% of ultrasounds required referral to a more expert sonographer. Iatrogenic bleeding and pneumothorax both occurred in ≤1% of all pleural procedures. 1909 basic diagnostic bronchoscopies were recorded including 1236 bronchial washes, 328 brushes and 221 endobronchial biopsies where definite tumour was identified (biopsy sensitivity 74%). Preimplementation and postimplementation survey data confirmed the PP had increased the consistency of logging procedures by trainees, the depth of data captured, the review of procedural performance metrics in appraisal and the frequency of formal supervisor feedback.DiscussionIn this regional project, the implementation of a web-based procedural logbook has been feasible with excellent uptake and has enhanced procedural recording, supervision and appraisal. Furthermore, it provides unprecedented quality assurance at an individual trainee, trust and deanery level and has a number of potential wider applications in the future.

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“…Widespread thoracic ultrasound use has reduced the incidence of complications [6] which can include incorrect placement, drain displacement, bleeding, infection, failure to place the drain, pneumothorax, surgical emphysema, re-expansion pulmonary oedema and death. BTS guidance now further mandates preprocedure invasive checklists [7].…”

Section: Introductionmentioning

confidence: 99%

Complications after Thoracocentesis and Chest Drain Insertion: A Single Centre Study from the North East of England

Jackson

Kafi

Bhullar

et al. 2021

JoR

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Introduction: There are no prospective studies looking at complications of pleural procedures. Previous British Thoracic Society Pleural audits and retrospective case series inform current practice. Incidence of any complication is between 1–15%. We sought to add to the existing literature and inform local practice with regards to intercostal drains and thoracocenteses. Methods: Local Caldicott approval was sought for a review of all inpatient adult pleural procedures coded as ‘T122 drainage of pleural cavity’ and ‘T124 insertion of tube drain into pleural cavity’. Those undergoing thoracocentesis (all with a Rocket 6 Fg catheter) and intercostal drain insertion (ICD, all with Rocket 12 Fg drain) were identified. Continuous variables are presented as mean (±range) and categorical variables as percentages where appropriate. Results: 1159 procedures were identified. A total of 199 and 960 were done for pneumothorax and effusions respectively. Mean age was 68.1 years (18–97). There were 280 thoracocenteses and 879 ICDs. Bleeding occurred in 6 (0.5%), all ICDs (clotting and platelets were within normal range; one patient was on aspirin and one on aspirin and clopidogrel). All settled except for one who had intercostal artery rupture needing cardiothoracic intervention (no anti-coagulation). Nine pneumothoraces occurred (0.78%) in seven ICDs and two aspirations). There were three definite pleural space infections (0.3%) with three ICDs. Fall out rates for ICDs were 35 (3%). Nine were not sutured, and out of those, seven inserted in the Accident and Emergency department, out of hours. All others ‘came out’ due to patient factors (previous quoted rates up to 14%). Surgical emphysema occurred in 43 (41 ICDs), 3.7%. Eight were due to fall outs and three required surgical intervention. There was no re-expansion pulmonary oedema nor direct deaths. Conclusions: Complication rates of ICD and thoracocenteses are low. Checklists might help to remind operators of the need for suturing. Limitations of this study are its retrospective nature and reliance on correct hospital coding. We are currently contributing to a prospective observational study on pleural complications.

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British Thoracic Society Training Standards for Thoracic Ultrasound (TUS)

Cited by 23 publications

References 11 publications

Appropriateness of lung ultrasound for the diagnosis of COVID‐19 pneumonia

Appropriateness of lung ultrasound for the diagnosis of COVID‐19 pneumonia

Pulmonary passport: a service evaluation study of a standardised web-based procedure logbook to aid specialist respiratory training and appraisal

Complications after Thoracocentesis and Chest Drain Insertion: A Single Centre Study from the North East of England

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