Should point-of-care ultrasonography replace stethoscopes in acute respiratory failure?

Abstract

Ultrasonography would be a better diagnostic test than auscultation or chest radiography, say Nicholas Smallwood and colleagues. But Mark Hew and colleagues argue the costs are hard to justify without evidence that it would improve patient outcomes

The diagnostic accuracy of lung auscultation in adult patients with acute pulmonary pathologies: a meta-analysis

“…Segall et al stated in 1963: "By the year 2016, electronic systems of collecting and analysing data about the cardiovascular system may render the stethoscope obsolete. " 49 Next to newer stethoscopes, with computerized acoustic technology which can correlate lung sounds with disease states, lung ultrasonography (LUS) has been studied extensively and seems to fulfil the role of new modality as also fantasized by Segall 49,50 . LUS, which should be seen as part of the physical examination, has many potential advantages over lung auscultation and CXR: its high accuracy, quick and easy performance and interpretation at the bedside; dynamic imaging; avoidance of radiation and contrast burden; evaluation of disease progress; and reduction of costs 51 .…”

“…There is also evidence showing that LUS detects respiratory problems at an early stage and impacts clinical decision making 54,[57][58][59][60][61] . Therefore, it has been suggested before that LUS should replace lung auscultation 50,51,62 . Some important implemantations have to take place before LUS can be further implemented in today's Forrest plot of sensitivity and specificity together with their 95% confidence intervals for different acute pulmonary pathology.…”

“…For example, more ultrasounds devices have to be purchased and medical education has to shift its attention to ultrasonography 62 . Experts think these barriers for the implementation of LUS can relatively easily be tackled 50 www.nature.com/scientificreports www.nature.com/scientificreports/ conclusion This meta-analysis shows that in different patient populations with acute respiratory pathology, lung auscultation has a low sensitivity, LR + and AUC and an acceptable specificity and LR−. The results underline that auscultation only marginally alters the provisional diagnosis, although results are limited by a high risk of bias and heterogeneity of included studies.…”

Point-of-Care Ultrasound in Respiratory Failure

“…We were fascinated to read the yes-no debate in a recent issue of CHEST (September 2019) on the use of pointof-care ultrasound (POCUS) in the breathless patient, 1,2 particularly as some of us were involved with a similar publication recently. 3 We should declare we are clearly in favor of the "yes" camp and think it is important to highlight two important deficiencies in the "no" argument.…”

“…Second, the no debate ignores the elephant in the room: both auscultation and chest radiography have poor diagnostic utility in the diagnosis of the breathless patient. 3 We have to acknowledge this fact, or it is difficult to have a reasoned discussion about the possible alternatives. Although the data regarding lung ultrasound are not perfect (as reasonably highlighted by Corcoran and Laursen), we must not pretend that continuing with the current standard of care is an alternative with a good evidence base.…”