CHEST Guidelines-Better-With-Ultrasound_2020

Better-With-Ultrasound_2020_chest
Pdf Summary
The paper "Better With Ultrasound: Thoracic Ultrasound" by Ariel Hendin, Seth Koenig, and Scott J. Millington highlights the advantages and methods of using thoracic ultrasound (also known as lung ultrasound, LUS) over traditional chest radiographs or physical examinations for diagnosing respiratory conditions such as pneumonia, pulmonary edema, pleural effusion, and pneumothorax. The authors stress that ultrasound is more accurate, quick to perform, and involves no ionizing radiation, making it suitable for settings that require frequent monitoring and aid in guiding clinical management without the need for patient transport.<br /><br />Thoracic ultrasound can easily be learned through the basic "building block" techniques, despite the initially daunting appearance, as these techniques are fundamentally straightforward. The authors of the paper do not advocate for a specific ultrasound scanning protocol but instead focus on core techniques like scanning the anterior pleural line, searching for A and B lines, and examining areas for consolidation and effusion. The paper refers to the BLUE (bedside lung ultrasound in emergency) protocol landmarks as a starting point for those learning the technique, encouraging customization with experience.<br /><br />The paper highlights multiple advantages of thoracic ultrasound, such as its high sensitivity and specificity in identifying various lung diseases, surpassing those of a chest radiograph. For example, LUS demonstrates high sensitivity (90%-97%) and specificity (94%-99%) for pneumonia and can detect pleural effusions as small as 5 to 20 mL, much smaller than what chest radiographs can typically reveal.<br /><br />Furthermore, ultrasound is particularly beneficial in critical care settings where transporting unstable patients may not be viable. It also offers procedural guidance for interventions like thoracentesis or chest tube placements and can be used for ongoing assessment of respiratory and volume status.<br /><br />In conclusion, thoracic ultrasound provides a powerful, non-invasive diagnostic and monitoring tool for respiratory conditions in emergency and critical care, offering real-time, repeatable imaging without the risks associated with radiation exposure.
Keywords
thoracic ultrasound
lung ultrasound
respiratory conditions
pneumonia
pulmonary edema
pleural effusion
pneumothorax
BLUE protocol
high sensitivity
critical care