CHEST Guidelines-Response_chest

Response_chest_3

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This document presents an academic correspondence in the medical journal "Chest" concerning the use of ultrasound techniques in pleural procedures for critically ill patients. Dr. Jansen Koh from the Department of Respiratory and Critical Care Medicine at Changi General Hospital, Singapore, provides feedback on an article by Dr. Scott J. Millington and Dr. Seth Koenig. Dr. Koh appreciates the article but offers constructive criticism on their methodologies. He highlights the risks associated with using ultrasound-assisted techniques that do not employ real-time needle guidance, particularly when larger pleural effusions are involved. Koh recommends a repeat landmarking scan whenever there is a patient movement, or alternatively, employing real-time ultrasound-guided techniques.<br /><br />Dr. Koh also brings up discrepancies in the technique for quantifying pleural effusion size compared to referenced articles. He notes the cited method uses the posterior axillary line with the patient at 15 degrees, while Millington and Koenig recommended the mid-axillary line with the patient supine. Koh suggests including a "common errors" section in future articles to help learners avoid frequent mistakes.<br /><br />In response, Drs. Millington and Koenig express gratitude for the constructive feedback, acknowledging the importance of discussions to address disparities in techniques. They agree with the criticisms and express their intent to incorporate a "common errors" section in future publications to enhance educational value. The correspondence emphasizes the importance of continuous dialogue and feedback in advancing clinical practices and education, particularly in complex medical procedures.

Keywords

ultrasound techniques

pleural procedures

critically ill patients

real-time guidance

pleural effusion

landmarking scan

common errors

clinical practices

medical education

constructive feedback