The Bottom Line on Point-of-Care Lung Ultrasound

Why Learn?

Lung ultrasonography has developed into an incredibly potent tool for the management of the breathless patient. Using a mix of analysis of actual images (effusions, consolidation, lung sliding) and the analysis of artefacts (A-lines, B-lines), in the right hands lung ultrasonography has sensitivity and specificity approaching CT scanning. And all done within 5-10 minutes at the bedside.

Limitations/Challenges

• Access to training/trainers and maintaining competencies.
• Debate remains around precise technique. Which probe- linear (for pleura), phased array, micro convex, or curvilinear? How many zones to scan- 6, 8, 12, 24?
• Potential for overdiagnosis and overtreatment- arguably lung ultrasonography picks up clinically insignificant pneumonias and pneumothoraces.
• To be performed properly it requires an ultrasound machine with all post processing (e.g. tissue harmonics) disabled. Not every unit has a machine that can do this.
• It remains an integrative skill involving history and examination, as opposed to an imaging tool that provides all the answers. True mastery involves a careful analytical approach, and potentially multi-organ ultrasonography skills (especially cardiac).

Resources

• International evidence-based recommendations for point of care lung ultrasound.
• Ultrasound podcast- Lungs with Vicki Noble Part 1 Part 2
• Holistic Ultrasound in the ICU-An overview of lung ultrasound (superb video series from Daniel Lichtenstein, the father of critical care lung ultrasonography)
• ICM Teaching- lung ultrasound
• the efficacy of bedside chest ultrasound- from accuracy to outcomes 
• University of Toronto Lung Ultrasound simulator