Quantification of changes in lung aeration associated with physiotherapy using lung ultrasound in mechanically ventilated patients: a prospective cohort study

Louise Hansell; Maree Milross; Anthony Delaney; Chung Mo Koo; David H Tian; George Ntoumenopoulos

doi:10.1016/j.physio.2022.11.003

Quantification of changes in lung aeration associated with physiotherapy using lung ultrasound in mechanically ventilated patients: a prospective cohort study

Physiotherapy. 2023 Jun:119:26-33. doi: 10.1016/j.physio.2022.11.003. Epub 2022 Nov 17.

Authors

Louise Hansell¹, Maree Milross², Anthony Delaney³, Chung Mo Koo⁴, David H Tian⁵, George Ntoumenopoulos⁶

Affiliations

¹ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, St Leonards, Sydney, Australia. Electronic address: Louise.Hansell@health.nsw.gov.au.
² Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia. Electronic address: Maree.Milross@sydney.edu.au.
³ Malcolm Fisher Department of Intensive Care Medicine, Royal North Shore Hospital, Sydney, Australia; Division of Critical Care, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia; ANZIC Research Centre, Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia. Electronic address: ADelaney@georgeinstitute.org.au.
⁴ Department of Radiology, Royal North Shore Hospital, St Leonards, Sydney, Australia; Department of Nuclear Medicine, Royal North Shore Hospital, St Leonard, Sydney, Australia. Electronic address: chungmokoo@gmail.com.
⁵ Division of Critical Care, The George Institute for Global Health, University of New South Wales, Sydney, Australia; Department of Anaesthesia and Perioperative Medicine, Westmead Hospital, Australia. Electronic address: drdavidtian@gmail.com.
⁶ Physiotherapy Department, St Vincent's Hospital, Sydney, Australia. Electronic address: georgentou@yahoo.com.

PMID: 36706623
DOI: 10.1016/j.physio.2022.11.003

Abstract

Background: Lung ultrasound (LUS) is a novel and emerging tool for physiotherapists in ICU and may provide a way of monitoring lung aeration change in response to respiratory physiotherapy treatment during a patient's ICU stay.

Objective: To measure change in the LUS score associated with a respiratory physiotherapy treatment; to determine whether change in LUS score correlates with other physiological measures.

Design and setting: A single-centre prospective cohort study was undertaken in a tertiary teaching hospital in Sydney, Australia.

Patients: Adult mechanically ventilated patients in ICU with suspicion of atelectasis.

Measurements: Primary outcome: pre-post difference in LUS score.

Secondary outcomes: PaO₂/FiO₂ (PF) ratio, tidal volume (V_T), lung auscultation score, driving pressure (DP) and the modified radiological atelectasis score (mRAS) on CXR.

Results: 43 patients were included. There was a mean improvement in total LUS score after physiotherapy treatment of - 2.9 (95%CI -4.4, -1.4), and a mean improvement in LUS of the right and left lungs of - 1.6 (-2.5, -0.7) and - 1.3 (-2.5, -0.1) respectively. There was a mean improvement in PF ratio, V_T and auscultation score of 10.4 (-11.89, 32.7), 19 (-7.4, 44.5) and - 1.8 (-2.6, -1.0) respectively. There was no improvement in mRAS or DP. There was a weak correlation between change in LUS score compared with change in mRAS score.

Limitations: Limitations included the prospective cohort single site design and the small sample size.

Conclusions: The LUS score can be used to detect changes in lung aeration associated with respiratory physiotherapy treatment for acute lobar atelectasis in mechanically ventilated patients. Australian and New Zealand Clinical Trials Registry Number: ACTRN12619000783123. CONTRIBUTION OF THE PAPER.

Keywords: Atelectasis; Lung ultrasound; POCUS; Respiratory physiotherapy treatment.

MeSH terms

Adult
Australia
Humans
Lung / diagnostic imaging
Physical Therapy Modalities
Prospective Studies
Pulmonary Atelectasis* / diagnostic imaging
Pulmonary Atelectasis* / therapy
Respiration, Artificial*
Ultrasonography