ORIGINAL ARTICLE • Results from a Spanish National Survey on the Application of Ultrasound in Pulmonology Services

BACKGROUND

While ultrasound use initially started for guidance during pleural procedures, over time it has proven useful in the assessment of the lung parenchyma, diaphragm, and chest wall. Therefore, it has become a basic first-line tool to establish a differential diagnosis in patients with dyspnea.

Lung ultrasound (LUS) is a technique performed in bronchopleural procedures units and in intermediate respiratory care units, but its use in conventional hospital floor settings or in pneumology consultations is not as well established.

The authors undertook this study to evaluate the current state of ultrasound use among pulmonologists in clinical settings. Their main objective was to describe current clinical care practices regarding the use of ultrasound and to collect data related to its use in pulmonology services, organizational and infrastructural factors, the portfolio of services available, and ultrasound teaching and research activity.

METHODS

This was a cross-sectional, national level, multicenter study through a survey sent to every member of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) working in hospitals with different levels of complexity. Every pulmonologist and medical intern residents (MIR) in this specialty who were SEPAR members and who may be involved in the routine use of LUS (in hospital wards, consultations, intermediate respiratory care units, or bronchopleural procedures area) were sent the study survey.

SEPAR members were contacted with the questionnaire by email and asked to complete it using an online platform. The survey included a total of 21 items, four of them designed to assess technological resources and the organization and infrastructure available for LUS, 12 items aimed to assess the portfolio of services available using this technique, and five items were used to understand the center’s involvement in teaching, training, and research related to ultrasound

RESULTS

Data from 104 publicly managed hospitals were analyzed in this work, of which 58 (55.8%) were highly complex centers, 30 (28.8%) were of intermediate complexity, and 16 (15.4%) were low-complexity centers.

Results related to organization and infrastructure

The authors found significant differences in the availability of ultrasound machines depending on the complexity of the care provided at the center. The pneumology service in high-complexity centers more often had at least 3 ultrasound machines compared to low-complexity centers (37.9% vs. 0%; p = 0.008), with the latter being more likely to share an ultrasound system with other services.

LUS was routinely used (in 56.7% of cases) both in the bronchopleural procedures area and in the hospital ward, with no differences between the center types. However, high- and intermediate-complexity care centers more often performed LUS exclusively in the bronchopleural procedures area compared to low complexity centers.

LUS was most often used to evaluate pleural effusion (91.3%), to determine a differential diagnosis between pulmonary pathologies (51.9%), and to rule out iatrogenic pneumothorax after completing a broncho-pleural procedure (50.9%). The least common uses for LUS were for the evaluation of vocal cord dysfunction (3.8%) and the use of elastography to study masses (7.6%) and pleural effusions (5.7%).

CONCLUSIONS

The authors concluded that the ultrasound use has increased in recent years, but not only in bronchopleural procedure units, but also in the context of conventional ward hospitalization, intermediate care units, and consultations. This expansion occurred while the availability of ultrasound machines in pneumology services has also increased because of the clear advantages of this technique.

The authors comment about the importance of gradually implementing ultrasound as the fifth pillar of the physical examination of every type of pulmonary pathology. Therefore, they suggest that pulmonologists must complete training to acquire advanced knowledge in this technique.