Lung ultrasound: an up-and-coming tool and skill

Chest x-ray and stethoscopes are the diagnostic tools acute respiratory physiotherapists commonly use to diagnose pulmonary complications. These tools, however, lack reliability and accuracy in the acute setting. Lung ultrasound (LUS) is a form of point-of-care ultrasound (PoCUS) and is a radiation-free, non-invasive diagnostic tool that can be used right at the bedside. LUS is comparable to computerised tomography (the gold standard for identifying pulmonary pathologies) and is superior to chest x-ray and auscultation in diagnostic accuracy. With the added benefit of its lack of radiation and more portable nature than chest x-ray and computerised tomography, LUS is increasingly becoming a tool of interest. Respiratory physiotherapists are beginning to gain accreditation in LUS, with more than 100 currently accredited across the UK. 

Research has been conducted on the use of LUS by other professions, but little currently exists on its use by physiotherapists. PoCUS is not new to physiotherapy – it is used across a range of specialisms (for example musculoskeletal, rheumatology, pelvic health and neurology). From the current literature, LUS appears to impact clinical decision-making and influence management planning for critically ill patients. Although more research is needed to inform clinical recommendations, the current evidence-base is in favour of LUS-use by physiotherapists.

Within the short time I have been performing LUS in my practice, I have found it to be an excellent tool to assist in differential diagnosis and achieve a more in-depth investigation into a patient’s condition. I often use LUS when my patient is not progressing, to assess treatment effectiveness, or to assess why physiotherapy is not having the desired effect. 

I once performed LUS and found two large pleural effusions in a patient who was acutely unwell for weeks, for no apparent reason, despite receiving physiotherapy. 

LUS is an up-and-coming tool within respiratory practice and has potential to change the way we assess and treat our patients; those looking to work in this field should take notice.