Lung Ultrasound Images Acquired and Assessed by Respiratory Care Students: Training Model Development

Abstract

Background:

Lung ultrasound (LUS) is a rapid non-invasive evidence-based assessment considered superior to the portable chest x-ray for evaluation of many acute conditions (Volpicelli et al 2012, Lichtenstein 2015). It was never designed who should hold the LUS probe (Lichtenstein 2016) placing impetus on expansion of assessment skills of the respiratory care practitioner (RCP) who assists the physician in the evaluation of the critically ill. This study sought to observe student pre-clinical self-efficacy for LUS upon completion of didactic training. This study also sought to identify physician perceptions of RCP involvement in LUS. This appears to be the first description of a LUS training model for RCP students noting a related study in Singapore (See et al 2016).

Methods:

IRB approval was obtained to survey perceptions of BS Respiratory Care students and physicians related to LUS training. In developing a training model, an evidence-based, standardized LUS protocol was sought that was practical to learn. The basic BLUE-Protocol (Lichtenstein, 2015) was selected following hands-on ICU practice by this author the author of the BLUE-Protocol, Daniel Lichtenstein. Twelve student participants were recruited. Also, 4 physicians were surveyed who were the medical director for respiratory care, the director of physician ultrasound training, and two critical care intensivists at our university medical center. BLUE-Protocol training during 8 hours over a 3-week period included how to place the probe and acquire images, how to recognize ten basic lung ultrasound signs, and identify seven BLUE-profiles.

Results:

All twelve students enrolled in LUS training mastered the ten signs of the BLUE-Protocol by examination and along with physicians had positive perceptions pertaining to RCPs performing LUS. See image.

Conclusions:

A LUS training model was completed by 12 students who elicited positive self-efficacy and perception of LUS usefulness. All of surveyed students (100%; n=12) and all of the physicians (100%; n=4) acknowledged the BLUE-Protocol to be an understood protocol for LUS practice. As this was a pilot study, further study evaluating a LUS training model with a larger sample size and using multi-centers is needed to confirm these results. Furthermore, study to establish LUS assessment accuracy by RCP students is needed; such may be accomplished using an inter rater assessment form by blinded physician evaluation.