Applications of perioperative lung ultrasound: from the clinic to the ICU.

Abstract

Contemporary lung ultrasound (LUS) use spansmany disciplines, and its ability to favorably impact care and improve patient safety has been described extensively in emergency medicine and critical care populations. LUS has shown excellent diagnostic accuracy in respiratory failure associated with several common conditions many of which can impact patients in the perioperative period. Anesthesiologists have historically embraced technological advances to improve patient safety. Point-of-care ultrasound (POCUS), including LUS, is another tool which anesthesiologists should eagerly adopt and add to their armamentarium. LUS, like many other components of POCUS, may guide therapeutic procedures or provide rapid diagnostic information, which enables a provider to make better informed and time-sensitive clinical decisions. The American Board of Anesthesiology (ABA) and the Accreditation Council for Graduate Medical Education (ACGME) have also adopted changes which will ensure that current anesthesiology trainees are both trained and evaluated on their knowledge and proficiency with LUS. In 2021 the ACGME designated POCUS as a separate milestone in the category of Patient Care, and it is expected that residents will be able to detect pneumothorax and pleural effusion with transthoracic LUS. In 2022 the ABA will include LUS in addition to other aspects of POCUS as an item on the Content Outline for the Objective Structured Clinical Examination (OSCE) portion of the ABA Applied Examination. Several professional societies including the Society for Critical Care Medicine, the American Society of Echocardiography, and the American Society of Anesthesiologists have developed POCUS guidelines for its use across a wide range of clinical settings. Despite the endorsement of LUS by these societies, obstacles remain to its widespread adoption by anesthesiologists, most notably a lack of trained providers and heterogeneity in training programs. Recognizing the substantial utility of LUS in the perioperative setting and the fact that it is an expected milestone for anesthesiology trainees, this article will discuss practical aspects of the utilization of LUS in the perioperative period. This article is not intended to discuss the technical aspects of LUS image acquisition or image interpretation, but rather it is practical application in a busy clinical setting.