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  • Thoracic ultrasound influences physiotherapist’s clinical decision-making in respiratory management of critical care patients: a multicentre cohort study

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Critical care
Original research
Thoracic ultrasound influences physiotherapist’s clinical decision-making in respiratory management of critical care patients: a multicentre cohort study
  1. Aymeric Le Neindre1,2,
  2. Louise Hansell3,4,
  3. Johan Wormser5,
  4. Andreia Gomes Lopes6,
  5. Carlos Diaz Lopez7,
  6. Christophe Romanet5,
  7. Gerald Choukroun8,
  8. Maxime Nguyen9,
  9. François Philippart5,
  10. Pierre-Grégoire Guinot9,
  11. Hergen Buscher10,11,
  12. Bélaid Bouhemad2,9,
  13. George Ntoumenopoulos12
  1. 1 Respiratory Intensive Care and Clinical Research Units, Hopital Forcilles, Ferolles-Attilly, France
  2. 2 UMR1231 - Lipide Nutrition Cancer, Université de Bourgogne, Dijon, France
  3. 3 Physiotherapy, Royal North Shore Hospital, St Leonards, New South Wales, Australia
  4. 4 Sydney School of Health Sciences, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
  5. 5 Intensive Care Unit, Fondation Hopital Saint Joseph, Paris, France
  6. 6 Physiotherapy and Clinical Research Units, Hopital Forcilles, Ferolles-Attilly, France
  7. 7 Physiotherapy, Hopital Forcilles, Ferolles-Attilly, France
  8. 8 Soins intensifs respiratoires & Réadaptation post-réanimation, Hopital Forcilles, Ferolles-Attilly, Île-de-France, France
  9. 9 Anesthesiology and Intensive Care Medicine, University Hospital Centre of Dijon, Dijon, France
  10. 10 Intensive Care Unit, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
  11. 11 South Western Sydney Clinical School, University of New South Wales, Liverpool, New South Wales, Australia
  12. 12 Physiotherapy, St Vincent's Hospital Sydney, Darlinghurst, New South Wales, Australia
  1. Correspondence to Professor Bélaid Bouhemad, Pole Anesthesie Reanimations Chirurgicales Urgences et Medecine legale, Centre Hospitalier Universitaire de Dijon, 21000 Dijon, France; belaid_bouhemad{at}hotmail.com

Abstract

Background The potential influence of thoracic ultrasound on clinical decision-making by physiotherapists has never been studied. The aim of this study was to assess the impact of thoracic ultrasound on clinical decision-making by physiotherapists for critical care patients.

Methods This prospective, observational multicentre study was conducted between May 2017 and November 2020 in four intensive care units in France and Australia. All hypoxemic patients consecutively admitted were enrolled. The primary outcome was the net reclassification improvement (NRI), quantifying how well the new model (physiotherapist’s clinical decision-making including thoracic ultrasound) reclassifies subjects as compared with an old model (clinical assessment). Secondary outcomes were the factors associated with diagnostic concordance and physiotherapy treatment modification.

Results A total of 151 patients were included in the analysis. The NRI for the modification of physiotherapist’s clinical decisions was—40% (95% CI (−56 to −22%), p=0.02). Among the cases in which treatment was changed after ultrasound, 41% of changes were major (n=38). Using a multivariate analysis, the physiotherapist’s confidence in their clinical diagnosis was associated with diagnostic concordance (adjusted OR=3.28 95% CI (1.30 to 8.71); p=0.014). Clinical diagnosis involving non-parenchymal conditions and clinical signs reflecting abolished lung ventilation were associated with diagnostic discordance (adjusted OR=0.06 95% CI (0.01 to 0.26), p<0.001; adjusted OR=0.26 95% CI (0.09 to 0.69), p=0.008; respectively).

Conclusion Thoracic ultrasound has a high impact on the clinical decision-making process by physiotherapists for critical care patients.

Trial registration number NCT02881814; https://clinicaltrials.gov.

  • imaging/CT MRI etc
  • critical care

Data availability statement

Data are available upon reasonable request. Individual participant data that underlie the results are reported in this article, after deidentification, and study protocol, statistical analysis plan and analytic code are available immediately following publication, with no end date. Investigators whose proposed use of the data have been approved by an independent review committee identified for this purpose, to achieve aims in the approved proposal. Proposals should be directed to aymeric.leneindre@gmail.com. To gain access, data requestors will need to sign a data access agreement.

http://dx.doi.org/10.1136/thoraxjnl-2021-218217

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    Data availability statement

    Data are available upon reasonable request. Individual participant data that underlie the results are reported in this article, after deidentification, and study protocol, statistical analysis plan and analytic code are available immediately following publication, with no end date. Investigators whose proposed use of the data have been approved by an independent review committee identified for this purpose, to achieve aims in the approved proposal. Proposals should be directed to aymeric.leneindre@gmail.com. To gain access, data requestors will need to sign a data access agreement.

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    Footnotes

    • Twitter @georgentou1

    • Presented at Abstract presentation: European Respiratory Society International Congress, September 7, 2021.

    • Contributors BB is the guarantor of the content of the manuscript. BB, ALN, LH and GN have full access to all of the data in the study; take responsibility for the integrity of the data and the accuracy of the data analysis; contributed to the study concept and design; performed the data collection and analysis, and drafted the manuscript. JW, AGL, CDL, GC, MN, FP, P-GG and HB contributed to the analysis and interpretation of data, critically and substantially revising the manuscript. All authors approved the final version of the manuscript.

    • Funding This work was sponsored by the Groupe Hospitalier Paris Saint-Joseph and the Australasian Society of Ultrasound in Medicine Research Grant 2018.

    • Disclaimer The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.