Evaluating the effectiveness of chest physiotherapy treatment using lung ultrasound in an intensive care population

Lung ultrasound examinations, as an adjunct to standard clinical assessment, will be performed on mechanically ventilated patient’s pre and post standard care chest physiotherapy treatment during a single clinical physiotherapy session in the ICU stay. LU will be conducted by the research physiotherapist, Louise Hansell. The patient will be imaged in the semi-recumbent, 30-45 degree head-up, position. Lung ultrasound will be used to determine aeration patterns prior to delivery of physiotherapy treatment, and again following treatment, with a lung ultrasound score and lung reaeration score assigned to demonstrate the amount of focal and global aeration change. It is estimated that each lung ultrasound will take between 15-30 minutes. Lung auscultation and chest radiographs obtained from conventional respiratory bedside assessment as well as physiological measures (including arterial blood gas data, peripheral oxygen saturations, respiratory rate, tidal volume, pressure support and positive end expiratory pressure values as appropriate, PaO2/FiO2 ratio and static lung compliance (tidal volume on driving pressure) if in mandatory ventilation mode) will also be used to determine aeration change. Standard care chest physiotherapy for ventilated patients will vary between patients depending on the location of atelectasis and the clinical decision made by the clinical physiotherapist. Treatment typically comprises of positioning, mobilisation, manual/ventilator hyperinflation, Percussions/vibrations/shakes, suctioning or augmented cough, or a combination of any of these techniques. For all patients who have undergone LU, results of thoracic CT scans performed for clinical purposes (if available) within 12hrs of having LU will also be collected. Presence or absence of acute lobar atelectasis on LU, chest radiograph and CT will be recorded.