Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Institute for Breathing and Sleep, Austin Health, Melbourne, Victoria, Australia.
Intern Med J. 2014 Jan;44(1):50-6. doi: 10.1111/imj.12290.
There is strong evidence that direct ultrasound localisation for pleural aspiration reduces complications, but this practice is not universal in Australia and New Zealand.
To describe the current utilisation and logistical barriers to the use of direct ultrasound localisation for pleural aspiration by respiratory physicians from Australia and New Zealand, and to determine the cost benefits of procuring equipment and training resources in chest ultrasound.
We surveyed all adult respiratory physician members of the Thoracic Society of Australia and New Zealand regarding their use of direct ultrasound localisation for pleural aspiration. We performed a cost-benefit analysis for acquiring bedside ultrasound equipment and estimated the capacity of available ultrasound training.
One hundred and forty-six of 275 respiratory physicians responded (53% response). One-third (33.6%) of respondents do not undertake direct ultrasound localisation. Lack of training/expertise (44.6%) and lack of access to ultrasound equipment (41%) were the most frequently reported barriers to performing direct ultrasound localisation. An average delay of 2 or more days to obtain an ultrasound performed in radiology was reported in 42.7% of respondents. Decision-tree analysis demonstrated that clinician-performed direct ultrasound localisation for pleural aspiration is cost-beneficial, with recovery of initial capital expenditure within 6 months. Ultrasound training infrastructure is already available to up-skill all respiratory physicians within 2 years and is cost-neutral.
Many respiratory physicians have not adopted direct ultrasound localisation for pleural aspiration because they lack equipment and expertise. However, purchase of ultrasound equipment is cost-beneficial, and there is already sufficient capacity to deliver accredited ultrasound training through existing services.
有强有力的证据表明，直接超声定位用于胸腔穿刺可减少并发症，但这种做法在澳大利亚和新西兰并不普遍。
描述澳大利亚和新西兰呼吸科医生目前对直接超声定位用于胸腔穿刺的使用情况和使用障碍，并确定在胸部超声方面采购设备和培训资源的成本效益。
我们调查了澳大利亚和新西兰胸科学会的所有成年呼吸科医生会员，了解他们对直接超声定位用于胸腔穿刺的使用情况。我们对获取床边超声设备进行了成本效益分析，并估计了可用超声培训的能力。
275 名呼吸科医生中有 146 名（53%的回应率）做出了回应。三分之一（33.6%）的受访者不进行直接超声定位。缺乏培训/专业知识（44.6%）和缺乏超声设备（41%）是进行直接超声定位的最常报告的障碍。42.7%的受访者报告说，在放射科进行超声检查平均需要 2 天或更长时间才能获得结果。决策树分析表明，临床医生进行胸腔穿刺的直接超声定位具有成本效益，初始资本支出可在 6 个月内收回。在 2 年内，已经有足够的能力通过现有服务来提升所有呼吸科医生的超声培训基础设施，且无需成本。
许多呼吸科医生尚未采用直接超声定位用于胸腔穿刺，因为他们缺乏设备和专业知识。然而，购买超声设备具有成本效益，并且已经有足够的能力通过现有服务提供认证的超声培训。
