Hansell Louise, Milross Maree, Ntoumenopoulos George
Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Sydney, Australia.
Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
Aust Crit Care. 2025 Mar;38(2):101114. doi: 10.1016/j.aucc.2024.08.010. Epub 2024 Sep 20.
Positioning is an important physiotherapy treatment modality for the management of aeration loss associated with acute lobar atelectasis (ALA). Physiotherapists typically rely on lung auscultation and interpretation of chest x-ray (CXR) to inform treatment selection. These tools lack diagnostic accuracy, which could limit the ability of a physiotherapist to locate ALA and select an appropriate treatment position.
The objectives of this study were to determine the number of clinical physiotherapist treatment positions found to be in agreement with lung ultrasound (LUS)-identified aeration loss and to determine the diagnostic accuracy of CXR and lung auscultation against LUS as the reference standard for locating aeration loss in mechanically ventilated patients with ALA.
A prospective cohort study was conducted in a tertiary teaching hospital in Sydney. Mechanically ventilated adult patients in critical care with ALA were included. Physiotherapist-selected positions were compared against location of aeration loss based on LUS results to determine appropriateness. Location of aeration loss as identified by CXR results and lung auscultation was compared against LUS as the reference standard to determine diagnostic accuracy.
Forty-three participants were included in this study. Four out of 43 patients (9.3%) were positioned appropriately. The rate of true positives for CXR and auscultation in locating aeration loss were highest in the lower lobes. Lung auscultation had higher sensitivities (16.7%-97.4%) than CXR (0%-59.5%) in a majority of lobes when detecting location of aeration loss. CXR had higher specificities (16.7%-100%) than lung auscultation (0%-64.9%) in a majority of lobes when detecting location of aeration loss.
Physiotherapists did not deliver appropriate positioning in a majority of cases. Overall, the diagnostic accuracy of lung auscultation and CXR in detecting location of ALA was low. Correctly locating lung aeration loss is imperative to ensure appropriate respiratory physiotherapy positions are selected. Physiotherapists should consider additional assessment tools such as LUS to increase their diagnostic ability.
体位摆放是治疗与急性肺叶不张（ALA）相关的通气丧失的一种重要物理治疗方式。物理治疗师通常依靠肺部听诊和胸部X光片（CXR）解读来指导治疗方案的选择。这些工具缺乏诊断准确性，这可能会限制物理治疗师定位ALA并选择合适治疗体位的能力。
本研究的目的是确定临床物理治疗师选择的治疗体位与肺部超声（LUS）确定的通气丧失相符的数量，并以LUS作为定位ALA的机械通气患者通气丧失的参考标准，确定CXR和肺部听诊相对于LUS的诊断准确性。
在悉尼的一家三级教学医院进行了一项前瞻性队列研究。纳入重症监护病房中患有ALA的机械通气成年患者。将物理治疗师选择的体位与基于LUS结果的通气丧失位置进行比较，以确定其合适性。将CXR结果和肺部听诊确定的通气丧失位置与作为参考标准的LUS进行比较，以确定诊断准确性。
本研究纳入了43名参与者。43名患者中有4名（9.3%）体位摆放合适。CXR和听诊在定位通气丧失时的真阳性率在下叶最高。在大多数肺叶中，检测通气丧失位置时，肺部听诊的敏感性（16.7%-97.4%）高于CXR（0%-59.5%）。在大多数肺叶中，检测通气丧失位置时，CXR的特异性（16.7%-100%）高于肺部听诊（0%-64.9%）。
在大多数情况下，物理治疗师没有进行合适的体位摆放。总体而言，肺部听诊和CXR检测ALA位置的诊断准确性较低。正确定位肺部通气丧失对于确保选择合适的呼吸物理治疗体位至关重要。物理治疗师应考虑使用诸如LUS等额外的评估工具来提高其诊断能力。
