Think “Ultrasound First” When Evaluating for—and Preventing—Pneumothorax

April 25, 2012

I find it ironic that one of the most efficient ways to detect pneumothorax in patients is also one of the most effective ways to prevent two of its more common clinical causes.
While scenarios that might trigger the suspicion of pneumothorax are too numerous to list, screening for it has included the standard trinity of chest-imaging procedures: x-rays, tomography, and ultrasound. In “Think Ultrasound When Evaluating for Pneumothorax” (featured in AIUM’s Journal of Ultrasound in Medicine), author Vicki E. Noble, MD, of Massachusetts General, proposes that ultrasound is the ideal screening modality due to its portability and lack of “risk associated with repeated measures as clinical scenarios change.”
Dr. Noble’s article goes on to provide instruction for performing the examination, incorporates excellent research citations, and then concludes: “Using thoracic sonography as a screening tool may lead to decreased ordering of chest radiographs, thus saving time and money and improving the efficiency of treatment.”
It may come as no surprise that my colleagues and I at Sonosite enthusiastically support Dr. Noble’s conclusion. The entire article—a part of AIUM’s “think ultrasound first” Sound Judgment Series—is available here and is worth a thorough read.
Ultrasound not only helps to diagnose pneumothorax, but it can play a significant role in helping to prevent it. A leading procedural cause for it in hospital settings is a failed central line placement or a poorly executed thoracentesis. However, a growing body of research and documented clinical experience supports that ultrasound-guided central line placements and thoracentesis greatly reduce the number of failed attempts and resulting complications.
By using ultrasound guidance for central venous line placement, the Memorial Hermann Healthcare System was able to attain zero pneumothorax complications in multiple hospitals for a full year. See the full Memorial Hermann story. Additionally, a study in the Journal of Clinical Ultrasound, Sonographically Guided Thoracentesis and Rate of Pneumothorax, documented a 52% decrease in the occurrence of an iatrogenic pneumothorax complication with the use of ultrasound guidance. (Barnes TW, Morgenthaler TI, et al.)
Numerous studies have been published indicating the medical advantages of using ultrasound guidance for increased accuracy in performing thoaracentesis. United BioSource Corporation in a large study demonstrated that ultrasound guidance during thoracentesis also provides significant economic advantages by reducing occurrences of pneumothorax. You can read the evidence here.
I encourage you to review and distribute Dr. Noble’s article and the studies I’ve cited above. The more the medical establishment hears of the healthcare and economic benefits associated with the broader uses of ultrasound, the sooner more clinicians will—as the AIUM encourages—“think ultrasound first” when faced with many clinical scenarios.