student profile: Mrs Louise Hansell


Thesis work

Thesis title: Diagnostic Lung Ultrasound in Critical Care: Evaluation of the effectiveness of physiotherapy treatment and feasibility of implementation

Supervisors: Jim ELLIOTT , Maree MILROSS

Thesis abstract:

�p��strong��span style="color:black"�Background�/span��/strong��span style="color:black"� The diagnostic accuracy of standard bedside respiratory assessment tools used by physiotherapists in intensive care units (ICU) is limited. Lung auscultation is subjective with poor intra-rater reliability. Chest radiographs expose patients to radiation are of limited value unless interpreted by an expert reader. Thoracic computed tomography is the gold standard for diagnosing lung pulmonary pathology, however brings with it its own limitations. Diagnostic lung ultrasound (LU) is a repeatable, portable and affordable assessment tool which eliminates radiation exposure. �/span��/p� �p��strong��span style="color:black"�Methods/Design�/span��/strong� A systematic search of published studies will be undertaken, comparing the diagnostic accuracy of LU for pleural effusion, lung consolidation and collapse, against comparators of lung auscultation and chest radiograph, with thoracic CT scan as the reference standard, in a mechanically ventilated adult population. Cinahl, The Cochrane Library, Embase, Medline, Web of Science and grey literature will be searched for relevant studies. Study setting, design and chactersistics will be extracted. Pooled sensitivity and specificity and positive and negative likelihood ratios will be calculated. Quality will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool.�/p� �p��span style="color:black"�A single group prospective cohort study (n=43) will also be conducted at Royal North Shore Hospital in Sydney. Data collection will take place over a six month period. Eligible adults are those in an ICU, mechanically ventilated for an expected period of greater than 24 hours, for whom chest physiotherapy is indicated but has not yet been delivered in their current admission and have a chest radiograph taken on the day lung ultrasound is performed. A clinical physiotherapist will perform their standard pre-treatment bedside respiratory assessment followed by the research physiotherapist performing a lung ultrasound and assigning a lung ultrasound aeration score. The clinical physiotherapist will then perform routine physiotherapy treatment and reassessment. The research physiotherapist will perform a post-treatment lung ultrasound and assigned lung ultrasound aeration score. The study aims to show agreement between lung ultrasound and standard bedside respiratory assessments to establish lung ultrasound as a useful clinical assessment tool for physiotherapists. The primary outcome measure will be the lung ultrasound aeration score. Secondary measures include time taken to perform lung ultrasound and diagnostic agreement between a novice and expert lung ultrasound physiotherapist. The sensitivity and specificity of the LUS score in detecting clinical change with chest physiotherapy treatment will be calculated. Kappa coefficient will be used to determine the agreement between the LU score and the clinical physiotherapists’ impression as to whether treatment has been effective or ineffective. The Kappa coefficient will also be used to determine the inter-rater reliability between a novice and expert LUS physiotherapist in assigning a lung ultrasound score. �/span��/p� �p��strong��span style="color:black"�Discussion�/span��/strong��span style="color:black"� This thesis discusses the background, design and intended analysis of a systematic review of diagnostic test accuracy and a prospective cohort study of a novel respiratory assessment tool for physiotherapists in intensive care. �/span��/p�

Note: This profile is for a student at the University of Sydney. Views presented here are not necessarily those of the University.