ERS statement on ultrasound-guided interventions in respiratory disease

BACKGROUND: The use of ultrasound to guide percutaneous thoracic interventions improves the safety and effectiveness of procedures and leads to reduced healthcare costs. A task force was convened to produce a statement on various clinical aspects of these procedures. METHODS: The task force included respiratory physicians and nurses, thoracic surgeons, radiologists and patient representatives. The statement covers the following procedures: thoracentesis; chest tube/indwelling catheter; medical thoracoscopy; and percutaneous biopsies of lung, pleura, mediastinum and cervical lymph nodes. Systematic searches were carried out for 18 PICO (patient, intervention, comparator, outcome) questions under five major topics to inform the writing of the statement. A narrative synthesis of the evidence from relevant literature is presented for each topic. Surveys and interviews with patients who underwent ultrasound-guided interventions were conducted to explore patient perspectives. RESULTS: A review of the evidence is presented on the use of ultrasound-guided interventions in diagnostic and treatment pathways for pleural and thoracic diseases (section 1); comparative data on the type/size of biopsy, chest tube size and disease outcome, and optimal settings for procedures and portable ultrasound (section 2); ultrasound-specific methodology and association with outcomes, real-time ultrasound guidance for different interventions, and contrast-enhanced ultrasound in procedure guidance (section 3); diagnostic yield/treatment success and complications (section 4); and training requirements (section 5). Major themes emerging from patient surveys and interviews are presented in section 6. Recommendations for future research conclude the statement. CONCLUSIONS: The use of ultrasound to guide percutaneous thoracic procedures is reported to show higher success and lower complication rates in the reviewed evidence. Further research is needed to better inform the procedural settings, techniques and training.