An exploration on the use of lung ultrasound by physiotherapists within the cardiac surgery population.

Farrell, Casey Juliet

Abstract

Cardiac surgery places patients at a high risk of developing postoperative pulmonary complications (PPCs), some of which can have fatal consequences if not detected and treated in adequate time. Physiotherapists are an essential part of the postoperative team that aid in assessing for PPCs. Current diagnostic tools commonly used by physiotherapists postoperatively (e.g. chest x-ray and stethoscopes) lack reliability. Lung ultrasound (LUS) is a bedside diagnostic tool that has been shown to reliably detect PPCs when used by other healthcare professionals and may influence clinical decision-making. Physiotherapists use LUS, but currently there is a paucity of research exploring experiences or influence of LUS on physiotherapy practice. The aim of this thesis was to explore the use of LUS by physiotherapists within the cardiac surgery population through mapping the literature within a scoping review, empirically assessing the influence of LUS on pathology identification and management planning, exploring the perceptions and experiences of those engaging with LUS, exploring the current use of LUS with cardiac surgery patients, and exploring potential relationships between patient demographic and surgery details and changes in pathology identification and/or management. This thesis first presents a scoping review that mapped the literature on the use of LUS within the cardiac surgery population. A fully integrated convergent mixed methods study was conducted, beginning with a quantitative phase that empirically assessed the influence of LUS on pathology identification, management planning, and confidence of physiotherapists assessing day one non-emergency cardiac surgery patients through paper-based questionnaires. The preliminary results from the quantitative phase informed the qualitative data collection, which consisted of semi-structured interviews analysed using the Framework approach. The data were integrated at the interpretation level using a statistics-by-themes joint display and through the construction of meta-inferences, with statistics and themes weaved further together through narrative discussion. The scoping review found that, while LUS has garnered significant attention in the field of cardiac surgery, further research is needed to establish best practices for LUS, particularly in standardising methods. Future research should explore use by non-medical professionals and explore experiences and perceptions of those engaging with LUS. The mixed methods study resulted in ten meta-inferences. In summary, the meta-inferences found LUS has an influence on pathology identification by improving confidence and certainty, particularly for pleural fluid. The meta-inferences also found LUS is seldom performed on, and changed management for, day one non-emergency cardiac surgery patients for several reasons. The qualitative phase resulted in three themes: (1) Views of physiotherapists on the use and impact of LUS in the cardiac surgery population, (2) Views of physiotherapists on skill development in LUS and importance within the field of respiratory physiotherapy, and (3) Barriers and facilitators to the use of LUS by physiotherapists within the cardiac surgery population. This doctoral thesis has comprehensively explored the use of LUS by physiotherapists when assessing cardiac surgery patients. This exploratory thesis identified several areas for future research into the use of LUS by physiotherapists. Overall, LUS is viewed positively with numerous benefits and roles within physiotherapy practice, and therefore, further research is encouraged and considered worthwhile. The original knowledge generated from this doctoral thesis should be considered to guide the direction of future research. Lung ultrasound is showing the potential to be a valuable tool for physiotherapists working with cardiac surgery, as well as respiratory physiotherapy in general, and may assist in identifying PPCs early on to improve patient outcomes.

Citation

FARRELL, C.J. 2024. An exploration on the use of lung ultrasound by physiotherapists within the cardiac surgery population. Robert Gordon University, DPT thesis. Hosted on OpenAIR [online]. Available from: https://doi.org/10.48526/rgu-wt-2565254

• Thesis Type: Thesis
• Deposit Date: Nov 1, 2024
• Publicly Available Date: Nov 1, 2024
• DOI: https://doi.org/10.48526/rgu-wt-2565254
• Keywords: Lungs; Ultrasound; Ultrasonography; Cardiac patients; Cardiac surgery; Physiotherapy; Physiotherapists
• Public URL: https://rgu-repository.worktribe.com/output/2565254
• Award Date: Jun 30, 2024