ERS Statement on ultrasound guided interventions in respiratory disease

BACKGROUND: The use of ultrasound (US) to guide percutaneous thoracic interventions improves safety and effectiveness of procedures and leads to reduced healthcare costs. A taskforce was convened to produce a statement on various clinical aspects of these procedures. METHODS: The taskforce 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 questions under five major topics to inform the writing of the statement. Narrative synthesis of the evidence from relevant literature is presented for each topic. Surveys and interviews with patients who underwent US-guided interventions were conducted to explore patient perspectives. RESULTS: Review of evidence is presented on: the use of US-guided interventions in diagnostic and treatment pathways for pleural and thoracic diseases (Section 1), comparative data on type/size of biopsy, chest tube size and disease outcome, optimal settings for procedures and portable ultrasound (Section 2), US specific methodology and association with outcomes, real-time US guidance for different interventions and contrast-enhanced US 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 US 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.