An audit to evaluate the quantification of pleural effusions using thoracic ultrasonography in ICU setting at a tertiary care hospital.
Keywords:Clinical audit, Ultrasonographic quantification of pleural effusions, Volumetry, Volumetry. Thoracocentesis
Objective: To develop a practical method of estimating the volume of pleural effusions with ultrasonography in ICU setting at a tertiary care hospital.
Methodology: A clinical audit study was conducted at Department of Radiology, Jinnah Burn & Reconstructive Surgery Center, Lahore, from December 2018 to August 2019. Scans of 21 patients who underwent ultrasonography for quantification of pleural effusions in the ICU in December 2018 were studied retrospectively to assess the parameters being followed in the first audit.
Results: In the first audit, it was ascertained that the pleural effusion was being quantified into mild, moderate and severe based on subjective values. The method of quantification used was the same for supine and erect patients. The separation between two pleura was measures in mm and aspirated effusion in ml. A positive correlation was noted between these two measurements. The re-audit performed 6 months later showed improvement with 100% compliance to standards.
Conclusion: The first audit revealed that the qualitative method was being used solely. The effusion was classified as minimal if the hypoechoic space was at the costophrenic angle only, small if it covered the costophrenic angle but limited within the image formed by the transducer, moderate if the space was larger than the image but limited within two images; and large or massive if it was larger than two images formed by the transducer. But being a qualitative classification, this did not give the amount of effusion in each category.