key: cord-0992260-1iq6u664
authors: Smith, M. J.; Hayward, S. A.; Innes, S. M.
title: Point‐of‐care ultrasound in respiratory and critical care: consolidation and expansion of imaging skills
date: 2020-05-31
journal: Anaesthesia
DOI: 10.1111/anae.15119
sha: 836e9a5c378f3619ed63acf3cfb1966cd3c8c787
doc_id: 992260
cord_uid: 1iq6u664

We thank Drs Sikachi and Agrawal [1] for their response to our article [2] and wholeheartedly agree that point of care ultrasound imaging has a valuable role to play across a range of organ systems and disease presentations [3], including those of relevance in COVID-19 disease.

In our article [2] , we presented mechanisms by which a sub-set of these skills could be rapidly gained by clinicians with a range of pre-existing ultrasound imaging and/or respiratory and critical care experience.

Ensuring that an ultrasound operator works within their area of competency is a cornerstone of safe and effective practice [4] . In identifying a narrow remit and application of ultrasound imaging in COVID-19 disease, our publication empowers the deployment of workforces to address one of the principal organs compromised by COVID-19 disease.

As the peak of the pandemic curve starts to flatten, the opportunity presents itself to re-evaluate the skill-set and configuration of healthcare workforces. In the UK, vascular technologists already provide a highly skilled service in specific clinical scenarios, including critical care. In the same way, we postulate that a 'lung ultrasound' workforce to provide dedicated services in this area could be a highly valuable addition to respiratory and critical care.

In parallel, upskilling of point-of-care clinicians in lung, as well as multi-organ system, imaging should be seen as a high priority. However, three essential elements must be addressed, regardless of the professional background of the individual or the healthcare configuration into which point-of-care ultrasound imaging is incorporated. In each case the scope of sonographic practice should be clarified and this should reflect the necessary governance requirements; alignment with the training undertaken and demonstrable competency must be assured [4] .

The scope of sonographic practice incorporates the imaging performed, the findings communicated and the subsequent clinical inferences derived from them. By omission, they crucially also exclude tissue or disease processes not within scope and for which the scan cannot be relied upon to identify, confirm or exclude. One 'silver lining' of the pandemic might therefore be more widespread, shared cross-disciplinary learning.

Therefore, although we endorse the view of Drs Sikachi and Agrawal that 'consideration be given to the consolidation of skills and expertise to a whole body approach to point-of-care ultrasound', we urge individuals and professions to ensure that consolidation and expansion of point of care ultrasound is framed by quality and rigour.

Whole body point-care ultrasound for COVID-19: a multi-system approach to a multi-system disease

Point-of-care lung ultrasound in patients with COVID-19 -a narrative review

Expert Round Table on Ultrasound in ICU. International expert statement on training standards for critical care ultrasonography

Point of care ultrasound: a WFUMB position paper

Time to establish pillars in point-of-care ultrasound

We thank Dr Miller (Shrewsbury and Telford Hospitals, UK) and Dr Venables (College of Health and Social Care, University of Derby, UK) for their contribution to the text. No competing interests declared.