Authors: (including presenting author): :
Kong ISY, Lam KHM, Cheung EYY, Leung KKL
Affiliation: :
Physiotherapy Department, Kowloon Hospital
Keyword 1: :
Lung ultrasound
Keyword 2: :
Community acquired pneumonia
Keyword 3: :
Non-invasive mechanical ventilation
Keyword 4: :
Length of stay
Introduction: :
Community-acquired pneumonia(CAP) remains a leading cause of hospitalization and mortality worldwide. In severe cases, impaired airway clearance and reduced diaphragmatic mobility can precipitate acute respiratory failure, often necessitating non-invasive ventilation(NIV). Respiratory physiotherapy is integral for optimizing mucus clearance, improving ventilation, and facilitating NIV weaning. Precise localization of pulmonary consolidation and guided diaphragmatic exercise are critical for effective intervention. Lung ultrasound(LUS), an emerging equipment internationally in recent decade, enables real-time, bedside visualization of pulmonary structures with high diagnostic accuracy, potentially supporting more targeted and individualized physiotherapy management alongside standard approaches.
Objectives: :
To evaluate LUS-guided respiratory physiotherapy versus usual care in patients with CAP who required or had received NIV, assessing oxygenation, dyspnoea, sputum viscosity and length of stay
Methodology: :
A prospective, controlled study was conducted in the respiratory medicine ward at Kowloon Hospital from January 2025. Patients diagnosed with CAP who required or had received NIV were recruited and assigned LUS-guided(intervention) and usual care(control) physiotherapy. Exclusion criteria included hemodynamic instability or factors affecting LUS accuracy. In addition to usual care, intervention group received bedside LUS by Vscan Air™ CL device. Trained physiotherapists performed scans across thoracic zones to identify consolidation, pleural effusion, irregular pleural lines, and B-lines. Diaphragmatic excursion was also assessed to evaluate respiratory mechanics. These findings facilitate modification of postural drainage, chest percussion and vibration, and breathing retraining. Outcomes were recorded pre- and post-intervention, including resting oxygen saturation(SpO₂), Modified Borg Dyspnoea Scale(0–10) during self-paced walking, sputum viscosity and length of stay(LOS).
Result & Outcome: :
Twenty-two patients were included:LUS group(n=11, age 80.3±8.5 years) and usual care(n=11, age 78.3±12.9 years), with comparable baseline characteristics and NIV patterns. Both groups exceed the MCID of Borg scores of 1, indicating effective respiratory condition management. LUS-guided group demonstrated better improvements: SpO₂ increased from 92.4±1.2%to96.4±1.1%(vs. controls 92.0±1.3%to94.3±1.2%;p< 0.001); Borg scores decreased from 6.1±0.8to3.5±1.0(vs. 6.1±0.8to4.5±0.7;p=0.016). Sputum viscosity improved from thick/tenacious to mucoid/thin in 9 patients in the intervention group compared with 7 in the controls. LOS was also reduced in LUS group(15.1±6.4vs20.6±11.5 days), indicating a substantial decrease in healthcare resource use. Diaphragmatic excursion assessment guided breathing retraining and improved respiratory mechanics. LUS is a valuable adjunct in physiotherapy, offering real-time diagnostic accuracy, individualized treatment, and improved outcomes. Integrating LUS into routine care enhances respiratory physiotherapy practice, evidence-based practice, and interdisciplinary collaboration.
