Lung Ultrasound in Critical Care and Emergency Medicine: Clinical Review

Abstract

Lung ultrasound has become a part of the daily examination of physicians working in intensive, sub-intensive, and general medical wards. The easy access to hand-held ultrasound machines in wards where they were not available in the past facilitated the widespread use of ultrasound, both for clinical examination and as a guide to procedures; among point-of-care ultrasound techniques, the lung ultrasound saw the greatest spread in the last decade. The COVID-19 pandemic has given a boost to the use of ultrasound since it allows to obtain a wide range of clinical information with a bedside, not harmful, repeatable examination that is reliable. This led to the remarkable growth of publications on lung ultrasounds. The first part of this narrative review aims to discuss basic aspects of lung ultrasounds, from the machine setting, probe choice, and standard examination to signs and semiotics for qualitative and quantitative lung ultrasound interpretation. The second part focuses on how to use lung ultrasound to answer specific clinical questions in critical care units and in emergency departments.

Point-of-Care Ultrasound (POCUS) in Adult Cardiac Arrest: Clinical Review

“…A dilated and poorly collapsible inferior vena cava may be observed as well [26]. Prompt intervention for tamponade can quickly address pulseless electrical activity (PEA), leading to higher survival rates compared to other causes of PEA (15% vs. 1.3%) [5,24]. In the presence of suspected or confirmed cardiac tamponade, an emergency pericardiocentesis to drain the accumulated fluid is indicated to restore circulation.…”

“…This portable diagnostic tool delivers real-time insights, thereby enabling the rapid and precise assessments that are crucial in high-stakes situations. In recent years, resuscitation guidelines have increasingly recognized the potential role of POCUS in cardiac arrest scenarios and have emphasized its multifaceted benefits, although admitting that its usefulness has not yet been well established [3][4][5][6]. Specifically, ultrasound applications aim to optimize cardiopulmonary resuscitation outcomes by facilitating crucial tasks such as:…”

Lung Ultrasound Score on Postoperative Day 1 Is Predictive of the Occurrence of Pulmonary Complications after Major Abdominal Surgery: A Multicenter Prospective Observational Study

“…Bedside LUS examination was performed with a Philips Sparq device (Philips, The Netherlands) and a low-frequency 5-MHz convex probe ("abdominal" probe) fitting with intercostal spaces, according to international guidelines. 26 Since preoperative LUS is part of the standard preoperative respiratory assessment of patients undergoing major abdominal surgery, and the LUS guides daily postoperative management as part of the lung point-of-care ultrasound ("POCUS"), 27,28 LUSs were performed before surgery (baseline: at day -1, the day before surgery, or day 0, the day of surgery, but still before the surgery), at day 1 (the day after surgery), and then at day 4 and day 7. Depending on the center and the period of inclusion, the LUSs were performed by one of the three experienced anesthesiologist investigators (N.H., A.L., or L.D.…”

Lung ultrasound score and in-hospital mortality of adults with acute respiratory distress syndrome: a meta-analysis

“…Lung ultrasound (LUS) has emerged as a valuable and non-invasive modality for promptly assessing chest conditions in individuals with respiratory disorders, particularly in acute scenarios like emergency department and ICU settings [ 7 , 8 ]. The growing body of evidence indicates that LUS offers several advantages, including cost-effectiveness, expeditiousness, absence of ionizing radiation, bedside accessibility, and method repeatability [ 9 , 10 ].…”