Defining basic (lung) ultrasound skills: not so basic after all?

Lung Ultrasound in Critical Care and Emergency Medicine: Clinical Review

“…After the recently published consensus statement on the critical care ultrasound of the ESICM [ 27 ], an issue has been raised about the definitions of basic and advanced skills [ 103 ]. Pleural effusion is easy to identify, but recognizing the etiology and determining the volume can be more challenging.…”

“…Similarly, B-lines are easy to recognize, but their etiology and clinical interpretation could be difficult to assess. An echo-texture of a lung consolidation is easily identified, but distinguishing between atelectasis and pneumonia would require the sonographer to be capable of recognizing dynamic air bronchograms and to interpret the color Doppler, which probably are at least intermediate skills [ 103 ]. Concern has been created, indeed, for the lack of clearly defined criteria in the scientific literature for defining basic lung ultrasonographic skills and distinguishing them from the advanced ones, especially in comparison with the cardiac ultrasound in the critical care setting, which has more literature in support and well-defined steps of knowledge [ 104 ].…”

“…So far, the only recognized advanced skill is the computation of the LUS score, which clearly requires a dedicated training [ 105 ]. A four-step definition of LUS skills, classified on the basis of the items that determine if a particular skill is assessed as basic or advance, has been proposed [ 103 ]. The incidence of the considered disease, the easiness to acquire the images and to interpret it, and finally the capability of answering to relevant clinical questions have been evaluated and, based on these, a suggested number of training scans has been proposed as the minimum to acquire specific LUS skills.…”

The Impact of Thoracic Ultrasound on Clinical Management of Critically Ill Patients (UltraMan): An International Prospective Observational Study*

“…Furthermore, cardiac ultrasound requires a high level of expertise along with availability of cardiac windows during suboptimal ICU positioning, decreasing its feasibility. Lung ultrasound, by comparison, requires few examinations to obtain basic proficiency, does not rely on specific thoracic windows, and may readily detect fluid overload as a surrogate for cardiac function (20, 21).…”

Lung ultrasound and supine chest X-ray use in modern adult intensive care: mapping 30 years of advancement (1993–2023)

“…In 2012, the international consensus conference also introduced the important concept of monitoring lung aeration and de-aeration with LUS scores to quantify the effect of ventilatory strategies [ 3 ]. However at the moment, it is difficult to separate LUS knowledge into basic and advanced on a continuum, and citing the recent work of Kraaijenbrink et al, “the high negative predictive value of ruling-out a PNX with lung sliding suggests this is straightforward, but ruling-in a PNX is much more complicated needing a different number of exams to become proficient showing that artifacts have a different learning curve.” [ 70 ]. Therefore, the low incidence of pneumothorax makes the recognition of the lung point difficult, with the need for a long training.…”