Thoracic ultrasonography: a narrative review

Abstract

This narrative review focuses on thoracic ultrasonography (lung and pleural) with the aim of outlining its utility for the critical care clinician. The article summarizes the applications of thoracic ultrasonography for the evaluation and management of pneumothorax, pleural effusion, acute dyspnea, pulmonary edema, pulmonary embolism, pneumonia, interstitial processes, and the patient on mechanical ventilatory support. Mastery of lung and pleural ultrasonography allows the intensivist to rapidly diagnose and guide the management of a wide variety of disease processes that are common features of critical illness. Its ease of use, rapidity, repeatability, and reliability make thoracic ultrasonography the "go to" modality for imaging the lung and pleura in an efficient, cost effective, and safe manner, such that it can largely replace chest imaging in critical care practice. It is best used in conjunction with other components of critical care ultrasonography to yield a comprehensive evaluation of the critically ill patient at point of care.

Using lung ultrasound to quantitatively evaluate pulmonary water content

“…Lung ultrasound (LUS) has become a bedside technology for critical care due to its availability for implementation and immediate interpretation by clinicians. Standardized LUS signs have been established for both adults and neonates . Extravascular lung water (EVLW) refers to the water content in lungs outside of the pulmonary blood vessels, typically, fluid accumulates in the interstitial and alveolar spaces, while the accumulation of EVLW clinically manifests as pulmonary edema …”

“…In contrast, transthoracic LUS, a technique used on the basis of B‐line visualization, is highly sensitive and specific to the diagnosis of EVLW . LUS scoring systems have been developed to meet the need for standardization and have been shown to correlate with various metrics in adults and neonates .…”

“…Standardized LUS signs have been established for both adults and neonates. [1][2][3][4][5] Extravascular lung water (EVLW) refers to the water content in lungs outside of the pulmonary blood vessels, typically, fluid accumulates in the interstitial and alveolar spaces, while the accumulation of EVLW clinically manifests as pulmonary edema. 6 Pulmonary edema is one of the most critical pathological changes in various pulmonary diseases.…”

“…9 In contrast, transthoracic LUS, a technique used on the basis of B-line visualization, is highly sensitive and specific to the diagnosis of EVLW. [1][2][3][4][5] LUS scoring systems have been developed to meet the need for standardization and have been shown to correlate with various metrics in adults and neonates. [10][11][12][13] These scoring systems are used to assess the severity, course, and prognosis of the disease and then guide the treatment.…”

CLUE: COVID‐19 lung ultrasound in emergency department

“…Lung ultrasound (LUS) is a vital part of critical care evaluation of multiple lung pathologies, like pneumothorax, acute respiratory distress syndrome (ARDS), pulmonary oedema, interstitial lung disease (ILD) and pneumonia (1). As SARS-CoV-2 infection causes interstitial pneumonitis, there is an extensive use of LUS in COVID-19 patients in China (2) and Italy (3).…”