Advances in lung ultrasound in critically ill patients

Since its introduction 20 years ago, transthoracic lung ultrasound in critically ill patients has been shown to be an invaluable bedside diagnostic tool to influence patient management and to guide therapeutic decisions. Furthermore, to optimise mechanical ventilation, a systematic evaluation of the lung region can be carried out. We can predict that in the future transthoracic lung ultrasound may play an important role in the definition of adult respiratory distress syndrome (ARDS) grading. In the diagnosis of pneumothorax, the use of transthoracic lung ultrasound has progressively spread, leading it to become the first-line tool in ruling out tension pneumothorax in haemodynamic unstable patients, even in pre-hospital emergency settings. In septic patients, fluid administration is still a matter of concern. Transthoracic lung ultrasound can detect fluid refractory, i.e., lung fluid “intolerance”, which is a useful guide in the haemodynamic management of these patients. Lung ultrasound also allows pleural effusion quantification and whether or not it is appropriate to drain the patient, of course, in a clinical context. However, urgent standardisation in the methodology of pleural effusion quantification is required. As a result, transthoracic lung ultrasound seems to be a powerful tool in the hands of a trained intensivist, and, at present, to avoid using it seems unjustified.