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Mongodi S, Cortegiani A, Alonso-Ojembarrena A, Biasucci DG, Bos LDJ, Bouhemad B, Cantinotti M, Ciuca I, Corradi F, Girard M, Gregorio-Hernandez R, Gualano MR, Mojoli F, Ntoumenopoulos G, Pisani L, Raimondi F, Rodriguez-Fanjul J, Savoia M, Smit MR, Tuinman PR, Zieleskiewicz L, De Luca D. ESICM-ESPNIC international expert consensus on quantitative lung ultrasound in intensive care. Intensive Care Med 2025:10.1007/s00134-025-07932-y. [PMID: 40353867 DOI: 10.1007/s00134-025-07932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2025] [Accepted: 04/28/2025] [Indexed: 05/14/2025]
Abstract
PURPOSE To provide an international expert consensus on technical aspects and clinical applications of quantitative lung ultrasound in adult, paediatric and neonatal intensive care. METHODS The European Society of Intensive Care (ESICM) and the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) endorsed the project. We selected an international panel of 20 adult, paediatric and neonatal intensive care experts with clinical and research expertise in quantitative lung ultrasound, plus two non-voting methodologists. Fourteen clinical questions were proposed by the chairs to the panel, who voted for their priority (1-9 Likert-type scale) and proposed modifications/supplementing (two-round vote). All the questions achieved the predefined threshold (mean score > 5) and 14 groups of 3 mixed adult/paediatric experts were identified to develop the statements for each clinical question; predefined groups of experts in the fields of adult and paediatric/neonatal intensive care voted statements specific for these subgroups. An iterative approach was used to obtain the final consensus statements (two-round vote, 1-9 Likert-type scale); statements were classified as with agreement (range 7-9), uncertainty (4-6), disagreement (1-3) when the median score and ≥ 75% of votes laid within a specific range. RESULTS A total of 46 statements were produced (4 adults-only, 4 paediatric/neonatal-only, 38 interdisciplinary); all obtained agreement. This result was also achieved by acknowledging in the statements the current limitations of quantitative lung ultrasound. CONCLUSION This consensus guides the use of quantitative lung ultrasound in adult, paediatric and neonatal intensive care and helps identify the fields where further research will be needed in the future.
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Affiliation(s)
- Silvia Mongodi
- Intensive Care Unit 1, San Matteo Hospital, Pavia, Italy.
| | - Andrea Cortegiani
- Department of Precision Medicine in Medical, Surgical and Critical Care Area (Me.Pre.C.C.), University of Palermo, Palermo, Italy
- Department of Anaesthesia, Intensive Care and Emergency Policlinico Paolo Giaccone, Palermo, Italy
| | - Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain
- Research Unit, Biomedical Research and Innovation Institute of Cádiz, Hospital Universitario Puerta del Mar, Cadiz, Spain
| | - Daniele Guerino Biasucci
- Department of Clinical Science and Translational Medicine, Tor Vergata' University of Rome, Rome, Italy
| | - Lieuwe D J Bos
- Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Belaid Bouhemad
- Department of Anaesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France
- Université Bourgogne Franche‑Comté, LNC UMR866, Dijon, France
| | - Massimo Cantinotti
- Fondazione CNR Regione Toscana G. Monasterio, Ospedale del Cuore, Massa, Italy
| | - Ioana Ciuca
- Pediatric Department, "Victor Babes" University of Medicine and Pharmacy Timisoara, Timisoara, Romania
- Pediatric Pulmonology Unit, Clinical County Hospital Timisoara, Timisoara, Romania
| | - Francesco Corradi
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Martin Girard
- Department of Anesthesiology, Centre Hospitalier de L'Université de Montréal, Montréal, Canada
- Imaging and Engineering, Centre de Recherche du Centre Hospitalier de L'Université de Montréal, Montréal, Canada
| | | | - Maria Rosaria Gualano
- UniCamillus - Saint Camillus International University of Health and Medical Sciences, Rome, Italy
- Leadership Research Center, Università Cattolica del Sacro Cuore-Campus Di Roma, Rome, Italy
| | - Francesco Mojoli
- Intensive Care Unit 1, San Matteo Hospital, Pavia, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, Università Di Pavia, Pavia, Italy
| | | | - Luigi Pisani
- Department of Precision-Regenerative Medicine and Jonic Area (DiMePRe-J), Section of Anesthesiology and Intensive Care Medicine, University of Bari "Aldo Moro", Bari, Italy
- Mahidol Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand
| | - Francesco Raimondi
- Division of Neonatology, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Javier Rodriguez-Fanjul
- Pediatric Intensive Care Unit. Hospital Germans Trias I Pujol, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Marilena Savoia
- Neonatal Intensive Care Unit, S Maria Della Misericordia Hospital, Udine, Italy
| | - Marry R Smit
- Department of Intensive Care, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam Institute for Immunology and Infectious Diseases, Amsterdam, the Netherlands
| | - Laurent Zieleskiewicz
- Department of Anesthesia and Critical Care, North Hospital, Marseille APHM, Aix Marseille University, Marseille, France
| | - Daniele De Luca
- Division of Paediatrics and Neonatal Critical Care, APHP-Paris Saclay University, Paris, France
- Physiopathology and Therapeutic Innovation Unit-INSERM U999, Paris Saclay University, Paris, France
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Hansell L, Milross M, Ntoumenopoulos G. Appropriateness of respiratory physiotherapy positioning for acute lobar collapse. Aust Crit Care 2025; 38:101114. [PMID: 39304404 DOI: 10.1016/j.aucc.2024.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 08/28/2024] [Accepted: 08/29/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Positioning is an important physiotherapy treatment modality for the management of aeration loss associated with acute lobar atelectasis (ALA). Physiotherapists typically rely on lung auscultation and interpretation of chest x-ray (CXR) to inform treatment selection. These tools lack diagnostic accuracy, which could limit the ability of a physiotherapist to locate ALA and select an appropriate treatment position. OBJECTIVES The objectives of this study were to determine the number of clinical physiotherapist treatment positions found to be in agreement with lung ultrasound (LUS)-identified aeration loss and to determine the diagnostic accuracy of CXR and lung auscultation against LUS as the reference standard for locating aeration loss in mechanically ventilated patients with ALA. METHODS A prospective cohort study was conducted in a tertiary teaching hospital in Sydney. Mechanically ventilated adult patients in critical care with ALA were included. Physiotherapist-selected positions were compared against location of aeration loss based on LUS results to determine appropriateness. Location of aeration loss as identified by CXR results and lung auscultation was compared against LUS as the reference standard to determine diagnostic accuracy. RESULTS Forty-three participants were included in this study. Four out of 43 patients (9.3%) were positioned appropriately. The rate of true positives for CXR and auscultation in locating aeration loss were highest in the lower lobes. Lung auscultation had higher sensitivities (16.7%-97.4%) than CXR (0%-59.5%) in a majority of lobes when detecting location of aeration loss. CXR had higher specificities (16.7%-100%) than lung auscultation (0%-64.9%) in a majority of lobes when detecting location of aeration loss. CONCLUSIONS Physiotherapists did not deliver appropriate positioning in a majority of cases. Overall, the diagnostic accuracy of lung auscultation and CXR in detecting location of ALA was low. Correctly locating lung aeration loss is imperative to ensure appropriate respiratory physiotherapy positions are selected. Physiotherapists should consider additional assessment tools such as LUS to increase their diagnostic ability.
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Affiliation(s)
- Louise Hansell
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, Sydney, Australia.
| | - Maree Milross
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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Wang Y, Yi Y, Zhang F, Yao YY, Chen YX, Wu CM, Wang RY, Yan M. Lung Ultrasound Score as a Predictor of Failure to Wean COVID-19 Elderly Patients off Mechanical Ventilation: A Prospective Observational Study. Clin Interv Aging 2024; 19:313-322. [PMID: 38404479 PMCID: PMC10887876 DOI: 10.2147/cia.s438714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 02/06/2024] [Indexed: 02/27/2024] Open
Abstract
Background The lung ultrasound score was developed for rapidly assessing the extent of lung ventilation, and it can predict failure to wean various types of patients off mechanical ventilation. Whether it is also effective for COVID-19 patients is unclear. Methods This single-center, prospective, observational study was conducted to assess the ability of the 12-region lung ultrasound score to predict failure to wean COVID-19 patients off ventilation. In parallel, we assessed whether right hemidiaphragmatic excursion or previously published predictors of weaning failure can apply to these patients. Predictive ability was assessed in terms of the area under the receiver operating characteristic curve (AUC). Results The mean age of the 35 patients in the study was (75 ± 9) years and 12 patients (37%) could not be weaned off mechanical ventilation. The lung ultrasound score predicted these failures with an AUC of 0.885 (95% CI 0.770-0.999, p < 0.001), and a threshold score of 10 provided specificity of 72.7% and sensitivity of 92.3%. AUCs were lower for previously published predictors of weaning failure, and right hemidiaphragmatic excursion did not differ significantly between the two groups. Conclusion The lung ultrasound score can accurately predict failure to wean critically ill COVID-19 patients off mechanical ventilation, whereas assessment of right hemidiaphragmatic excursion does not appear helpful in this regard. Trial Registration https://clinicaltrials.gov/ct2/show/NCT05706441.
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Affiliation(s)
- Ying Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, People’s Republic of China
| | - Yu Yi
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, People’s Republic of China
| | - Fan Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, People’s Republic of China
| | - Yuan-Yuan Yao
- Department of Anesthesiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
| | - Yue-Xiu Chen
- Department of Anesthesiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
| | - Chao-Min Wu
- Department of Anesthesiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
| | - Rui-Yu Wang
- Department of Anesthesiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
| | - Min Yan
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, 221004, People’s Republic of China
- Department of Anesthesiology, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310016, People’s Republic of China
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Al-Husinat L, Jouryyeh B, Rawashdeh A, Robba C, Silva PL, Rocco PRM, Battaglini D. The Role of Ultrasonography in the Process of Weaning from Mechanical Ventilation in Critically Ill Patients. Diagnostics (Basel) 2024; 14:398. [PMID: 38396437 PMCID: PMC10888003 DOI: 10.3390/diagnostics14040398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 01/22/2024] [Accepted: 02/10/2024] [Indexed: 02/25/2024] Open
Abstract
Weaning patients from mechanical ventilation (MV) is a complex process that may result in either success or failure. The use of ultrasound at the bedside to assess organs may help to identify the underlying mechanisms that could lead to weaning failure and enable proactive measures to minimize extubation failure. Moreover, ultrasound could be used to accurately identify pulmonary diseases, which may be responsive to respiratory physiotherapy, as well as monitor the effectiveness of physiotherapists' interventions. This article provides a comprehensive review of the role of ultrasonography during the weaning process in critically ill patients.
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Affiliation(s)
- Lou’i Al-Husinat
- Department of Clinical Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan;
| | - Basil Jouryyeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.)
| | - Ahlam Rawashdeh
- Faculty of Medicine, Yarmouk University, Irbid 21163, Jordan; (B.J.); (A.R.)
| | - Chiara Robba
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, 16132 Genova, Italy
| | - Pedro Leme Silva
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941, Brazil; (P.L.S.); (P.R.M.R.)
| | - Patricia Rieken Macedo Rocco
- Laboratory of Pulmonary Investigation, Carlos Chagas Filho Biophysics Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941, Brazil; (P.L.S.); (P.R.M.R.)
| | - Denise Battaglini
- Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy;
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Lockstone J, Love A, Hung Lau Y, Hansell L, Ntoumenopoulos G. The use of diaphragm and lung ultrasound in acute respiratory physiotherapy practice and the impact on clinical decision-making: A systematic review and meta-analysis. Aust Crit Care 2024; 37:176-184. [PMID: 38036384 DOI: 10.1016/j.aucc.2023.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVES Diaphragm and lung ultrasound (DLUS) is emerging as an important point-of-care respiratory assessment tool and is being used in clinical care by trained respiratory physiotherapists, both in Australia and internationally. However, the impact of DLUS on physiotherapists' clinical decision-making remains largely unknown. This systematic review aims to review the evidence for implementing DLUS in acute respiratory physiotherapy management. REVIEW METHOD USED We conducted a systematic review. DATA SOURCES We searched PubMed, Embase, CINAHL, CENTRAL, and Scopus from inception to 18th April 2023 for all original clinical studies reporting on the physiotherapy clinical decision-making, following a DLUS examination and/or where DLUS was used to evaluate the effect of respiratory physiotherapy, in adults over 18 years of age. REVIEW METHODS Two authors independently performed study selection and data extraction. Individual study risk of bias was assessed using the Newcastle-Ottawa Scale, and certainty in outcomes was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations framework. RESULTS A total of seven observational studies (n = 299) were included, all of which were in the intensive care setting. DLUS changed physiotherapy diagnosis, management, and treatment in 63.9% (50-64%), 16.8% (15-50%), and 48.4% (25-50%) of patients, respectively. There was a significant improvement in the lung ultrasound score post respiratory physiotherapy treatment (mean difference -2.31, 95% Confidence Interval (95% CI) -4.42 to -0.21; very low certainty) compared to before respiratory physiotherapy treatment. Moderate risk of bias was present in six studies, and there was variance in the DLUS methodology across included studies. CONCLUSIONS The findings of this review suggest DLUS influences physiotherapy clinical decision-making and can be used to evaluate the effects of acute respiratory physiotherapy treatment. However, the available data is limited, and further high-quality studies are needed. TRIAL REGISTRATION This study is registered with the International Prospective Register of Systematic Reviews; CRD42023418312.
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Affiliation(s)
- Jane Lockstone
- Physiotherapy Department, Launceston General Hospital, TAS, Australia.
| | - Annabel Love
- Physiotherapy Department, Launceston General Hospital, TAS, Australia
| | - Yin Hung Lau
- Physiotherapy Department, Royal Perth Bentley Group, Perth, Australia
| | - Louise Hansell
- The Kolling Institute, The University of Sydney, Sydney, Australia; Physiotherapy Department, Royal North Shore Hospital, Sydney, Australia
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