Chest ultrasound in acute respiratory distress syndrome

This review discusses the role of chest ultrasound in diagnosis and management of acute respiratory distress syndrome (ARDS) and the most recent technical progresses in this field.

Clinically, suspected ARDS can be easily confirmed by lung ultrasonography through the recognition of a typical pattern characterized by B-lines, spared areas, pleural line thickening, and subpleural consolidations. A visual score based on number and thickness of B-lines permits a semiquantitative evaluation of the amount of extravascular lung water and lung density. Recently, a quantitative lung ultrasound method has been proposed. The heart may be also involved in ARDS either primarily or by the application of positive pressure ventilation. The incidence of acute cor pulmonale during ARDS is, even if under protective ventilation, not negligible. The use of echocardiography combined with lung ultrasound is important for early detection of cor pulmonale, identification of the best ventilator strategy to preserve heart-to-lung interaction, and prediction of weaning success.

An ultrasound-integrated approach combining lung ultrasound and echocardiography should be recommended as a suitable technique to manage ARDS during diagnosis, mechanical ventilation setting, and weaning.