Lung Ultrasound in Mechanical Ventilation: A Purposive Review

Background/Objectives: Lung ultrasound (LUS) has emerged as a crucial bedside tool for evaluating and managing patients with respiratory failure, particularly those receiving mechanical ventilation (MV). Its ability to rapidly characterise lung pathology, including extent, severity, and progression, has established LUS as a key diagnostic and monitoring modality in both hospital and home-care settings. Methods: This narrative review analyses the specific applications of LUS in the assessment and management of patients undergoing MV, aiming to optimise ventilatory strategies. Results: We examine the role of LUS in (1) identifying patients requiring MV; (2) guiding ventilator settings (Positive End Expiratory Pressure selection, inspiratory pressure adjustment, and patient-ventilator synchrony optimisation); (3) performing and monitoring recruitment manoeuvres; (4) assessing parenchymal damage and evaluating the response to medical and ventilatory therapies; (5) detecting ventilation-associated complications; (6) facilitating weaning from MV; and (7) assisting with airway management procedures, specifically tracheostomy. The utility of Transesophageal Lung Ultrasound (TELU) is also briefly discussed. Conclusions: This review highlights the potential of LUS to improve clinical decision making and patient outcomes in the context of MV.