Practical Applications of Lung and Diaphragm Ultrasound in the Intensive Care Unit: An Updated Narrative Review

Lung ultrasound (LUS) has evolved significantly during the past few decades. Its use has been integrated into daily practices of intensive care units (ICUs) worldwide, and it has proven to be a valuable tool in the assessment and management of patients with respiratory failure caused by lung, pleural, diaphragmatic, and other diseases. LUS techniques are becoming increasingly standardized, which can help in interpreting data and improving patients' outcomes. In this narrative review, the focus was on the practical daily applications of lung, pleural, and diaphragmatic ultrasound with emphasis on different signs and artifacts that guide the interpretation of data and identification of disease. Discussions and analysis from the new international guidelines were added to help close the gap in the use of LUS. This review is intended to serve as a practical guide for using bedside ultrasound in evaluating patients with shortness of breath and respiratory failure and to provide guidance to help providers manage patients and generate standardized reports. We start with an analysis of best practices and guidelines on performing an LUS exam in the ICU setting. This analysis is followed by data interpretation of findings starting at the pleural line and traveling deeper into the lung tissue. The review includes discussions of the diaphragm evaluation and its function and abnormalities, as well as common LUS-related procedures in the ICU, such as thoracentesis, tracheostomy, and cricothyrotomy.