Lung ultrasound in acute respiratory distress: diagnostic and prognostic utility in intensive care

Resumen

Lung ultrasound has emerged as a bedside tool for managing critically ill patients with acute respiratory distress. This article argues that it should be considered a primary diagnostic and prognostic tool for any patient with acute respiratory distress admitted to the intensive care unit. Its ability to rapidly differentiate between cardiogenic edema, acute respiratory distress syndrome (ARDS), pneumonia, pleural effusion, and pneumothorax makes it an indispensable complement to clinical examination and chest radiography. However, despite international evidence supporting its high sensitivity and specificity, its systematic implementation in intensive care units (ICUs) varies and is not always standardized. The article maintains that lung ultrasound not only improves bedside diagnostic accuracy but also allows for the quantification of aeration loss using the lung ultrasound (LUS) score; this score correlates with oxygenation parameters—such as the PaO₂/FiO₂ ratio—and clinical outcomes, including duration of mechanical ventilation and mortality. It is argued that integrating a standard ultrasound algorithm into the initial assessment of patients with acute respiratory distress is cost-effective, reduces radiation exposure, shortens diagnostic times, and guides therapeutic decisions, such as positive end-expiratory pressure (PEEP) titration or pleural drainage. Nevertheless, specific training for intensive care staff and local validation of ultrasound patterns are required. The article concludes that lung ultrasound should be considered an essential competency in intensive care medicine.