The majority of acute respiratory disorders involve the pleura, and therefore are accessible to LUS that is a surface imaging technique. 1a), using both low frequency and high-frequency probes with the best combination of sector or curved array probe (3.5–5 MHz) and a small-parts linear probe (5–10 MHz), an assessment for various pathologies can be made by examining the pleural line (sliding, thickness, regularity), the sub-pleural regions (presence or absence of echogenic changes) and whether there are A-lines or B-lines present (with the amount and location of B-lines assessed) (Table 2). By evaluating 8 zones of the chest-4 on each side (2 anterior and 2 lateral) (Fig. Diagnoses of chronic obstructive pulmonary disease (COPD), asthma, pulmonary embolism, pneumothorax, and pneumonia can also be made with POC LUS with a positive predictive value ranging from 83 to 100% (Table 1). The sensitivity of LUS for diagnosis of pulmonary oedema, in some literature articles, approaches 94%, with a specificity of 92%. Several diseases can be detected at the bedside with POC LUS with several clinical implications and management, especially in critically ill patients. Thus, in the brief review, we discuss the LUS of the facts, that is often substance in the critical clinical context (clinical-dependent exam), and the LUS of the artifacts that, equally often, may become only imagination in a generic or inappropriate clinical context (virtual anatomical dependent exam). If on one hand, many studies have shown the efficacy of LUS in diagnosing pulmonary pathology, with increased sensitivity compared to that of chest X-ray (CXR), on the other hand, little is discussed about its limits and pitfalls especially in generic and off label clinical contest. These claims are so much actually in these days of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) pandemic spread so that LUS seems to be strongly adapting to the follow-up for lung involvement of patients with ascertaining Coronavirus Disease 19 (COVID-19) up to, in our opinion emblematic, use of LUS at the emergency triage or at home medical visit as a screening imaging test of suspected COVID-19 patients. We lacked on-site diagnostic capacity, so as I worked to secure critical resources to improve over all care, I also sought and received approval to incorporate point-of-care ultrasonography”. You cannot risk touching your face to readjust your PPE, so visual cues can also be a challenge. The ability to auscultate is gone, you cannot smell, and layers of gloves blunt your tactile sense. Layers of impermeable and stifling personal protective equipment (PPE) constitute an enormous physical barrier to patient care, complicating management of Ebola virus disease (EVD). After a decade of honing my ability to quickly determine “sick or not sick” and allocating time and resources accordingly, I learned that when managing a ward of patients with Ebola, clinical appearance did not always predict survival. They died from one disease, but so many different deaths. Patricia Henwood, in her heartfelt experience during the epidemic Ebola outbreak in West Africa, perfectly summarizes the potential role of LUS in critically ill patients: “half my patient died. In recent years, point-of-care (POC) lung ultrasound (LUS) has gained significant popularity as a diagnostic tool in the acutely dyspnoeic patients. Furthermore, the portability of the equipment, which allows for even bedside examination, the comfort of the patient, repeatability, and reduced cost are the true strength of this imaging technique. Ultrasound is the most disruptive innovation in intensive care life, above all in this time, with a high diagnostic value when applied appropriately, virtually free from the damaging biological effects caused by applying ionizing radiation.
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