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Crit Care
Critical Care
1364-8535
1466-609X
BioMed Central London

5075
10.1186/s13054-024-05075-y
Matters Arising
Lung ultrasound and ARDS: global collaboration is the way to go
Smit Marry R. 12345
Boumans Maud 12345
Aerts William 12345
Tuinman Pieter R. p.tuinman@amsterdamumc.nl
http://www.alifeofpocus.com

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1 grid.12380.38 0000 0004 1754 9227 Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
2 https://ror.org/05grdyy37 grid.509540.d 0000 0004 6880 3010 Department of Intensive Care Medicine, Amsterdam UMC, Amsterdam Medisch Centrum, Meibergdreef 9, Amsterdam, The Netherlands
3 Amsterdam Leiden IC Focused Echography (ALIFE), Amsterdam, The Netherlands
4 grid.12380.38 0000 0004 1754 9227 Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
5 grid.12380.38 0000 0004 1754 9227 Amsterdam Institute for Immunity and Infectious Diseases, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
17 9 2024
17 9 2024
2024
28 30719 8 2024
20 8 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
We would like to extend our gratitude to Dr. da Hora Passos et al. for their interest in our recently published review and meta-analysis in Critical Care. In this response, we will elaborate on the points raised by the authors. We agree with the authors that LUS, like any other diagnostic technique, is valuable and safe only when utilized by trained operators. The authors expressed uncertainty regarding the sensitivity of LUS in detecting mild ARDS or ARDS at an early stage. This variance in sensitivity is more likely due to diversity in diagnostic thresholds. We advocate for global collaboration among LUS experts to align LUS methodologies and strengthen the evidence supporting LUS in the diagnosis of ARDS and its morphological subphenotypes.

issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
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pmcReply to Da Hora Passos et al.

We would like to extend our gratitude to Dr. da Hora Passos et al. [1] for their interest in our recently published review and meta-analysis in Critical Care [2]. We appreciate that the authors share our enthusiasm for the clinical application of lung ultrasound (LUS) in diagnosing acute respiratory distress syndrome (ARDS) and concur that ongoing research remains imperative. In this response, we will elaborate on the points raised by the authors.

We agree with the authors that LUS, like any other diagnostic technique, is valuable and safe only when utilized by trained operators. Although several studies have demonstrated that LUS is relatively quick to learn, there is a pressing need to standardize training protocols to ensure that current literature can be effectively applied in clinical practice. Efforts to establish international consensus on LUS and to estimate interobserver agreement for LUS diagnosis of ARDS among various groups of operators will guide future progress.

The authors express uncertainty regarding the sensitivity of LUS in detecting mild ARDS or ARDS at an early stage. We, however, question whether these concerns are indeed significant. While detecting mild ARDS is inherently more complex than severe ARDS, LUS is generally known to be a highly sensitive technique and is unlikely to be less sensitive than chest radiography or substantially less sensitive than chest computed tomography [3]. The variance in sensitivity found in our review is, in our view, more likely due to diversity in diagnostic thresholds rather than an inherent limitation of LUS. For instance, one of the larger studies included in our meta-analysis demonstrated that LUS can diagnose or exclude ARDS with certainty using different thresholds [4]. Future studies need to adopt coherent approaches to determine optimal diagnostic thresholds. Regarding early diagnosis of ARDS, our review included larger studies where LUS was performed early during the ICU stay [4] or even in the ward or emergency department settings [5, 6]. Thus, we are confident in the capacity of LUS to detect ARDS also at an early stage.

The ability of LUS to differentiate between focal and non-focal subphenotypes is highly promising, as demonstrated by current studies, one of which has been externally validated [7]. However, we agree with the authors that current retrospective studies necessitate prospective validation with an adequate sample size.

Finally, we advocate for global collaboration among LUS experts to align LUS methodologies and strengthen the evidence supporting LUS in the diagnosis of ARDS and its morphological subphenotypes.

Marry R. Smit.

Maud Boumans.

William Aerts.

Pieter R. Tuinman.

Abbreviations

ARDS Acute respiratory distress syndrome

LUS Lung ultrasound

Author contributions

M.S. and P.R.T. wrote the main manuscript textM.B. reviewed manuscript text and provided referencesW.A. reviewed manuscript text and provided abstract.

Funding

None.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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References

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