Conference Reports and Expert Panel

Intensive Care Medicine

, Volume 38, Issue 4, pp 577-591

International evidence-based recommendations for point-of-care lung ultrasound

  • Giovanni VolpicelliAffiliated withDepartment of Emergency Medicine, San Luigi Gonzaga University Hospital Email author 
  • , Mahmoud ElbarbaryAffiliated withNational & Gulf Center for Evidence Based Health Practice, King Saud University for Health Sciences
  • , Michael BlaivasAffiliated withDepartment of Emergency Medicine, Northside Hospital Forsyth
  • , Daniel A. LichtensteinAffiliated withService de Réanimation Médicale, Hôpital Ambroise-Paré
  • , Gebhard MathisAffiliated withInternal Medicine Praxis
  • , Andrew W. KirkpatrickAffiliated withFoothills Medical Centre
  • , Lawrence MelnikerAffiliated withClinical Epidemiology Unit, Division of General Internal Medicine, Department of Medicine, Weill Medical College of Cornell University
  • , Luna GarganiAffiliated withInstitute of Clinical Physiology, National Research Council
  • , Vicki E. NobleAffiliated withDivision of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General Hospital
    • , Gabriele ViaAffiliated withDepartment of Emergency Medicine, San Luigi Gonzaga University Hospital1st Department of Anesthesia and Intensive Care Pavia, IRCCS Foundation Policlinico San Matteo
    • , Anthony DeanAffiliated withDepartment of Emergency Medicine, San Luigi Gonzaga University HospitalDivision of Emergency Ultrasonography, Department of Emergency Medicine, University of Pennsylvania Medical Center
    • , James W. TsungAffiliated withDepartment of Emergency Medicine, San Luigi Gonzaga University HospitalDepartments of Emergency Medicine and Pediatrics, Mount Sinai School of Medicine
    • , Gino SoldatiAffiliated withDepartment of Emergency Medicine, San Luigi Gonzaga University HospitalEmergency Medicine Unit, Valle del Serchio General Hospital
    • , Roberto CopettiAffiliated withDepartment of Emergency Medicine, San Luigi Gonzaga University HospitalMedical Department, Latisana Hospital
    • , Belaid BouhemadAffiliated withDepartment of Emergency Medicine, San Luigi Gonzaga University HospitalSurgical Intensive Care Unit, Department of Anesthesia and Critical Care, Groupe Hospitalier Paris Saint-Joseph
    • , Angelika ReissigAffiliated withDepartment of Emergency Medicine, San Luigi Gonzaga University HospitalDepartment of Pneumology and Allergology, Medical University Clinic I, Friedrich-Schiller University
    • , Eustachio AgricolaAffiliated withDepartment of Emergency Medicine, San Luigi Gonzaga University HospitalDivision of Noninvasive Cardiology, San Raffaele Scientific Institute, IRCCS
    • , Jean-Jacques RoubyAffiliated withDepartment of Emergency Medicine, San Luigi Gonzaga University HospitalMultidisciplinary Intensive Care Unit, Department of Anesthesiology, Pitié-Salpêtrière Hospital, University Pierre and Marie Curie (UPMC)
    • , Charlotte ArbelotAffiliated withDepartment of Emergency Medicine, San Luigi Gonzaga University HospitalMultidisciplinary Intensive Care Unit, Department of Anesthesiology, Pitié-Salpêtrière Hospital, University Pierre and Marie Curie (UPMC)
    • , Andrew LiteploAffiliated withDepartment of Emergency Medicine, San Luigi Gonzaga University HospitalEmergency Medicine, Massachusetts General Hospital
    • , Ashot SargsyanAffiliated withNational & Gulf Center for Evidence Based Health Practice, King Saud University for Health SciencesWyle/NASA Lyndon B. Johnson Space Center Bioastronautics Contract
    • , Fernando SilvaAffiliated withNational & Gulf Center for Evidence Based Health Practice, King Saud University for Health SciencesDepartment of Emergency Medicine, UC Davis Medical Center
    • , Richard HoppmannAffiliated withNational & Gulf Center for Evidence Based Health Practice, King Saud University for Health SciencesInternal Medicine, University of South Carolina School of Medicine
    • , Raoul BreitkreutzAffiliated withNational & Gulf Center for Evidence Based Health Practice, King Saud University for Health SciencesDepartment of Anaesthesiology, Intensive Care and Pain Therapy, University Hospital of the Saarland and Frankfurt Institute of Emergency Medicine and Simulation Training (FINEST)
    • , Armin SeibelAffiliated withNational & Gulf Center for Evidence Based Health Practice, King Saud University for Health SciencesDiakonie Klinikum jung-stilling
    • , Luca NeriAffiliated withNational & Gulf Center for Evidence Based Health Practice, King Saud University for Health SciencesAREU EMS Public Regional Company, Niguarda Ca’ Granda Hospital
    • , Enrico StortiAffiliated withNational & Gulf Center for Evidence Based Health Practice, King Saud University for Health SciencesIntensive Care Unit “G. Bozza,”, Niguarda Ca’ Granda Hospital
    • , Tomislav PetrovicAffiliated withNational & Gulf Center for Evidence Based Health Practice, King Saud University for Health SciencesSamu 93, University Hospital Avicenne
    • , International Liaison Committee on Lung Ultrasound (ILC-LUS) for the International Consensus Conference on Lung Ultrasound (ICC-LUS)

Abstract

Background

The purpose of this study is to provide evidence-based and expert consensus recommendations for lung ultrasound with focus on emergency and critical care settings.

Methods

A multidisciplinary panel of 28 experts from eight countries was involved. Literature was reviewed from January 1966 to June 2011. Consensus members searched multiple databases including Pubmed, Medline, OVID, Embase, and others. The process used to develop these evidence-based recommendations involved two phases: determining the level of quality of evidence and developing the recommendation. The quality of evidence is assessed by the grading of recommendation, assessment, development, and evaluation (GRADE) method. However, the GRADE system does not enforce a specific method on how the panel should reach decisions during the consensus process. Our methodology committee decided to utilize the RAND appropriateness method for panel judgment and decisions/consensus.

Results

Seventy-three proposed statements were examined and discussed in three conferences held in Bologna, Pisa, and Rome. Each conference included two rounds of face-to-face modified Delphi technique. Anonymous panel voting followed each round. The panel did not reach an agreement and therefore did not adopt any recommendations for six statements. Weak/conditional recommendations were made for 2 statements, and strong recommendations were made for the remaining 65 statements. The statements were then recategorized and grouped to their current format. Internal and external peer-review processes took place before submission of the recommendations. Updates will occur at least every 4 years or whenever significant major changes in evidence appear.

Conclusions

This document reflects the overall results of the first consensus conference on “point-of-care” lung ultrasound. Statements were discussed and elaborated by experts who published the vast majority of papers on clinical use of lung ultrasound in the last 20 years. Recommendations were produced to guide implementation, development, and standardization of lung ultrasound in all relevant settings.

Keywords

Lung ultrasound Chest sonography Emergency ultrasound Critical ultrasound Point-of-care ultrasound Guideline RAND GRADE Evidence-based medicine