Lung Ultrasound for Acute Respiratory Distress Syndrome Diagnosis: A Systematic Review and Meta-analysis.

Summary

Across 16 studies (N=5,888), lung ultrasound showed pooled sensitivity 0.75, specificity 0.87, DOR 14.98, and AUROC 0.91 for ARDS diagnosis. Diagnostic performance improved with ≥8-zone scanning, ICU setting, and severe ARDS, but substantial heterogeneity indicates negative scans should not exclude ARDS.

Key Findings

• Pooled sensitivity 0.75 and specificity 0.87 for ARDS diagnosis with LUS; AUROC 0.91.
• Diagnostic odds ratio 14.98; positive LR 4.89 and negative LR 0.15.
• Higher accuracy with ≥8-zone scanning, ICU settings, and in severe ARDS.
• Substantial heterogeneity cautions against using LUS alone to exclude ARDS.

Clinical Implications

Integrate LUS into ARDS diagnostic pathways, prioritizing ≥8-zone protocols and trained operators, especially where CT is unavailable. Treat negative LUS cautiously given modest sensitivity; use as part of a multimodal diagnostic strategy.

Limitations

• Substantial heterogeneity across studies
• Variability in LUS protocols and reference standards; operator dependence

Future Directions

Standardize LUS protocols for ARDS, conduct prospective multicenter diagnostic studies with uniform reference standards, and evaluate training interventions to improve performance.