Quantitative lung ultrasound (LUS) is emerging as one of the most promising tools for managing critically ill patients in intensive care. Evolving from traditional chest ultrasound, this technique enables precise, dynamic, non-invasive assessment of lung ventilation and offers crucial support for clinical decision-making.
The growing importance of this approach is confirmed by an international document recently published in the prestigious journal Intensive Care Medicine. This document is the result of a collaboration between experts from the European Society of Intensive Care Medicine (ESICM) and the European Society for Paediatric and Neonatal Intensive Care (ESPNIC).
Prof. Maria Rosaria Gualano, lecturer in General and Applied Hygiene at UniCamillus University, was also a co-author of the document. She actively contributed to drafting the recommendations and multidisciplinary evaluation of the technique in intensive care settings, playing a key role in the methodology of the entire process.
A rigorous process for shared guidance
The project involved 20 international experts in adult, paediatric and neonatal intensive care, supported by two methodologists (including Prof. Gualano). After selecting and voting on 14 priority clinical questions, the participants produced 46 consensus statements. Of these, 38 were applicable to all age groups, 4 were specific to adults, and 4 were specific to paediatric and neonatal patients.
The recommendations cover all the main aspects related to the use of quantitative lung ultrasound, including when to use it, which probe to use, how to perform the procedure correctly, how to train staff, how to interpret the results and potential future developments of the technique.
Why does quantitative LUS make a difference?
The value of quantitative LUS lies in providing a clear picture of the lung situation directly at the patient’s bedside. The LUS score, which is based on a scale of 0 to 3 for each lung region, enables the evolution of potential lung or respiratory disease to be monitored, the loss of aeration to be quantified, and targeted interventions to be made.
This technique has been shown to be effective in clinical settings such as acute respiratory failure, mechanical ventilation and in cases of COVID-19 infection, with a strong correlation between LUS score and clinical severity. Furthermore, quantitative LUS has proven useful in therapeutic strategies commonly employed in intensive care units, such as the prone position and alveolar recruitment manoeuvres (ARMs). The prone position (where the patient lies on their stomach) is a well-established technique for improving oxygenation in severe cases of respiratory failure. Recruitment manoeuvres, on the other hand, consist of special ventilatory interventions aimed at reopening collapsed pulmonary alveoli. In both cases, quantitative LUS proves to be a valuable tool, allowing the effectiveness of these strategies to be assessed in real time by monitoring lung ventilation and offering immediate feedback on the patient’s clinical evolution.
Pushing boundaries in training and safety
The document emphasises the importance of well-organised training for the proper application of quantitative lung ultrasound. For those working with children and infants in particular, training should be adapted according to the age and condition of young patients, who require greater attention and specificity.
It also highlights some current limitations: the need to reduce inter-operator variability, probe contamination issues, and the need for more scientific studies in paediatric populations.
Prof. Gualano’s role at UniCamillus
Prof. Maria Rosaria Gualano’s presence among the paper’s authors testifies to UniCamillus University’s high level of competence and recognition in the field of international research. Prof. Gualano contributed to the study as a methodologist, thanks to her solid background in evidence-based medicine and her expertise in epidemiology, hygiene and public health. Alongside Prof. Cortegiani of the University of Palermo, she guided the process of collecting evidence and ensured the correct use and collection of data from participants.
“This paper could be a real milestone in the innovative diagnostic and clinical approach for patients, ensuring better health outcomes. The fact that so many Italian institutions are involved in promoting and implementing this consensus is a great source of pride for us”, says Prof. Gualano.
In addition to UniCamillus University, the other institutions that participated in the creation of the paper include the following, at the Italian level: San Matteo Hospital and University of Pavia (Pavia); University of Palermo and Paolo Giaccone Hospital (Palermo); Tor Vergata University (Rome); CNR Foundation – Gabriele Monasterio Heart Hospital (Massa); University of Pisa (Pisa); Centre for Leadership in Medicine of the Università Cattolica del Sacro Cuore – Rome campus (Rome); University of Bari ‘Aldo Moro’ (Bari); Federico II University (Naples); Santa Maria della Misericordia Hospital (Udine).
These institutions represent national excellence in intensive, paediatric and neonatal medicine, and have made a substantial contribution to both the clinical and methodological parts of the consensus.
Among international research organisations and teaching hospitals are: Amsterdam UMC and Amsterdam University Medical Centers (Netherlands); CHU Dijon and Université Bourgogne Franche-Comté (France); Hospital Universitario Puerta del Mar and Gregorio Marañón University Hospital (Spain); University of Medicine and Pharmacy Timisoara (Romania); Centre Hospitalier de L’Université de Montréal (Canada); Royal Perth Hospital (Australia); Mahidol Oxford Tropical Medicine Research Unit – MORU (Thailand); Hospital Germans Trias I Pujol – Universitat Autònoma de Barcelona (Spain); APH-P Paris Saclay University and INSERM U999 (Francia); North Hospital – Aix Marseille University (France).
This international collaboration has ensured a broad and integrated perspective, enabling the development of recommendations that can be applied in various clinical settings, in line with global best practice.
The paper emphasises that quantitative lung ultrasound is now reliable and well-established technology for monitoring critically ill patients. The newly published international consensus (12th May 2025) provides a solid basis for the systematic and safe adoption of LUS, while outlining areas for future research, such as the automation of LUS scoring and its validation in neonates. Thanks to contributions from experts such as Prof. Gualano, this paper paves the way for a wider and more effective use of this technology, to the benefit of patients and healthcare professionals worldwide.