The Application of Point-of-Care Ultrasonography (POCUS) in the Management of Acute Respiratory Distress Syndrome (ARDS) in the Intensive Care Unit

Summary

Here, we present a protocol for bedside POCUS application in ARDS management within the ICU. It details standardized techniques for lung, cardiac, diaphragm, venous, and gastric assessments to guide ventilation, predict weaning, and prevent complications.

Abstract

Acute respiratory distress syndrome (ARDS) is a life-threatening condition that necessitates dynamic, non-invasive monitoring for optimal management. Traditional imaging modalities, such as computed tomography (CT), are often limited by radiation exposure and patient instability, particularly in critically ill populations. Point-of-care ultrasonography (POCUS) has emerged as a transformative tool, enabling real-time, multi-system evaluation at the bedside. This protocol highlights five key applications of POCUS in ARDS management: (1) Lung ultrasound (LUS) for assessing pulmonary aeration, edema, and pleural effusion status; (2) Echocardiography to evaluate right ventricular dysfunction and fluid responsiveness; (3) Diaphragm ultrasound to quantify diaphragmatic dysfunction and predict weaning outcomes; (4) Lower extremity venous duplex for early detection of deep vein thrombosis (DVT); and (5) Gastric ultrasonography to optimize enteral nutrition and reduce aspiration risk. By integrating these POCUS modalities, clinicians can tailor personalized ventilation strategies, prevent complications, and ultimately improve patient outcomes. The use of POCUS not only enhances diagnostic accuracy but also supports timely clinical decision-making, making it an indispensable tool in the management of ARDS.

Introduction

Acute respiratory distress syndrome (ARDS) is a life-threatening condition characterized by severe hypoxemia, non-cardiogenic pulmonary edema, and diffuse lung inflammation^1,2. It is triggered by various etiologies, including pneumonia, sepsis, and trauma, and is associated with a high mortality rate of approximately 40%. The pathophysiology of ARDS involves alveolar-capillary barrier damage, leading to impaired gas exchange and respiratory failure. Despite advances in critical care, ARDS remains a significant challenge in intensive care units (ICUs) worldwide.

The management of ARD....

Protocol

This retrospective study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committee of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (Approval Number: Run Run Shaw Hospital Ethics Review 2025 No. 1200). The requirement for informed consent was waived by the ethics committee due to the retrospective nature of the study, and all patient data were anonymized to protect confidentiality.

1. Lung ultrasound operation procedure

1. Preparation
   1. Equipment: Use a high-frequency linear probe (7-12 MHz) or a low-frequency convex probe (2-5 MHz).
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Results

The ultrasound images were acquired in the EICU of Sir Run Run Shaw Hospital following standardized protocols using a portable ultrasound system. All patients underwent systematic evaluation following the sequence: lung-heart-diaphragm-stomach-lower extremity deep veins. For study design, we established two comparison groups: 1) a control group comprising patients with acute cerebrovascular disease demonstrating normal pulmonary findings, and 2) a positive control group consisting of ARDS patients meeting Berlin diagnost.......

Discussion

Point-of-care ultrasonography (POCUS) has emerged as a transformative tool in the management of acute respiratory distress syndrome (ARDS) in the intensive care unit (ICU), enabling real-time, non-invasive, and comprehensive assessments at the bedside. By integrating multi-system evaluations, POCUS facilitates personalized therapeutic strategies, early detection of complications, and optimized clinical decision-making. Central to its utility in ARDS is the ability to dynamically monitor lung aeration, cardiac function, d.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Ultrasound System M9	Mindray	7E-58000295	Used for medical ultrasound diagnosis, supporting cardiac/vascular/abdominal imaging