Lung ultrasound for acute respiratory distress syndrome diagnosis: A systematic review and meta-analysis

BACKGROUND/OBJECTIVES: Acute respiratory distress syndrome (ARDS) requires prompt diagnosis. Lung ultrasound (LUS) is a non-invasive tool with potential diagnostic value, but its accuracy needs systematic evaluation. METHODS: A systematic search of PubMed, Embase, Cochrane Library, and Web of Science (inception-December 2024) identified studies assessing LUS for ARDS using established reference standards. Data were extracted independently, and a random-effects meta-analysis was performed to calculate diagnostic odds ratios (DOR), sensitivity, specificity, likelihood ratios, and AUROC. RESULTS: = 75.2%), with higher diagnostic performance observed in ICU settings, studies using ≥8-zone scanning protocols, and those focusing on severe ARDS. Meta-regression identified scanning zones and operator experience as key sources of heterogeneity. The presence of bilateral B-patterns with ≥3 B-lines per intercostal space showed the highest specificity (0.92; 95% CI, 0.87-0.96). CONCLUSIONS: This meta-analysis demonstrated that LUS has good diagnostic accuracy for ARDS (pooled DOR 14.98, sensitivity 0.75, specificity 0.87, AUROC 0.91). Higher diagnostic performance was observed with ≥8-zone scanning protocols, in ICU settings, and for severe ARDS. The modest sensitivity indicates that negative LUS findings should not exclude ARDS diagnosis. CLINICAL IMPLICATIONS: Lung ultrasound (LUS) provides a rapid, bedside, and radiation-free diagnostic option for ARDS, offering good accuracy, especially in ICU and resource-limited settings. Comprehensive scanning protocols and trained operators enhance reliability, supporting LUS integration into clinical practice where advanced imaging is unavailable.