The updated recommendations for lung ultrasound in internal medicine (POLLUS-IM 2020) build on the initial guidelines published in 2018. The team developed these new recommendations through a comprehensive process that involved reviewing the literature, evaluating expert opinions, and analyzing the quality of evidence.
The team examined 528 publications, including 253 new reports. These recommendations focus on key clinical areas, such as pneumonia, heart failure, pleural effusion, pulmonary embolism, hydration status monitoring in dialysis patients, and diaphragm function assessment. They aim to enhance the clinical utility of lung ultrasound (LUS) in various settings and improve diagnostic accuracy.
The guidelines specifically highlight LUS’s role in evaluating pneumonia and assessing pleural effusion. Additionally, they emphasize LUS as a valuable tool for monitoring patients with heart failure and pulmonary embolism, enabling timely interventions.
Expert Evaluation
The process of updating the recommendations involved several stages. It began with a literature review of relevant studies from PubMed, Medline, OVID, and Embase databases. The inclusion criteria focused on publications addressing the use of lung ultrasound (LUS) in adult patients not treated in intensive care units. However, the team excluded publications such as case reports, reviews, and studies related to pediatrics, neonatology, anesthesiology, and surgery.
The selected studies included prospective, retrospective, observational studies, and meta-analyses. The credibility of the literature data was assessed using the QUADAS, QUADAS-2, and GRADE criteria.
A multidisciplinary team, composed of experts in internal medicine, pulmonology, cardiology, geriatrics, radiology, and pediatrics, conducted thorough discussions and evaluations to develop the updated guidelines. The team included specialists from various fields to ensure a comprehensive and well-rounded approach to the recommendations. These experts employed the Delphi method, a structured communication technique, to build consensus. The process involved three rounds of online discussions, where each expert shared their insights, followed by secret ballots after each round to gather anonymous feedback. This iterative process allowed for a careful examination of all perspectives
