Point-of-Care Lung Ultrasound: Common Misconceptions and Limitations

Point-of-care lung ultrasound (PoCLUS) has significantly advanced over the past two decades, revolutionizing bedside diagnosis of respiratory conditions, particularly in emergency and critical care settings. This highly accessible, cost-effective tool has become integral in assessing conditions like pneumothorax, pulmonary edema, and pneumonia. Despite its proven utility, misconceptions and methodological challenges hinder its broader adoption. Key issues include the overemphasis on randomized controlled trials (RCTs) for validation, inappropriate use of diagnostic gold standards, inconsistent definitions of lung patterns, and confusion between diagnostic and scoring techniques. Unlike therapeutic interventions, PoCLUS can complement conventional imaging, making RCTs less critical for its validation. Similarly, gold standards like CT scans may not always align with the clinical context needed for accurate PoCLUS evaluations. Standardized definitions of lung patterns tailored to specific patient settings are vital for improving research outcomes. For example, identifying interstitial syndrome or pneumothorax demands context-specific combinations of sonographic signs. Misapplying scoring techniques designed to quantify lung injury for diagnostic purposes can compromise study validity. Furthermore, the inherent operator dependency of PoCLUS highlights the need for standardized training to minimize variability. Intrinsic limitations, such as its dependency on skill levels and the lack of universal nomenclature, require standardized protocols and terminology to enhance consistency. PoCLUS remains underutilized in diagnostic guidelines despite its demonstrated sensitivity and specificity, which surpass conventional chest radiography for many conditions. Recognizing these limitations and misconceptions is crucial to advancing PoCLUS research and solidifying its role as a standard of care in clinical practice.