Lung ultrasound and respiratory physiotherapy in hospitalized adults: A narrative review
DOI:
https://doi.org/10.62827/fb.v27i8.1291Keywords:
Respiratory Therapy; Pulmonary Atelectasis; Physical Therapy Modalities.Abstract
Introduction: Lung ultrasound enables bedside assessment of aeration loss, but its role in selecting interventions remains limited by the available evidence. Objective: To critically analyze the contribution of lung ultrasound to respiratory physiotherapy in hospitalized adults, distinguishing aeration assessment, changes in management, ultrasound responses, and clinical outcomes. Methods: Narrative review with searches in PubMed, Scientific Electronic Library Online, and Latin American and Caribbean Health Sciences Literature in September 2026, supplemented by reference tracking. Publications from 2021 to 2026 were prioritized, alongside earlier foundational studies. The synthesis distinguished measurement properties, clinical decisions, and interventions, without formal risk-of-bias assessment. Results: Ultrasound scores allow monitoring of regional aeration changes, with limitations in quantifying recruitment and identifying hyperinflation. Observational studies reported changes in physiotherapy decisions and lower scores after treatment, not consistently accompanied by improved oxygenation. One recent trial reported shorter ventilation and intensive care stays, but differences in treatment delivery prevented attributing the benefit exclusively to ultrasound guidance. Perioperative trials provided contextual evidence. Conclusion: Lung ultrasound complements the assessment and monitoring of respiratory physiotherapy. Imaging improvement does not necessarily indicate sustained clinical benefit, and the superiority of ultrasound-guided care with equivalent treatment delivery remains insufficiently established.
References
Mojoli F, Bouhemad B, Mongodi S, Lichtenstein D. Lung Ultrasound for Critically Ill Patients. Am J Respir Crit Care Med. 2019;199(6):701-714. doi:10.1164/rccm.201802-0236ci.
Le Neindre A, Mongodi S, Philippart F, Bouhemad B. Thoracic ultrasound: Potential new tool for physiotherapists in respiratory management. A narrative review. J Crit Care. 2016;31(1):101-109. doi:10.1016/j.jcrc.2015.10.014.
Mongodi S, De Luca D, Colombo A, Stella A, Santangelo E, Corradi F, et al. Quantitative Lung Ultrasound: Technical Aspects and Clinical Applications. Anesthesiology. 2021;134(6):949-965. doi:10.1097/aln.0000000000003757.
Demi L, Wolfram F, Klersy C, De Silvestri A, Ferretti VV, Muller M, et al. New International Guidelines and Consensus on the Use of Lung Ultrasound. J Ultrasound Med. 2023;42(2):309-344. doi:10.1002/jum.16088.
Mongodi S, Cortegiani A, Alonso-Ojembarrena A, Biasucci DG, Bos LDJ, Bouhemad B, et al. ESICM-ESPNIC international expert consensus on quantitative lung ultrasound in intensive care. Intensive Care Med. 2025;51(6):1022-1049. doi:10.1007/s00134-025-07932-y.
Lockstone J, Love A, Hung Lau Y, Hansell L, Ntoumenopoulos G. The use of diaphragm and lung ultrasound in acute respiratory physiotherapy practice and the impact on clinical decision-making: A systematic review and meta-analysis. Aust Crit Care. 2024;37(1):176-184. doi:10.1016/j.aucc.2023.10.001.
Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014;4(1):1. doi:10.1186/2110-5820-4-1.
Smit MR, Pisani L, de Bock EJE, van der Heijden F, Paulus F, Beenen LFM, et al. Ultrasound versus Computed Tomography Assessment of Focal Lung Aeration in Invasively Ventilated ICU Patients. Ultrasound Med Biol. 2021;47(9):2589-2597. doi:10.1016/j.ultrasmedbio.2021.05.019.
Chiumello D, Mongodi S, Algieri I, Vergani GL, Orlando A, Via G, et al. Assessment of Lung Aeration and Recruitment by CT Scan and Ultrasound in Acute Respiratory Distress Syndrome Patients. Crit Care Med. 2018;46(11):1761-1768. doi:10.1097/ccm.0000000000003340.
Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby JJ. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med. 2011;183(3):341-347. doi:10.1164/rccm.201003-0369oc.
Lichtenstein D, Mezière G, Seitz J. The dynamic air bronchogram. A lung ultrasound sign of alveolar consolidation ruling out atelectasis. Chest. 2009;135(6):1421-1425. doi:10.1378/chest.08-2281.
Le Neindre A, Hansell L, Wormser J, Gomes Lopes A, Diaz Lopez C, Romanet C, et al. Thoracic ultrasound influences physiotherapist's clinical decision-making in respiratory management of critical care patients: a multicentre cohort study. Thorax. 2023;78(2):169-175. doi:10.1136/thoraxjnl-2021-218217.
Swingwood E, Lunn T, James O, Harrison S, Hutchinson T, Hanney R, et al. The impact of physiotherapy led lung ultrasound on patient management: A single centre service evaluation. J Intensive Care Soc. 2026:17511437261471434. doi:10.1177/17511437261471434.
Hansell L, Milross M, Ntoumenopoulos G. Appropriateness of respiratory physiotherapy positioning for acute lobar collapse. Aust Crit Care. 2025;38(2):101114. doi:10.1016/j.aucc.2024.08.010.
Hansell L, Milross M, Delaney A, Koo CM, Tian DH, Ntoumenopoulos G. Quantification of changes in lung aeration associated with physiotherapy using lung ultrasound in mechanically ventilated patients: a prospective cohort study. Physiotherapy. 2023;119:26-33. doi:10.1016/j.physio.2022.11.003.
Battaglini D, Caiffa S, Gasti G, Ciaravolo E, Robba C, Herrmann J, et al. An Experimental Pre-Post Study on the Efficacy of Respiratory Physiotherapy in Severe Critically III COVID-19 Patients. J Clin Med. 2021;10(10):2139. doi:10.3390/jcm10102139.
Chen X, Wu Y, Zhang L, Sun M, Li Z, Fang H. Observation on the application effect of chest physical therapy based on lung ultrasound signs in the respiratory management of mechanically ventilated patients. Front Med (Lausanne). 2025;12:1708677. doi:10.3389/fmed.2025.1708677.
Liu Y, Wang J, Geng Y, Zhang Y, Su H, Yang Y. The effect of ultrasound-guided lung recruitment maneuvers on atelectasis in lung-healthy patients undergoing laparoscopic gynecologic surgery: a randomized controlled trial. BMC Anesthesiol. 2022;22(1):200. doi:10.1186/s12871-022-01742-1.
Liu T, Huang J, Wang X, Tu J, Wang Y, Xie C. Effect of recruitment manoeuvres under lung ultrasound-guidance and positive end-expiratory pressure on postoperative atelectasis and hypoxemia in major open upper abdominal surgery: A randomized controlled trial. Heliyon. 2023;9(2):e13348. doi:10.1016/j.heliyon.2023.e13348.
Hansell L, Milross M, Delaney A, Tian DH, Ntoumenopoulos G. Interrater reliability in assigning a lung ultrasound score. Aust Crit Care. 2023;36(5):732-736. doi:10.1016/j.aucc.2022.10.008.
Hayward S, McWilliams D, Kendrick C, Porter E. Exploring the training, implementation and utilisation experiences of lung ultrasound accredited physiotherapists in the United Kingdom: A national survey. J Intensive Care Soc. 2026;27(2):213-223. doi:10.1177/17511437251408630.
Longhini F, Bruni A, Garofalo E, Ronco C, Gusmano A, Cammarota G, et al. Chest physiotherapy improves lung aeration in hypersecretive critically ill patients: a pilot randomized physiological study. Crit Care. 2020;24(1):479. doi:10.1186/s13054-020-03198-6.
Qadir N, Sahetya S, Munshi L, Summers C, Abrams D, Beitler J, et al. An Update on Management of Adult Patients with Acute Respiratory Distress Syndrome: An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2024;209(1):24-36. doi:10.1164/rccm.202311-2011st.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Rafael Viana dos Santos Coutinho, Lorena Oliveira da Silva Prado, Yuri Porto Morais (Autor)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Autores que publicam nesta revista concordam com os seguintes termos:
Autores mantém os direitos autorais e concedem à revista o direito de primeira publicação, com o trabalho simultaneamente licenciado sob a Licença Creative Commons Attribution 4.0 que permite o compartilhamento do trabalho com reconhecimento da autoria e publicação inicial nesta revista.
Autores têm autorização para distribuição não-exclusiva da versão do trabalho publicada nesta revista (ex.: publicar em repositório institucional ou como capítulo de livro), com reconhecimento de autoria e publicação inicial nesta revista.
