Abstract
How to cite this article: Vijayasimha M, Srikanth M, Bhima J, Rao K, Singh AK, Rani T. From Diagnostic Concordance to Implementation-grade Lung Ultrasound in Critical Care. Indian J Crit Care Med 2026;30(5):453–454.
Keywords: Critical care, Diagnostic accuracy, Lung ultrasound
The Editor,
The article by Dhenki et al. on the diagnostic accuracy of lung ultrasound (LUS) vs high-resolution computed tomography in critically ill patients with respiratory problems is of great interest to us as it contributes to a key fact of current intensive care practice: When properly performed, LUS is not an addition to the toolset, but a high-yield bedside imaging modality that can speed up the decision.1
However, the following translational phase is not just to report diagnostic concordance, but to render LUS implementation-grade in a variety of intensive care contexts. Current reports still point to good diagnostic performance of LUS, such as outperforming chest radiography in the detection of pneumonia in critically ill patients, especially in the posterior lung areas, but also indicate a continuing problem: Performance is sensitive to the quality of acquisition, training of operators, methods of scoring, and consistency of protocols.2–4
Here, the work of Dhenki et al. is particularly relevant since the discussion of LUS accuracy is now overtaken by setting minimum standards for the person who scans, the manner of acquiring scans, the measurement of abnormality, and what management decisions the scan is likely to impact.1 There is already an international consensus of opinion that is heading toward this direction, with its focus on structured quantitative methods and its overt recognition of present limitations and the necessity of additional validation.4 A more comprehensive critical care review also highlights the importance of LUS being implemented as part of reproducible workflows, not as an informal continuation of clinical impression alone.5
Future ICU research, therefore, ought to go beyond diagnostic comparison to the results of decision-grade implementation: Inter-operator reliability, competency thresholds, protocol adherence, time-to-treatment, lessened requirement of confirmatory imaging where safe, and patient-centered outcomes like ventilator days or ICU length of stay. This would render LUS more actionable on a global scale, particularly in environments with minimal access to CT yet high morbidity of acute respiratory failure.
It is worth praising Dhenki et al. not only for providing valuable evidence in a real-world critical care setting but also for opening a bigger opportunity: To transform bedside ultrasonography from an operator-dependent skill into a standardized, scalable, and equity-promoting critical care platform.1
Orcid
Mulavagili Vijayasimha https://orcid.org/0000-0003-2038-7006
Mulavagili Srikanth https://orcid.org/0009-0005-8488-6041
Jayanthi Bhima https://orcid.org/0009-0005-6122-4088
Keerthi Rao https://orcid.org/0009-0002-8848-2691
Amit K Singh https://orcid.org/0000-0003-2753-6510
Tara Rani https://orcid.org/0000-0002-1304-979X
Footnotes
Source of support: Nil
Conflict of interest: None
References
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