International evidence-based recommendations for point-of-care lung ultrasound: 2025 focused update of the 2012 recommendations

Abstract

Purpose: Since the publication of the previous consensus document on point-of-care lung ultrasound (PoCLUS) in 2012, new evidence has emerged. This consensus aims to update current recommendations by focusing on the clinical applications of PoCLUS as a standalone tool, while acknowledging that this focused approach represents a necessary preliminary step toward its effective integration with other organ-specific ultrasound examinations and complementary diagnostic modalities. Methods: A Delphi-based consensus process was conducted under the supervision of a Steering Committee (five voting members) and a Delphi Committee (two non-voting members). Experts were selected according to strict predefined criteria based on highly impactful scientific output and were assigned to specific domains. A structured literature review covering publications from 2012 to 2025 was performed. Statements were drafted, discussed through multiple online rounds, and iteratively refined. Anonymous voting was conducted for each statement using a predefined agreement threshold (80% full agreement); abstentions were excluded from percentage calculations. The process adhered to ACCORD recommendations. Results: Twenty-one experts participated in the entire process. A total of 1775 new publications were reviewed, including 892 original studies, 62 meta-analyses, 38 guidelines, 162 original studies discussed in the first consensus. New statements were developed across multiple domains addressing ultrasound signs, technical aspects, monitoring strategies, and clinical applications of PoCLUS. Consensus was achieved for 83 statements following iterative discussion and voting rounds. Conclusion: This updated consensus provides evidence-based recommendations on the use of PoCLUS in clinical practice, defining its strengths and limitations as a standalone tool and identifying areas requiring further investigation. Visual abstract: (Figure presented.)