Lung re-aeration assessment by ultrasound during mechanical ventilation: Current knowledge of literature review

Paolo Formenti; Paolo Carlucci; Dejan Radovanovic; Giovanni Bruno; Gino Soldati; Francesco Tursi

doi:10.5826/mrm.2025.1029

Lung re-aeration assessment by ultrasound during mechanical ventilation: Current knowledge of literature review

Authors

Paolo Formenti SC Anestesia e Rianimazione, ASST Nord Milano https://orcid.org/0000-0001-8081-7480
Paolo Carlucci Department of Health Sciences, Università degli Studi di Milano, Respiratory Unit, ASST Santi Paolo e Carlo, San Paolo Hospital, Milan, Italy https://orcid.org/0000-0003-3178-4832
Dejan Radovanovic Division of Respiratory Diseases, Ospedale Luigi Sacco, Polo Universitario, ASST Fatebenefratelli-Sacco, Department of Biomedical and Clinical Sciences (DIBIC), Università degli Studi di Milano, Milan, Italy https://orcid.org/0000-0002-9013-3418
Giovanni Bruno School of Medicine and Surgery, University of Milano-Bicocca, 20126 Milano, Italy https://orcid.org/0000-0003-2900-7196
Gino Soldati Diagnostic and Interventional Ultrasound Unit, Centro Medico Ippocrate, Castelnuovo di Garfagnana, Lucca, Italy https://orcid.org/0000-0003-0135-8218
Francesco Tursi Pulmonary Medicine Unit, Codogno Hospital, Azienda Socio Sanitaria Territoriale Lodi, Codogno, Italy https://orcid.org/0000-0003-1163-2815

DOI: https://doi.org/10.5826/mrm.2025.1029

Keywords:

Lung recruitment, lung lung ultrasound, lung consolidation, mechanical ventilation

Abstract

Lung collapse, commonly associated with conditions such as atelectasis, pneumonia, and acute respiratory distress syndrome, significantly impairs gas exchange and respiratory function. Monitoring lung re-aeration is therefore crucial in evaluating the effectiveness of therapeutic interventions, including non-invasive ventilation, invasive mechanical ventilation, and physiotherapy, which aim to restore lung volume and improve respiratory efficiency. Lung re-aeration involves two key physiological processes such as recruitment and inflation. Both mechanisms improve lung compliance and optimize ventilation-perfusion matching, improving overall respiratory function. LUS has emerged as a promising alternative for assessing lung aeration, supporting its feasibility in detecting and tracking lung re-aeration across various clinical scenarios, and providing real-time insights into lung recruitment and inflation. This review integrates current evidence on the physiological mechanisms of lung collapse and the clinical applications of ultrasound as a tool for monitoring lung re-aeration, highlighting its potential to optimize respiratory management in critically ill patients.

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